Letter to the editor on the outcomes in fracture patients infected with COVID-19.

Abstract

Letter to the editor on the outcomes in fracture patients infected with COVID-19. Dear editor, In January 2020, China's center of disease control identified a novel coronavirus(COVID-19) as responsible of a cluster of respiratory infections [1, 2]. This virus rapidly spread through the world, and the World Health Organization (WHO) declared the outbreak a Pandemic [3-5]. In France, the situation became worrisome and evolved quickly despite lockdown [6, 7]. Local health authorities urged hospitals to cancel scheduled surgeries and to deal only with emergent cases. In orthopedics, this meant dealing mainly with surgical trauma patients. Being conscious that patients with fracture are very susceptible to pneumonia, strict preventive and protective measures were offered to all patients [8, 9]. Some trauma patients presented with covid-19 infection and we wondered if these patients with emergent fractures (spine, hip, ankle..) should be operated. Available literature shows only one report from Wuhan reporting their experience with fracture patients infected with Covid-19, and one paper from Italy showing their experience on 13 Covid-19 operated trauma patients [10, 11]. Through this letter, we share with you our in-crisis experience as an orthopedic surgery department from France, so we can draw conclusions, lessons, and be ready for a possible second epidemic surge.

Delayed Presentation of Patients with Hip Fractures during the COVID-19 “Stay-at-Home” Order in the Southmost Region of the United States

“…is is confirmed by independent reports from New York [24], United Kingdom [26], France [27], and China [28]. While we only had one patient who resulted positive for COVID-19 shortly after surgery, the delay in surgical intervention in light of poorer outcomes in patients with active COVID-19 deserves additional attention at the national and multinational levels.…”

Mortality escalates in patients of proximal femoral fractures with COVID-19: A systematic review and meta-analysis of 35 studies on 4255 patients

“…Five more papers were discovered on hand search. After screening duplicates and excluding unrelated articles based on the title, 65 papers8–72 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 5 with 35 having hip fracture data were finally considered for review after full-text assessment. ( Fig.…”

“…Twenty papers reported data on both COVID-19 and non-COVID -19 patients with hip fractures and were considered for meta-analysis of 30-day mortality statistics. Rest articles were opinion pieces (4), general epidemiological studies (16), Specialist society guideline (1) 23 infographic analysis (1), errata (2), and reviews (7).These 35 studies in total 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 22 , 24 , 25 , 27 , 28 , 30 , 31 , 32 , 33 , 41 , 42 , 44 , 51 , 52 reported a total of 4225 patients with hip fracture in the current ongoing pandemic, out of which 692 patients were positive for COVID -19 ( Table 1 , Table 2A , Table 2B B).…”

“…Fifteen studies, reporting data separately for 158 patients (132 hip fracture patients) with COVID- 19 were summarized separately. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 22 , 24 , 25 , 32 , 33 , 41 , 42 , 52 ( Table 1 ). Apart from these, 20 studies reported mortality and other relevant statistics on hip fracture patients with and without COVID -19 {reporting 4123 hip fracture patients in the year 2020–21, out of which 560 had or were suspected to be having COVID- 19}, but individual patient data was not reported.…”

“…1 However, early limited evidence published so far suggests poor outcomes with high postoperative mortality in patients with a hip fracture and concomitant COVID-19 infection (available studies indicate a mortality rate greater than 30%). 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 We have undertaken a ...…”