Should we operate on all patients with COVID-19 and proximal femoral fractures? An analysis of thirty, sixty, and ninety day mortality rates based on patients’ clinical presentation and comorbidity: a multicentric study in Northern Italy

Abstract

Purpose This study aims to evaluate 30–60–90-day mortality of operated proximal femur fractures (PFFs) suffering from COVID-19 and correlation with patients’ clinical presentation and comorbidities. Methods Between February 1, 2020, and December 31, 2020, patients with COVID-19 infection and surgically treated PFF were included. Patients’ demographic characteristics, oxygen (O2) therapy, comorbidities, and AO type fracture were collected. Chi-square test or Fisher test and hazard ratio were used to assessing the correlation between mortality rate, patient characteristics, and COVID-19 status. Kaplan-Meyer curve was used to analyze 30–60–90-day mortality. Level of significance was set as p < 0.05. Results Fifty-six patients (mean age of 82.7 ± 8.85 years) were included. Thirty-day mortality rate was 5%, which increased to 21% at 60 days and 90 days. Eleven patients died, eight due to AO type A-like and three due to AO type B-like fractures. No significant difference in mortality rate between patients with cardiopulmonary comorbidity or no cardiopulmonary comorbidity was found ( p = 0.67); a significant difference in patients with chronic obstructive pulmonary disease (COPD) or history of pulmonary embolism (PE) and patients without COPD was found ( p = 0.0021). A significant difference between asymptomatic/mild symptomatic COVID-19 status and symptomatic COVID-19 status was found ( p = 0.0415); a significant difference was found for O2 therapy with < 4 L/min and O2 therapy ≥ 4 L/min ( p = 0.0049). Conclusion Thirty-day mortality rate of COVID-19 infection and PFFs does not differ from mortality rate of non-COVID-19 PFFs. However, patients with pre-existing comorbidities and symptomatic COVID-19 infection requiring a high volume of O2 therapy have a higher incidence of 60–90-day mortality when surgically treated.

Extracapsular femoral neck fractures treated with total hip arthroplasty: identification of a population with better outcomes

“…However, none of these absolutely ensure a fracture stability and a viable consolidation in unstable EC fractures, with unpredictable outcomes especially in patients with severe osteoporosis and concomitant hip osteoarthritis (HO). 12,17,18 Moreover, these factors and the intrinsic fracture instability were reported to be associated to the unsatisfactory results reported with internal fixation. [19][20][21] Considering also the high failure and the complications rates reported with both IN and DHS, hip replacement has been recommended by some authors as a primary treatment for unstable EC fractures.…”

“…Therefore, the use of THA as a primary treatment for EC fractures had been proposed by several authors with viable outcomes. 11,12 However, THA in EC fractures are not complication free, and a high risk of both mechanical (i.e. dislocation) and local complications (i.e.…”

Which Problematics in Tha After Acetabular Fractures: Experience of 38 Cases

“…In other terms, the above-mentioned parameters are prognostically significant for future implantation. [1][2][3][4][5][6] Modest initial acetabular deformation and conservative treatment are two favourable parameters for an uncomplicated hip arthroplasty. [7][8][9] On the contrary, complex fracture patterns, bad reduction, pseudoarthrosis, previous surgeries, infections, devices, dense wound tissue and heterotopic ossification, can gravely complication a hip arthroplasty procedure.…”