State of Fragility Fractures Management during the COVID-19 Pandemic

Tarantino, Umberto; Cariati, Ida; Tancredi, Virginia; Casamassima, D.; Piccirilli, Eleonora; Iundusi, Riccardo; Gasbarra, Elena

doi:10.3390/ijerph17217732

Cited by 16 publications

(21 citation statements)

References 29 publications

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“…Older individuals are overrepresented among COVID-19 deaths. Evidence shows that the infection fatality ratio is very low for people between the ages of 15 and 44, increasing to 3.1% for 65–74-year-old people and to 11.6% for older ages [ 2 , 3 , 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Higher 90-Day Mortality after Surgery for Hip Fractures in Patients with COVID-19: A Case–Control Study from a Single Center in Italy

Grassi

Andriolo

Golinelli

et al. 2021

IJERPH

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The mortality of hip fracture (HF) patients is increased by concomitant COVID-19; however, evidence is limited to only short follow-up. A retrospective matched case–control study was designed with the aim to report the 90-day mortality and determine the hazard ratio (HR) of concomitant HF and COVID-19 infection. Cases were patients hospitalized for HF and diagnosed with COVID-19. Controls were patients hospitalized for HF not meeting the criteria for COVID-19 diagnosis and were individually matched with each case through a case–control (1:3) matching algorithm. A total of 89 HF patients were treated during the study period, and 14 of them were diagnosed as COVID-19 positive (overall 15.7%). Patients’ demographic, clinical, and surgical characteristics were similar between case and control groups. At 90 days after surgery, 5 deaths were registered among the 14 COVID-19 cases (35.7%) and 4 among the 42 HF controls (9.5%). COVID-19-positive cases had a higher risk of mortality at 30 days (HR = 4.51; p = 0.0490) and 90 days (HR = 4.50; p = 0.025) with respect to controls. Patients with concomitant HF and COVID-19 exhibit high perioperative mortality, which reaches a plateau of nearly 30–35% after 30 to 45 days and is stable up to 90 days. The mortality risk is more than four-fold higher in patients with COVID-19.

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Section: Introductionmentioning

confidence: 99%

Higher 90-Day Mortality after Surgery for Hip Fractures in Patients with COVID-19: A Case–Control Study from a Single Center in Italy

Grassi

Andriolo

Golinelli

et al. 2021

IJERPH

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“…These ndings might be caused by the fear of elderly being infected by COVID-19 virus in the hospital, since they have more risks to develop severe disease when getting infected [10,20]. The recommendation to not go to the health facilities unless urgent might also lead to the reluctance of elder people and people with osteoporotic fractures to go to the hospital [21].…”

Section: Discussionmentioning

confidence: 99%

A Comparative Multicenter Study on the Epidemiology of Traumatic Fractures During the COVID-19 Early Emergency Response Period in Yogyakarta Special Region, Indonesia

Hidayat

Rahayu

Khadafi

et al. 2021

Preprint

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Background: The changes of lifestyle and mobility during the Coronavirus Disease 2019 (COVID-19) pandemic may influence the epidemiology of traumatic fractures. This study aimed to investigate the epidemiology of traumatic fractures in Yogyakarta Special Region (Daerah Istimewa Yogyakarta/DIY) during the COVID-19 emergency response period and compare the data with the similar period in the previous year.Methods: This was a retrospective study involving five secondary referral hospitals and one tertiary referral hospital. We included all patients who presented to the emergency departments or orthopedic clinics who were then diagnosed with new onset fractures. We compared the data during the emergency response period (COVID group) with a similar period in 2019 (control group).Results: There were 1,249 patients with 1,428 fractures included in this study. There was almost half reduction of patients during the emergency response period. There was no significant difference in proportion of gender and mean of age between patients in the control group and the COVID group. During the emergency response period, there was significant increases in the proportions of patients experiencing low energy injuries (38.0% vs. 30.8%), injuries occurring at home (34.0% vs. 23.8%), and surgically treated closed fractures (51.8% vs. 45.3%), along with decrease of patients’ referrals (1.6% vs. 4.1%). The difference in proportions of fracture type, osteoporotic fractures, and multiple trauma was not significant across the groups. Conclusions: During the COVID-19 emergency response period in DIY, there were nearly half reduction (47.68%) of patients with fractures, increased proportion of patients injured at home, reduced proportion of patients referred to another hospital, and increased proportion of surgically treated closed fractures. The knowledge about this epidemiological trend may help in developing preventive programs and treatment policy for fractures and other injuries during the current pandemic.

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“…Access to rehabilitation should be made available with application of the required social distancing and infection control measures. In cases of patients admitted with a hip fracture who are also affected with COVID-19 where mortality has been shown to be high as previously described [ 26 , 44 ], orthopaedic departments should organise specific accelerated care pathways for their treatment to reduce length of stay in hospital or requirement for intensive care bed [ 67 , 68 ]. In a recent study of 16 patients admitted with femoral neck fractures and COVID-19 infection, orthopaedic surgery on the day of or within three days of admission contributed to patients' haemodynamic and respiratory stability, improvement in respiratory function and comfort in bed [ 69 ].…”

Section: Methodsmentioning

confidence: 99%

Diagnosis and Management of Osteoporosis During COVID-19: Systematic Review and Practical Guidance

et al. 2021

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It is acknowledged that the COVID-19 pandemic has caused profound disruption to the delivery of healthcare services globally. This has affected the management of many long-term conditions including osteoporosis as resources are diverted to cover urgent care. Osteoporosis is a public health concern worldwide and treatment is required for the prevention of further bone loss, deterioration of skeletal micro-architecture, and fragility fractures. This review provides information on how the COVID-19 pandemic has impacted the diagnosis and management of osteoporosis. We also provide clinical recommendations on the adaptation of care pathways based on experience from five referral centres to ensure that patients with osteoporosis are still treated and to reduce the risk of fractures both for the individual patient and on a societal basis. We address the use of the FRAX tool for risk stratification and initiation of osteoporosis treatment and discuss the potential adaptations to treatment pathways in view of limitations on the availability of DXA. We focus on the issues surrounding initiation and maintenance of treatment for patients on parenteral therapies such as zoledronate, denosumab, teriparatide, and romosozumab during the pandemic. The design of these innovative care pathways for the management of patients with osteoporosis may also provide a platform for future improvement to osteoporosis services when routine clinical care resumes.

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State of Fragility Fractures Management during the COVID-19 Pandemic

Cited by 16 publications

References 29 publications

Higher 90-Day Mortality after Surgery for Hip Fractures in Patients with COVID-19: A Case–Control Study from a Single Center in Italy

Higher 90-Day Mortality after Surgery for Hip Fractures in Patients with COVID-19: A Case–Control Study from a Single Center in Italy

A Comparative Multicenter Study on the Epidemiology of Traumatic Fractures During the COVID-19 Early Emergency Response Period in Yogyakarta Special Region, Indonesia

Diagnosis and Management of Osteoporosis During COVID-19: Systematic Review and Practical Guidance

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