The epidemiology of proximal femur fractures during COVID-19 emergency in Italy: a multicentric study

Corrado Ciatti; Pietro Maniscalco; Fabrizio Quattrini; Serena Gattoni; Alessandra Magro; Patrizio Capelli; Filippo Banchini; Caterina Fiazza; Vito Pavone; Calogero Puma Pagliarello; Fabiana Valenti; Giulio Maccauro; Michele Cauteruccio; Riccardo Accetta; Giuseppe Basile; Carlo Ruosi; Fabio Di Santo; Nicola Orabona; Cristiano Coppola; Dario Perugia; Riccardo Maria Lanzetti; Mauro Roselli; Giuseppina Montanari; Francesco Benazzo; Mario Mosconi; Loris Perticarini; Vito Pesce; Giuseppe Maccagnano; Lorenzo Moretti; Biagio Moretti; Giuseppe Solarino

doi:10.23750/abm.v92i5.11925

The epidemiology of proximal femur fractures during COVID-19 emergency in Italy: a multicentric study

Authors

Corrado Ciatti Orthopedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy https://orcid.org/0000-0002-7094-4344
Pietro Maniscalco Orthopedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
Fabrizio Quattrini Orthopedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
Serena Gattoni Orthogeriatric Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
Alessandra Magro Orthogeriatric Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
Patrizio Capelli Surgery Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
Filippo Banchini Surgery Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
Caterina Fiazza Hospital Pharmacy, Guglielmo da Saliceto Hospital, Piacenza, Italy
Vito Pavone Orthopedics and Traumatology Department, University of Catania, Italy
Calogero Puma Pagliarello Orthopedics and Traumatology Department, University of Catania, Italy
Fabiana Valenti Orthopedics and Traumatology Department, University of Catania, Italy
Giulio Maccauro Orthopedics Department, IRCCS Fondazione Policlinico Gemelli, Rome, Italy
Michele Cauteruccio Orthopedics Department, IRCCS Fondazione Policlinico Gemelli, Rome, Italy
Riccardo Accetta Trauma Unit and Emergency Department, IRCCS Galeazzi Orthopedics Institute, Milano, Italy
Giuseppe Basile Trauma Unit and Emergency Department, IRCCS Galeazzi Orthopedics Institute, Milano, Italy
Carlo Ruosi Department of Orthopaedics, Federico II University, Napoli
Fabio Di Santo Orthopedics and Traumatology Department, AORN “Cardarelli” Hospital, Napoli
Nicola Orabona Orthopedics and Traumatology Department, ASL 1 “Ospedale del Mare “ Hospital, Napoli
Cristiano Coppola Orthopedics and Traumatology Department, ASL 1 “Ospedale del Mare “ Hospital, Napoli
Dario Perugia Orthopedics and Traumatology Department, San Camillo Forlanini Hospital, Rome, Italy
Riccardo Maria Lanzetti Orthopedics and Traumatology Department, San Camillo Forlanini Hospital, Rome, Italy
Mauro Roselli Orthopedic and Traumatology Unit, Maria Vittoria Hospital, Turin, Italy
Giuseppina Montanari Orthopedic and Traumatology Unit, Maria Vittoria Hospital, Turin, Italy
Francesco Benazzo Orthopedics and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
Mario Mosconi Orthopedics and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
Loris Perticarini Orthopedics and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
Vito Pesce U.O.C. di Ortopedia e Traumatologia Universitaria, Azienda Ospedaliero Universitaria Policlinico "Riuniti di Foggia", Dipartimento di Medicina Clinica e Sperimentale, Università di Medicina e Chirurgia Università di Foggia
Giuseppe Maccagnano U.O.C. di Ortopedia e Traumatologia Universitaria, Azienda Ospedaliero Universitaria Policlinico "Riuniti di Foggia", Dipartimento di Medicina Clinica e Sperimentale, Università di Medicina e Chirurgia Università di Foggia
Lorenzo Moretti School of Medicine, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, University of Bari Aldo Moro, Bari, Italy
Biagio Moretti School of Medicine, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, University of Bari Aldo Moro, Bari, Italy
Giuseppe Solarino School of Medicine, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, University of Bari Aldo Moro, Bari, Italy

DOI: https://doi.org/10.23750/abm.v92i5.11925

Keywords:

Covid-19, Proximal Femur Fracture, Multi-center Retrospective Study, Italian Covid Experience, Epidemiology, Anticoagulant, Antiaggregant

Abstract

Background and aim: After the first Italian case of Covid-19, the Government imposed the complete closure of all areas involved by the spread of the virus to contain transmissions. There was a massive reorganization of Hospitals, a stop of all elective activities and a convertion of many hospitals in “Covid Centers''. AITOG (Associazione Italiana Traumatologia e Ortopedia Geriatrica) conducted a retrospective study on all proximal femur fractures surgeries that occurred in this period, to find out whether the pandemic and the correlated lockdown somehow changed the incidence of these events.

Methods: 10 Italian orthopedic centers were involved in the study. Considering the geographic location, three groups were created (North, Centre and South). The considered period is the Italian “Phase 1” (February 23rd - May 3rd 2020).

Results: the cohort is composed of 412 patients, 116 male and 296 female (mean age 81.1 ± 9.1 years). The same period of 2019 has been used as control group, with 558 patients, 156 male and 402 female (mean age 84.2 ± 8.0 years). In 2020 we counted 323 (78.4%) fractures occurred at home, 61 (14.8%) in retirement houses and 28 (6.8%) in different locations. We mainly treated fractures with intramedullary nails (n.237 57.5%). Among all patients we had 46 (11.1%) Covid-19 positive. The mortality rate within 30 days was of 51 patients (12.4%); 23 of these died because of complications related to Covid-19 while 31 of these were in treatment with anticoagulant/antiaggregant.

Conclusions: AITOG analysis demonstrates a decrease in surgical interventions for proximal femur fractures from 2019 to 2020, a reduction in patients mean age and an increase in trauma occurred in domestic environment. We also registered a consistent difference between the North, Center and South of the Country.

References

Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. J Med Virol. 2020 Apr;92(4):401-402. doi: 10.1002/jmv.25678. Epub 2020 Feb 12. PMID: 31950516; PMCID: PMC7166628.

https://covid19.who.int/

Maniscalco P, Poggiali E, Quattrini F, et al. The deep impact of novel CoVID-19 infection in an Orthopedics and Traumatology Department: the experience of the Piacenza Hospital. Acta Biomed. 2020;91(2):97-105. Published 2020 May 11. doi:10.23750/abm.v91i2.9635

Gorbalenya AE, Baker SC, Baric RS, de Groot RJ, Drosten C, Gulyaeva AA et al; Severe acute respiratory syndrome-related coronavirus: the species and its viruses – a statement of the Coronavirus Study Group. BioRxiv, 2020, Feb 11.

Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.

Gattinoni L, Chiumello D, Rossi S. COVID-19 pneumonia: ARDS or not? Crit Care. 2020 Apr 16;24(1):154. doi: 10.1186/s13054-020-02880-z. PMID: 32299472; PMCID: PMC7160817.

Poissy J, Goutay J, Caplan M, Parmentier E, Duburcq T, Lassalle F, Jeanpierre E, Rauch A, Labreuche J, Susen S; Lille ICU Haemostasis COVID-19 Group. Pulmonary Embolism in Patients With COVID-19: Awareness of an Increased Prevalence. Circulation. 2020 Jul 14;142(2):184-186. doi: 10.1161/CIRCULATIONAHA.120.047430. Epub 2020 Apr 24. PMID: 32330083.

https://www.epicentro.iss.it/coronavirus/sars-cov-2-decessi-italia

Benazzo F, Rossi SMP, Maniscalco P, et al. The orthopaedic and traumatology scenario during Covid-19 outbreak in Italy: chronicles of a silent war. Int Orthop. 2020;44(8):1453-1459. doi:10.1007/s00264-020-04637-3

Maniscalco P, Poggiali E, Quattrini F, et al. Proximal femur fractures in COVID-19 emergency: the experience of two Orthopedics and Traumatology Departments in the first eight weeks of the Italian epidemic. Acta Biomed. 2020;91(2):89-96. Published 2020 May 11. doi:10.23750/abm.v91i2.9636

Kumar Jain V, Lal H, Kumar Patralekh M, Vaishya R. Fracture management during COVID-19 pandemic: A systematic review. J Clin Orthop Trauma. 2020 Jul;11(Suppl 4):S431-S441. doi: 10.1016/j.jcot.2020.06.035. Epub 2020 Jun 30. PMID: 32774008; PMCID: PMC7324923.

http://www.aitog.eu/

Solarino G, Piazzolla A, Mori CM, Moretti L, Patella S, Notarnicola A. Alumina-on-alumina total hip replacement for femoral neck fracture in healthy patients. BMC Musculoskelet Disord. 2011 Feb 1;12:32. doi: 10.1186/1471-2474-12-32. PMID: 21284879; PMCID: PMC3038170.

COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet. 2020 Jul 4;396(10243):27-38. doi: 10.1016/S0140-6736(20)31182-X. Epub 2020 May 29. Erratum in: Lancet. 2020 Jun 9;: PMID: 32479829; PMCID: PMC7259900.

Dallari D, Zagra L, Cimatti P, Guindani N, D'Apolito R, Bove F, et al. Early mortality in hip fracture patients admitted during first wave of the COVID-19 pandemic in Northern Italy: a multicentre study. J Orthop Traumatol. 2021 Apr 5;22(1):15. doi: 10.1186/s10195-021-00577-9. PMID: 33818650; PMCID: PMC8020826.