Proximal femur fractures in COVID-19 emergency: the experience of two Orthopedics and Traumatology Departments in the first eight weeks of the Italian epidemic
Keywords:
Coronavirus, Elderly patient, Proximal femur fracture, CoVID-19, Italian outbreakAbstract
Introduction: CoVID-19 (Coronavirus disease) is a worldwide infection which is causing millions of deaths. A significant number of elderly patients require hospitalization and develop serious and sometimes life-threatening complications. The aim of this study is to evaluate the preliminary impact (8 weeks) of CoVID-19, focusing on proximal femur fractures, analyzing data and results compared to the same period of 2019. Materials and methods: From February 22nd to April 18th, 2020 we surgically treated 121 proximal femur fractures (61 in Piacenza; 60 in Parma, 16 male, 44 female, mean age 81.1). In the same period of 2019, we treated 169 proximal femur fractures (90 in Piacenza, 33 male, 57 female, mean age 81.9; 79 in Parma, 29 males, 50 female, mean age 80.2). We had 21/61 (34.4%) patients resulted positive for COVID-19 and 11/61 in Parma (18.3%), based on nasal-pharyngeal swab, chest CT scan and/or lung US findings. Results: The incidence of proximal femur fractures had a significant reduction during CoVID-19 spread in Piacenza and Parma. Authors have noticed an elevated number of deaths within 21 days after surgery. Piacenza: 4 cases in 2019 (4.4%) and 11 in 2020 (18.0%), of which 9 cases CoVID positive. In Parma in 2019 two deaths were encountered; in 2020 6 patients died and 5 cases were CoVID positive. Conclusion: In the first two months of the Italian epidemic, in the cities of Piacenza and Parma over 80% of deaths have occurred in patients over 70 years old. Even if preliminary, our study shows a significant increase in death in elderly patients surgically treated for proximal femur fractures, particularly in the Piacenza Hospital.
References
Lu H et al, Oubreak of pneumonia of unkwown etiology in Wuhan China: the mistery and the miracle. J Med Virol 2020. Jan 16
Carlos et al. Novel Wuhan (2019 nCoV) coronavirus. Am J Resp Crit Care Med 2020; 201: P7-8.
Chih-Cheng Lai et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J of Antimic Agents, 20, 2020; 7:4
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497.
Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020 Feb 28. doi: 10.1056/NEJMoa2002032 [Epub ahead of print]
Jin X, Lian J, Hu J, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut 2020 Mar 24. pii: gutjnl-2020-320926. doi: 10.1136/gutjnl-2020-320926 [Epub ahead of print].
Poggiali E, Ramos PM, Bastoni D, Vercelli A, Magnacavallo A. Abdominal pain: a real challenge in novel COVID-19 infection. EJCRIM 2020;7: doi:10.12890/2020_001632
American Academy of Otolaryngology-Head and Neck Surgery. Coronavirus disease 2019: resources. Available from https://www.entnet.org/content/coronavirus-disease2019-resources (accessed 23 March 2020).
Giacomelli A, Pezzati L, Conti F, et al. Self-reported olfactory and taste disorders in SARS-CoV-2 patients: a cross-sectional study. Clin Infect Dis 2020 Mar 26. doi: 10.1093/cid/ciaa330 [Epub ahead of print].
World Health Organization. Novel coronavirus (2019-nCov): situation report, 2. 22 January 2020. Available from https://apps.who.int/iris/handle/10665/330761 (accessed 2 April 2020)
Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19. N Engl J Med 2020 Mar 18. doi: 10.1056/ NEJMoa2001282
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
Luigi Palmieri, Xanthi Andrianou, Pierfrancesco Barbariol, et al. Caratteristiche dei pazienti deceduti positivi all’infezione da SARS-CoV-2 in Italia. EpiCentro - Istituto Superiore di Sanità. 2020 April 23.
M.E. Muller, S. Nazarian, P. Koch, J. Schatzker The comprehensive classification of fractures of long bones Springer, Berlin. 1990
Garden RS. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br. 1961;43:647–663.
Pauwels F. Der Schenkelhalsbruch, ein mechanisches problem. Stuttgart: F. Enke; 1935.
Jensen JS: Classification of trochanteric fractures. Acta Orthop Scand 1980;51:803–810
Danila Oldani, Pietro Maniscalco. Preliminary experience with EBA ONE intramedullary nail for the tratment of pertrochanteric fractures. Acta Biomedica. 2019; Vol 90, Supplement 12:86-90
Danila Oldani, Pietro Maniscalco. Preliminary experience with MEDGAL DHS for treatment of proximal femoral fractures. Acta Biomedica. 2019; Vol 90, Supplement 12:82-85
Caforio M, Maniscalco P, Colombo M, Calori GM. Long endomedullary nail in proximal third humeral shaft fractures. Injury. 2016 Oct;47 Suppl 4:S64-S70. doi: 10.1016/j.injury.2016.07.037. Epub 2016 Aug 6. PubMed PMID: 27507546.
Ruffilli A, Traina F, Pilla F, et al. Marchetti Vincenzi elastic retrograde nail in the treatment of humeral shaft fractures: review of the current literature. Musckoloskelet Surg. 2015 Dec;99(3):201-9.
Rivera F, Leonardi F, Maniscalco P, Caforio M, Capelli R, Molinari G, Esopi P. Uncemented fully hydroxyapatite-coated hip stem for intracapsular femoral neck fractures in osteoporotic elderly patients: a multicenter study. Arthroplast Today. 2015 Aug 28;1(3):81-84. doi: 10.1016/j.artd.2015.02.002. eCollection 2015 Sep. PubMed PMID: 28326377; PubMed Central PMCID: PMC4956684.
Rebuzzi E, Pannone A, Schiavetti S, et al. IMHS clinical experience in the treatment of peritrochanteric fractures. The results of a multicentric Italian study of 981 cases. Injury. 2002 Jun;33(5):407-12.
Maniscalco P, Benazzo F, Ruggieri P, Di Maggio B. CIO: 360° in trauma care. Injury. 2019 Aug;50 Suppl 4:S1.
UrbiStat AdminStat Italia. https://ugeo.urbistat.com
Dipartimento della Protezione Civile. COVID-19 Italia - Monitoraggio della situazione. opendatadpc.maps.arcgis.com/apps/opsdashboard/index.html#/b0c68bce2cce478eaac82fe38d4138b1
Downloads
Published
Issue
Section
License
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
How to Cite
