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Zayat MN, Griend MV, Flesher N, Lightwine K, Ablah E, Okut H, Haan JM. Falls Among Older Adults During the COVID-19 Pandemic Compared to a Pre-pandemic Period: A Case-Control Study. Am Surg 2023; 89:5988-5995. [PMID: 37285470 PMCID: PMC10251062 DOI: 10.1177/00031348231180919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Little is known about how the COVID-19 pandemic impacted older adults admitted to the hospital with fall-related injuries. This research sought to determine if there was a difference in patient characteristics and hospital outcomes among older adults with fall-related injuries during the COVID-19 pandemic compared to a non-pandemic period. METHODS A retrospective chart review of patients 65 years or older admitted for traumatic falls before and during COVID-19 was undertaken. Data abstracted included demographics, fall details, injury data, and hospital course. RESULTS Of 1598 patients, 50.5% presented during COVID-19 (cases), and 49.5% presented pre-pandemic (controls). Fewer cases fell in rural areas (28.6% vs 34.1%, P = .018) and were transferred from outside hospitals (32.1% vs 38.2%, P = .011). More cases experienced alcohol (4.6% vs 2.4%, P = .017) and substance use disorders (1.4% vs .4%, P = .029). Fewer cases had subdural hemorrhages (11.8% vs 16.4%, P = .007), and more had pneumothoraxes (3.5% vs 1.8%, P = .032). More patients admitted during COVID-19 experienced acute respiratory failure (2.0% vs .0%, P < .001), hypoxia (1.5% vs .3%, P = .005), and delirium (6.3% vs 1.0%, P < .001). Fewer cases were discharged to skilled nursing facilities (50.8% vs 57.3%, P = .009) and more to home with services (13.1% vs 8.3%, P = .002). DISCUSSION This study suggested there was a similar frequency of presentation for falls among older adults during the two study periods. Older adults with fall-related injuries experienced differences in presenting comorbidities, injury patterns, complications, and discharge locations during the study periods.
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Affiliation(s)
- Marisa-Nicole Zayat
- Department of Population Health, The University of Kansas School of Medicine – Wichita, Wichita, KS, USA
| | - Micah Vander Griend
- Department of Population Health, The University of Kansas School of Medicine – Wichita, Wichita, KS, USA
| | - Nathan Flesher
- Department of Population Health, The University of Kansas School of Medicine – Wichita, Wichita, KS, USA
| | - Kelly Lightwine
- Departments of Trauma Services, Ascension Via Christi Hospital Saint Francis, Wichita, KS, USA
| | - Elizabeth Ablah
- Department of Population Health, The University of Kansas School of Medicine – Wichita, Wichita, KS, USA
| | - Hayrettin Okut
- Department of Population Health, The University of Kansas School of Medicine – Wichita, Wichita, KS, USA
| | - James M. Haan
- Department of Population Health, The University of Kansas School of Medicine – Wichita, Wichita, KS, USA
- Departments of Trauma Services, Ascension Via Christi Hospital Saint Francis, Wichita, KS, USA
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Iliopoulos ID, Lianou I, Kaspiris A, Ntourantonis D, Arachoviti C, Zafeiris CP, Lambrou GI, Chronopoulos E. Impact of COVID-19 Pandemic on Fragility Fractures of the Hip: An Interrupted Time-Series Analysis of the Lockdown Periods in Western Greece and Review of the Literature. Geriatrics (Basel) 2023; 8:72. [PMID: 37489320 PMCID: PMC10366837 DOI: 10.3390/geriatrics8040072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/26/2023] Open
Abstract
Since December 2019, the COVID-19 pandemic has had a significant impact on healthcare systems worldwide, prompting policymakers to implement measures of isolation and eventually adopt strict national lockdowns, which affected mobility, healthcare-seeking behavior, and services, in an unprecedented manner. This study aimed to analyze the effects of these lockdowns on hip-fracture epidemiology and care services, compared to nonpandemic periods in previous years. We retrospectively collected data from electronic patient records of two major hospitals in Western Greece and included patients who suffered a fragility hip fracture and were admitted during the two 5-week lockdown periods in 2020, compared to time-matched patients from 2017-2019. The results showed a drop in hip-fracture incidence, which varied among hospitals and lockdown periods, and conflicting impacts on time to surgery, time to discharge after surgery, and total hospitalization time. The study also found that differences between the two differently organized units were exaggerated during the COVID-19 lockdown periods, highlighting the impact of compliance with social-distancing measures and the reallocation of resources on the quality of healthcare services. Further research is needed to fully understand the specific variations and patterns of geriatric hip-fracture care during emergency health crises characterized by limited resources and behavioral changes.
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Affiliation(s)
- Ilias D Iliopoulos
- Laboratory for Research of the Musculoskeletal System, School of Medicine, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - Ioanna Lianou
- Department of Orthopaedic Surgery, "Rion" University Hospital and Medical School, School of Health Sciences, University of Patras, 26504 Patras, Greece
| | - Angelos Kaspiris
- Laboratory for Research of the Musculoskeletal System, School of Medicine, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - Dimitrios Ntourantonis
- Accident and Emergency Department, "Rion" University Hospital and Medical School, School of Health Sciences, University of Patras, 26504 Patras, Greece
| | - Christine Arachoviti
- Orthopedics Department, General Hospital of Patras "Agios Andreas", 26332 Patras, Greece
| | - Christos P Zafeiris
- Laboratory for Research of the Musculoskeletal System, School of Medicine, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - George I Lambrou
- Laboratory for Research of the Musculoskeletal System, School of Medicine, National and Kapodistrian University of Athens, 10679 Athens, Greece
- Choremeio Research Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Efstathios Chronopoulos
- Laboratory for Research of the Musculoskeletal System, School of Medicine, National and Kapodistrian University of Athens, 10679 Athens, Greece
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Prost S, Carissimi M, McCausland AM, Tropiano P, Argenson JN, Blondel B. [The proximal femur fracture epidemic continued during the COVID-19 pandemic: Results of an observational study]. REVUE DE CHIRURGIE ORTHOPEDIQUE ET TRAUMATOLOGIQUE 2023; 109:19-23. [PMID: 34786032 PMCID: PMC8585587 DOI: 10.1016/j.rcot.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 07/08/2021] [Indexed: 02/08/2023]
Abstract
Introduction L’objectif de cette étude était de comparer le volume et les caractéristiques des chirurgies urgentes traumatologiques réalisées dans notre institution entre le 20 mars et le 20 avril 2020, correspondant au premier mois de confinement, et de les comparer aux données de la période équivalente de 2019. Notre hypothèse de travail reposait sur le fait qu’il existe une part de traumatologie non évitable pour laquelle des mesures de prévention spécifique pourraient être nécessaires. Méthodes Il s’agit d’une étude continue mono-centrique observationnelle. Tous les patients ayant nécessités une prise en charge chirurgicale traumatologique entre le 20 mars et le 20 avril 2020 ont été inclus, et les données de la même période de 2019 étaient récupérées. L’ensemble des chirurgies était réalisé dans notre institution qui est un centre de traumatologie de niveau 2 de notre région. Résultats Pendant le premier mois de confinement, 70 patients ont été pris en charge chirurgicalement pour une urgence traumatologique, contre 109 patients sur la période de 2019, représentant une baisse d’activité globale de 36 %. Sur l’ensemble des patients, l’âge moyen était significativement plus élevé en 2020 (68,4 SD = 22 vs 60,3 SD = 24 p = 0,0210). Les accidents de loisirs et les accidents de la circulation étaient moins nombreux en 2020 (34 vs. 10), ainsi que les accidents liés au travail (7vs. 2) alors que les accidents domestiques restaient globalement stables (65 vs. 55). Conclusion En période d’urgence sanitaire, la poursuite des activités de traumatologie est essentielle, même si elle nécessite une organisation spécifique pour la prise en charge des patients. La période de confinement et les modifications de comportements associées ont changé le spectre global de la traumatologie. La réduction majeure de la traumatologie routière, de loisirs et celle liée au travail constitue une part évitable de cette activité chirurgicale justifiant d’une prévention spécifique en période crise sanitaire. À l’inverse, les traumatismes gériatriques et notamment les fractures de l’extrémité proximale du fémur n’étaient globalement que peu modifiées traduisant la nécessité de mesures de prévention supplémentaires pour ces patients. Niveau de preuve V ; étude observationnelle.
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Bolzinger M, Lopin G, Accadbled F, Sales de Gauzy J, Compagnon R. Pediatric traumatology in "green zone" during Covid-19 lockdown: A single-center study. Orthop Traumatol Surg Res 2023; 109:102946. [PMID: 33901717 PMCID: PMC8064820 DOI: 10.1016/j.otsr.2021.102946] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The 8-week lockdown for the Covid-19 epidemic in France restricted travel, and interrupted schooling and sports. The study hypothesis was that this exceptional situation temporarily altered childhood trauma epidemiology. MATERIAL AND METHOD A prospective study was performed during the 8 weeks of lockdown. Pediatric traumatology emergency activity was compared to that during the same period in the previous 3 years. RESULTS During lockdown, emergency consultations decreased by 50%. The number of patients operated on was 86% of that in the previous 3 years. Patients operated on during lockdown had a mean age of 7.6 years (median, 7.5 years) compared to 9.3 years (9.4 years). The rate of domestic accidents (59% versus 23%) and trampoline accidents (16% versus 5%) increased, while those of sport and locomotion-related accidents decreased. Wounds were more frequent, at 35% of procedures, versus 13% previously. The rate of surgery for upper-limb fracture deceased, while that of lower-limb fracture was unchanged. Distal forearm fracture was less frequent, as was distal tibial fracture. DISCUSSION The present study found a 50% decrease in pediatric traumatology emergency activity during lockdown, without decrease in surgery. In case of renewed lockdown, we recommend reorganizing emergency admission to free teams for management of Covid-19 patients, while maintaining operative rooms for emergency surgery. A general public information campaign could help prevent domestic accidents and risk related to use of trampolines. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Manon Bolzinger
- Service d’Orthopédie, Hôpital des Enfants, 330, Avenue de Grande Bretagne, 31300 Toulouse, France,Corresponding author
| | | | - Franck Accadbled
- Service d’Orthopédie, Hôpital des Enfants, 330, Avenue de Grande Bretagne, 31300 Toulouse, France
| | - Jérôme Sales de Gauzy
- Service d’Orthopédie, Hôpital des Enfants, 330, Avenue de Grande Bretagne, 31300 Toulouse, France
| | - Roxane Compagnon
- Service d’Orthopédie, Hôpital des Enfants, 330, Avenue de Grande Bretagne, 31300 Toulouse, France
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Prost S, Carissimi M, McCausland AM, Tropiano P, Argenson JN, Blondel B. The proximal femur fracture epidemic continued during the COVID-19 pandemic: Results of an observational study. Orthop Traumatol Surg Res 2023; 109:103143. [PMID: 34768004 PMCID: PMC8577050 DOI: 10.1016/j.otsr.2021.103143] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/17/2021] [Accepted: 06/08/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The aim of this study was to compare the volume and characteristics of emergency trauma surgery procedures done at our hospital between March 20 and April 20, 2020 (the first month of the national lockdown in France) and to compare these data to the same period in 2019. We hypothesized that a portion of fractures are unavoidable, thus specific preventative measures will be needed to reduce their incidence. METHODS This was a continuous, observational and single center study. All patients who required urgent surgery for a fracture between March 20 and April 20, 2020, were included. Data for the same period in 2019 was retrieved. All the procedures were done at our hospital, which is a regional level II trauma center. RESULTS During the first month of the lockdown, 70 patients underwent emergency surgery because of a fracture, versus 109 patients in the same period in 2019, thus an overall 36% drop. The mean age of the patients was higher in 2020 (68.4 years SD=22) than in 2019 (60.3 years SD=24, p=0.0210). There were fewer recreational and motor vehicle accidents in 2020 (34 vs. 10) and fewer work-related accidents (7 vs. 2) although the number of accidents at home were similar (65 vs. 55). CONCLUSION During a public health emergency, it is vital to continue doing trauma surgery procedures, even though it requires a specific care pathway. The lockdown and associated behavioral changes have altered the spectrum of trauma surgery. A major decrease in motor vehicle, recreation and work-related accidents is the avoidable portion of this surgical activity, justifying specific preventative measures during a public health crisis. Conversely, the incidence of geriatric fractures - particularly of the proximal femur - did not change much overall, thus there is need for additional preventative measures in these patients. LEVEL OF EVIDENCE V, observational study.
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The impact of confinement on orthopaedic and trauma surgical activity. Orthop Traumatol Surg Res 2023; 109:103113. [PMID: 34653645 DOI: 10.1016/j.otsr.2021.103113] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/09/2021] [Accepted: 05/14/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION On the 16th of March 2020, in the face of a health emergency declared in France, the government imposed containment measures whose impact on orthopaedic and trauma surgery remains to be demonstrated. The hypothesis of this study was that confinement reduced orthopaedic and trauma surgical activity. The main objective was to assess orthopaedic and trauma surgical activity during confinement and to compare it to the activity outside confinement. MATERIALS AND METHODS This was a retrospective, monocentric, observational and comparative study of a continuous cohort of patients included during the confinement period of March 16th to May 11th, 2020. This cohort was retrospectively compared to a group of patients over the same non-confinement period in the previous year, from March 16th to May 11th, 2019. The primary outcome measured was the incidence rate of surgical activity in 2020 versus 2019 over an identical period. The secondary outcome was the analysis of the trauma identified. RESULTS The number of patients operated on was significantly reduced during confinement: 194 patients were included in 2020, i.e. an incidence of 57 per 100,000 inhabitants against 772 patients included in 2019, i.e. an incidence of 227 per 100,000 inhabitants; p<0.001. Planned orthopaedic surgery decreased from an incidence rate of 147 in 2019 to 5 in 2020 per 100,000 inhabitants (p<0.001). Trauma surgery decreased from an incidence rate of 80 in 2019 to 50 in 2020 per 100,000 inhabitants (p: NS). We found a significant increase in patients over 65years of age during confinement, 70% compared to 61% in 2019; p=0.04. The rate of femoral neck fractures was significantly increased during confinement, 48.5% compared to 39.3% in 2019; p=0.03. Degenerative surgery was significantly reduced during confinement (p<0.001). DISCUSSION This study shows that the surgical activity of orthopaedics and trauma was significantly reduced by confinement, with a difference in incidence of 170 per 100,000 inhabitants, thus confirming the hypothesis of the authors. This decrease is due to both the cessation of planned orthopaedics and the 40% decrease in the number of trauma patients. During confinement, the percentage of patients over the age of 65 with a fracture increased significantly. CONCLUSION Confinement had a significant impact on orthopaedic and trauma surgical activity. LEVEL OF EVIDENCE III; comparative and retrospective.
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Impact of the SARS-CoV-2 Outbreak on the Epidemiology and Treatment Outcomes of Fractures of the Proximal Femur in Kazakhstan. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022. [DOI: 10.2478/sjecr-2022-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Abstract
The study aimed to assess the impact of isolation and quarantine on the frequency of registration and the treatment of fractures of the proximal femur in Kazakhstan in the context of the COVID-19 pandemic in 2020 (compared to the pre-pandemic period). This retrospective observational comparative study included all primary patients with injuries (the code S72) in the period 2019-2020 according to the national register.
In 2020, the number of S72 fractures was 6.6 % higher compared to 2019. In comparison with 2019, in 2020 the number of beddays of patients was reduced to 7.1±3.8 days (p≤0.001). Both in 2019 and in 2020, the number of women predominated among all patients (p ≤ 0.05). The frequency of conservative treatment in 2020 compared to 2019 was increased from 26.6% to 35.6%, while the surgical procedure for internal fixation was reduced to 34.2% in 2020. In 2020, the highest number of cases among women with S72 fractures cases were recorded in the age groups 60-74 years and 75-90 years. In 2019 in female patients (42%) with S72 cases were registered in the age group 75-90 years.
The incidence of fractures of the proximal femur did not change significantly in 2020 compared to 2019. However, the number of conservative treatment methods has increased along with the decrease in the frequency of surgical interventions. We observed the growth of the frequency of non-surgical treatment methods in 2020 that might impose the possible risks of mortality of these patients in the long term after conservative treatment.
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Lopez Gavilanez E, Navarro Chávez M, Gavilanes AWD, Cedeño German R, Chedraui P. Decreasing incidence rates of osteoporotic hip fractures in Ecuador during the COVID-19 pandemic. Arch Osteoporos 2022; 18:15. [PMID: 36574063 PMCID: PMC9793355 DOI: 10.1007/s11657-022-01202-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 12/13/2022] [Indexed: 12/28/2022]
Abstract
We aimed at comparing the incidence of hip fractures in older adults from Ecuador before and during the COVID-19 pandemic. There was a significant reduction in the number of hip fractures, with no change in the length of hospital stay, mortality, and case-fatality rate, during the period of social isolation. INTRODUCTION The impact that the COVID-19 pandemic has had on fragility fractures is being recently evaluated in the literature. Despite this, data from Latin America in this regard is scarce. PURPOSE This study aims to compare the incidence rate of hip fractures before and during the COVID-19 pandemic in older adults who received care in the public and private health system of Ecuador. METHODS This was a descriptive and retrospective study that analyzed data of individuals aged 60 years and older who had hip fractures before and during the COVID-19 pandemic. The information was obtained from the National Hospital Discharge Yearbook. We calculated the incidence, average length of hospital stay, mortality, and case-fatality rate associated with hip fractures. RESULTS There was a significant reduction in the incidence of hip fractures in adults 60 or older during the period of social isolation due to COVID-19. Between March and December 2019, there was an incidence of 152 hip fractures per 100,000 inhabitants, whereas during the same period but in 2020 in the incidence was 110 per 100,000 inhabitants (p < 0.0001). The main decrease was observed in women aged 80 or more. The average length of hospital stay did not show significant changes. Mortality displayed a non-significant decrease (p = 0.14), although this decrease was significant among women (p = 0.02). Case-fatality rate showed a non-significant increase for the whole group (p = 0.68) and for men (p = 0.09). CONCLUSION Hip fracture rates decreased significantly in adults aged 60 and older in 2020 compared to 2019. This decrease of hip fracture incidence rates was mainly due to the reductions observed in older people and women. The average length of hospital stay, mortality, and case-fatality rate associated with hip fractures did not show significant changes during the pandemic.
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Affiliation(s)
- Enrique Lopez Gavilanez
- AECE Research Group, The Association of Clinical Endocrinologists of Ecuador, Avenida de Las Américas, S/N Y E. Noboa, EC090150, Guayaquil, Ecuador.
- Servicio de Endocrinología, Hospital Docente Policía Nacional Guayaquil 2, Guayaquil, Ecuador.
| | - Manuel Navarro Chávez
- AECE Research Group, The Association of Clinical Endocrinologists of Ecuador, Avenida de Las Américas, S/N Y E. Noboa, EC090150, Guayaquil, Ecuador
| | - Antonio W D Gavilanes
- School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Instituto de Investigación E Innovación en Salud Integral, Laboratorio de Biomedicina, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Roberto Cedeño German
- AECE Research Group, The Association of Clinical Endocrinologists of Ecuador, Avenida de Las Américas, S/N Y E. Noboa, EC090150, Guayaquil, Ecuador
- Servicio de Endocrinología, Hospital de Especialidades "Abel Gilbert Pontón, Guayaquil, Ecuador
| | - Peter Chedraui
- Facultad de Ciencias de La Salud, Universidad Católica "Nuestra Señora de La Asunción", Asunción, Paraguay
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SCHUSSEL VICTORCAVALCANTE, SAITO BIANCA, BONELLI GERARDOMIGUELROMERO, DJEHIZIAN RICARDOKRIKOR, LUCARELLI JOSÉ, GAIA THOMASPESCECAVANHA, AMBRA LUIZFELIPEMORLIN. EPIDEMIOLOGICAL ANALYSIS OF FRACTURES IN THE PREVIOUS PERIOD AND DURING THE QUARANTINE OF COVID-19. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e256943. [PMID: 36561481 PMCID: PMC9757727 DOI: 10.1590/1413-785220223006e256943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/03/2021] [Indexed: 12/23/2022]
Abstract
Objectives Our aim was to compare the epidemiology of surgically treated fractures during the pandemic period with previous years without the pandemic. Methods This was a retrospective study with data collection that included patients hospitalized and operated for fractures between March 24th and June 23rd in 2018, 2019 and 2020. Results A total of 879 patients were registered, resulting in a total of 965 fractures. During the COVID-19 pandemic, 234 patients were registered, representing 26.62% of the total, and in the period before the pandemic, 645 patients were registered, 73.38% of the total. Conclusion We observed a proportional increase in high-energy trauma in the social isolation period and patient's average age. The other changes found in the study had no statistical difference. Level of Evidence IV, Case Series.
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Affiliation(s)
- VICTOR CAVALCANTE SCHUSSEL
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, São Paulo, SP, Brasil
| | - BIANCA SAITO
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, São Paulo, SP, Brasil
| | - GERARDO MIGUEL ROMERO BONELLI
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, São Paulo, SP, Brasil
| | - RICARDO KRIKOR DJEHIZIAN
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, Reconstruction and Stretching Group, São Paulo, SP, Brasil
| | - JOSÉ LUCARELLI
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, Reconstruction and Stretching Group, São Paulo, SP, Brasil
| | - THOMAS PESCE CAVANHA GAIA
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, Trauma Group, São Paulo, SP, Brasil
| | - LUIZ FELIPE MORLIN AMBRA
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, Knee Service Group, São Paulo, SP, Brasil
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da Silva WA, Martins VF, Haas AN, Gonçalves AK. Online Exercise Training Program for Brazilian Older Adults: Effects on Physical Fitness and Health-Related Variables of a Feasibility Study in Times of COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14042. [PMID: 36360923 PMCID: PMC9658741 DOI: 10.3390/ijerph192114042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic brought negative consequences such as social isolation and limited access to health services, especially for older adults. The objective was to evaluate effects of an online exercise training program and physical fitness and health-related variables on Brazilian older adults during the COVID-19 pandemic and secondarily to assess the feasibility and application of an online program. A study was developed with twenty older adults who participated in a 9-month online exercise program. The physical fitness, depressive symptoms, concern about falling, and quality of life were assessed pre- and post-intervention. One-way repeated measures ANOVA and effect size was used. The feasibility was proven by the adherence to the program, in addition to the absence of identification of adverse effects. The results showed that physical fitness was improved (upper limb strength) or maintained (lower limb strength, lower and upper limb flexibility, cardiorespiratory fitness), as well as for most of the health-related variables (depressive symptoms, concern about falling, and quality of life domains). The study was developed in the first COVID-19 lockdown in Brazil, but positive and important results were obtained. This research supports the feasibility of the online exercise training program and provides a basis for an online exercise program for older adults.
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Bharat A, Verma V, Afaque SF, Raikwar A, Chand S, Singh A. Effect of COVID 19 pandemic on time to care, use of ambulance, admission characteristics, demography, injury characteristics, management and outcome of Paediatric Orthopaedic trauma patients admitted to the trauma centre. INDIAN JOURNAL OF COMMUNITY HEALTH 2022. [DOI: 10.47203/ijch.2022.v34i03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: Lockdown imposed to limit the spread of COVID 19 may have had a significant effect on the time to care, demography, injury causation, injury characteristics, volume and nature of admission, management and outcome of paediatric orthopaedic trauma patients. Objective: To document the effect of lockdown on the time to care at KGMU, use of ambulance, volume and type of admissions, demography, injury causation, injury characteristics, management and outcome of paediatric orthopaedic trauma patients. Methods:. This record review compared age, sex, type of admission, mechanism of injury, injury characteristics, type of treatment, vehicle used for transport, and outcome among patients admitted in pre-lockdown, lockdown and post lockdown. Results: Lockdown was associated with decrease in the number of cases (p<0.01), increase in the time since injury to reception (p<0.040), a rise in the share of referred admission (p<0.040), time since reception at KGMU, time to definitive care (p<0.001), high energy falls (p<0.001), injuries at home (p<0.001), higher ISS (p<0.001), non operative treatment (p=0.038) and greater use of ambulance (p=0.003). Conclusion: Lockdown resulted in a significant change in the causation and management of injury, significant delays in timeliness of care, reduction in the volume of admissions, an increase in injury severity and share of referral admissions.
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Liu G, Yang M, Li N, Li S, Zhu S, Wu X. The Effects of COVID-19 on Geriatric Hip Fracture Management and 1-Year Mortality in Beijing. Orthop Surg 2022; 14:2527-2534. [PMID: 36029040 PMCID: PMC9531070 DOI: 10.1111/os.13464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives Concerns about the coronavirus disease 2019 (COVID‐19) pandemic resulted in unprecedented challenges to the management of geriatric hip fractures. We aimed to evaluate the effects of the COVID‐19 surge on the time to surgery and 1 year mortality in geriatric patients with hip fracture at a large, urban Level 1 trauma center in Beijing, and to guide the management of geriatric hip fracture patients throughout the COVID‐19 pandemic. Methods This single‐center retrospective study included consecutive patients aged ≥65 years and injured 3 weeks prior to admission. Demographic and surgical data were collected between January 20 and May 31, 2020, and from the same period in 2019. Mortality data and functional status were collected at follow‐up of 1‐year after surgery. The primary outcomes were time to surgery and 1 year mortality. Results There were no significant differences in sex, fracture type, and surgical pattern between the 2020 (n = 261) and 2019 time‐matched (n = 307) cohorts. The time from admission to surgery was significantly delayed in the 2020 cohort compared with that in the 2019 cohort (48.9 h vs 20.5 h, p < 0.001). Fewer patients underwent surgery within 48 h in the 2020 cohort (65.5% vs 87.6%, p < 0.001). Surgical delay was also associated with an increased risk of inpatient complications (30.2% vs 20.8%, p = 0.010), however there was no significant difference in the 1‐year mortality rate, nor between pre‐injury and 1 year follow‐up mobility as assessed by Parker score. Only approximately half of the patients in both groups completely returned to their pre‐injury mobility levels. Conclusions The COVID‐19 pandemic has significantly increased the surgery waiting time for geriatric patients with hip fractures, which resulted in increased inpatient complications without a higher mortality rate within 1 year. This reinforces the importance of maintaining timely and protocolized care for geriatric hip fractures throughout any subsequent waves of the pandemic.
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Affiliation(s)
- Gang Liu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Minghui Yang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Ning Li
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Shaoliang Li
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Shiwen Zhu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Xinbao Wu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
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13
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Maccagnano G, Maruccia F, Rauseo M, Noia G, Coviello M, Laneve A, Quitadamo AP, Trivellin G, Malavolta M, Pesce V. Direct Anterior versus Lateral Approach for Femoral Neck Fracture: Role in COVID-19 Disease. J Clin Med 2022; 11:jcm11164785. [PMID: 36013024 PMCID: PMC9410486 DOI: 10.3390/jcm11164785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 01/08/2023] Open
Abstract
Background: During the COVID-19 emergency, the incidence of fragility fractures in elderly patients remained unchanged. The management of these patients requires a multidisciplinary approach. The study aimed to assess the best surgical approach to treat COVID-19 patients with femoral neck fracture undergoing hemiarthroplasty (HA), comparing direct lateral (DL) versus direct anterior approach (DAA). Methods: A single-center, observational retrospective study including 50 patients affected by COVID-19 infection (30 males, 20 females) who underwent HA between April 2020 to April 2021 was performed. The patients were allocated into two groups according to the surgical approach used: lateral approach and anterior approach. For each patient, the data were recorded: age, sex, BMI, comorbidity, oxygen saturation (SpO2), fraction of the inspired oxygen (FiO2), type of ventilation invasive or non-invasive, HHb, P/F ratio (PaO2/FiO2), hemoglobin level the day of surgery and 1 day post operative, surgical time, Nottingham Hip Fractures Score (NHFS) and American Society of Anesthesiologists Score (ASA). The patients were observed from one hour before surgery until 48 h post-surgery of follow-up. The patients were stratified into five groups according to Alhazzani scores. A non-COVID-19 group of patients, as the control, was finally introduced. Results: A lateral position led to a better level of oxygenation (p < 0.01), compared to the supine anterior approach. We observed a better post-operative P/F ratio and a reduced need for invasive ventilation in patients lying in the lateral position. A statistically significant reduction in the surgical time emerged in patients treated with DAA (p < 0.01). Patients within the DAA group had a significantly lower blood loss compared to direct lateral approach. Conclusions: DL approach with lateral decubitus seems to preserved respiratory function in HA surgery. Thus, the lateral position may be associated with beneficial effects on gas exchange.
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Affiliation(s)
- Giuseppe Maccagnano
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Francesco Maruccia
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Michela Rauseo
- Department of Anesthesia and Intensive Care, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Giovanni Noia
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Michele Coviello
- Orthopaedic & Trauma Unit, AOU Consorziale Policlinico. Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico. Piazza Giulio Cesare 11, 70124 Bari, Italy
- Correspondence: ; Tel.: +39-3938165088
| | - Andrea Laneve
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Alessandro Pio Quitadamo
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Giacomo Trivellin
- Hip and Trauma Surgery Department, Piero Pederzoli Private Hospital, Peschiera del Garda, 37019 Verona, Italy
| | - Michele Malavolta
- Knee Surgery Department, Piero Pederzoli Private Hospital, Peschiera del Garda, 37019 Verona, Italy
| | - Vito Pesce
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
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14
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Oliveira T, Kendler DL, Schneider P, Juby AG, Wani RJ, Packalen M, Avcil S, Li S, Waters-Banker C, Graves E, McMullen S, Brown J. Trends in osteoporotic fracture and related in-hospital complications during the COVID-19 pandemic in Alberta, Canada. Arch Osteoporos 2022; 17:109. [PMID: 35920903 PMCID: PMC9349109 DOI: 10.1007/s11657-022-01114-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/25/2022] [Indexed: 02/03/2023]
Abstract
Fragility fractures (i.e., low-energy fractures) account for most fractures among older Canadians and are associated with significant increases in morbidity and mortality. Study results suggest that low-energy fracture rates (associated with surgical intervention and outcomes) declined slightly, but largely remained stable in the first few months of the COVID-19 pandemic. PURPOSE/INTRODUCTION This study describes rates of low-energy fractures, time-to-surgery, complications, and deaths post-surgery in patients with fractures during the coronavirus disease (COVID-19) pandemic in Alberta, Canada, compared to the three years prior. METHODS A repeated cross-sectional study was conducted using provincial-level administrative health data. Outcomes were assessed in 3-month periods in the 3 years preceding the COVID-19 pandemic and in the first two 3-month periods after restrictions were implemented. Patterns of fracture- and hospital-related outcomes over the control years (2017-2019) and COVID-19 restrictions periods (2020) were calculated. RESULTS Relative to the average from the control periods, there was a slight decrease in the absolute number of low-energy fractures (n = 4733 versus n = 4308) during the first COVID-19 period, followed by a slight rise in the second COVID-19 period (n = 4520 versus n = 4831). While the absolute number of patients with low-energy fractures receiving surgery within the same episode of care decreased slightly during the COVID-19 periods, the proportion receiving surgery and the proportion receiving surgery within 24 h of admission remained stable. Across all periods, hip fractures accounted for the majority of patients with low-energy fractures receiving surgery (range: 58.9-64.2%). Patients with complications following surgery and in-hospital deaths following fracture repair decreased slightly during the COVID-19 periods. CONCLUSIONS These results suggest that low-energy fracture rates, associated surgeries, and surgical outcomes declined slightly, but largely remained stable in the first few months of the pandemic. Further investigation is warranted to explore patterns during subsequent COVID-19 waves when the healthcare system experienced severe strain.
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Affiliation(s)
- T Oliveira
- Amgen Canada Inc, Mississauga, ON, Canada
| | - D L Kendler
- Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - P Schneider
- Division of Orthopaedic Trauma, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - A G Juby
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, AB, Canada
| | - R J Wani
- Amgen Canada Inc, Mississauga, ON, Canada
| | - M Packalen
- Amgen Canada Inc, Mississauga, ON, Canada
| | - S Avcil
- Amgen Canada Inc, Mississauga, ON, Canada
| | - S Li
- Medlior Health Outcomes Research Ltd, Suite 210 - 28 Quarry Park Blvd, Calgary, AB, T2C 5P9, Canada
| | - C Waters-Banker
- Medlior Health Outcomes Research Ltd, Suite 210 - 28 Quarry Park Blvd, Calgary, AB, T2C 5P9, Canada
| | - E Graves
- Medlior Health Outcomes Research Ltd, Suite 210 - 28 Quarry Park Blvd, Calgary, AB, T2C 5P9, Canada
| | - S McMullen
- Medlior Health Outcomes Research Ltd, Suite 210 - 28 Quarry Park Blvd, Calgary, AB, T2C 5P9, Canada.
| | - J Brown
- Department of Medicine, Laval University and CHU de Québec Research Centre, Quebec City, QC, Canada
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15
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Jiménez-Telleria I, Urra I, Fernández-Gutiérrez L, Aragon E, Aguirre U, Foruria X, Moreta J. [Artículo traducido] Mortalidad a 30 días en pacientes con fractura de fémur proximal durante la pandemia COVID-19 en Vizcaya (País Vasco). Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:T251-T259. [PMID: 35487483 PMCID: PMC9042409 DOI: 10.1016/j.recot.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/27/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Compare 30-day mortality rate following a proximal femur fracture (PFF) and SARS-CoV-2 infection versus a PFF and no SARS-CoV-2 infection. DESIGN Retrospective comparative study. SETTING Three university hospitals in Biscay province (Basque Country, Spain). PATIENTS 77 patients over 65 years-old with PFF (AO 31-A and 31-B). INTERVENTION Study conducted between 9 March and 15 April 2020. The COVID-19 group included only patients with SARS-CoV-2 infection, confirmed by a positive RT-PCR test. MAIN OUTCOME MEASUREMENTS 30-Day mortality rate and risk factors for mortality. RESULTS Of a total 77 patients, 10 were diagnosed with SARS-CoV-2 infection. Mean age was 85 years. Patients with SARS-CoV-2 infection had higher BMI (29.53 kg/m2) compared to patients without infection (24.09 kg/m2) (p = 0.001). No significant differences were found between both groups in terms of the Charlson Comorbidity Index, ASA score, use of oral anticoagulants or presence of cognitive impairment. Seven of the 10 patients in the COVID-19 group developed (viral) pneumonia, as compared to one single case (1/67) of (bacterial) pneumonia in the control group (p < 0.001). Thirty-days mortality was higher (p = 0.03) in COVID-19 patients (40%) than in those in the control group (11.9%). In the multivariate analysis, age ≥ 91 years-old, ASA class IV and BMI > 25 kg/m2 were significant predictors of 30-day mortality. All deaths in the COVID-19 group occurred while the patients were hospitalized. CONCLUSIONS SARS-CoV-2 infection in patients with a PFF was seen to result in higher rates of early mortality, with COVID-19-related pneumonia being the leading direct cause of mortality. LEVEL OF EVIDENCE Level III study.
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Affiliation(s)
- I Jiménez-Telleria
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Galdakao-Usansolo, Bizkaia, España.
| | - I Urra
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Galdakao-Usansolo, Bizkaia, España
| | - L Fernández-Gutiérrez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Basurto, Bizkaia, España
| | - E Aragon
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Cruces, Bizkaia, España
| | - U Aguirre
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Unidad de Investigación Barrualde-Galdakao IHO, Galdakao, España
| | - X Foruria
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Galdakao-Usansolo, Bizkaia, España; Grupo de Reconstrucción de Extremidad Inferior, Instituto de Investigación en Salud de Bizkaia Biocruces, Hospital Galdakao-Usansolo, Osakidetza, Bizkaia, España
| | - J Moreta
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Galdakao-Usansolo, Bizkaia, España; Grupo de Reconstrucción de Extremidad Inferior, Instituto de Investigación en Salud de Bizkaia Biocruces, Hospital Galdakao-Usansolo, Osakidetza, Bizkaia, España
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16
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Qin HC, He Z, Luo ZW, Zhu YL. Management of hip fracture in COVID-19 infected patients. World J Orthop 2022; 13:544-554. [PMID: 35949705 PMCID: PMC9244961 DOI: 10.5312/wjo.v13.i6.544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/07/2022] [Accepted: 04/26/2022] [Indexed: 02/06/2023] Open
Abstract
Given that the global population of elderly individuals is expanding and the difficulty of recovery, hip fractures will be a huge challenge and a critical health issue for all of humanity. Although people have spent more time at home during the coronavirus disease 2019 (COVID-19) pandemic, hip fractures show no sign of abating. Extensive studies have shown that patients with hip fracture and COVID-19 have a multifold increase in mortality compared to those uninfected and a more complex clinical condition. At present, no detailed research has systematically analyzed the relationship between these two conditions and proposed a comprehensive solution. This article aims to systematically review the impact of COVID-19 on hip fracture and provide practical suggestions. We found that hip fracture patients with COVID-19 have higher mortality rates and more complicated clinical outcomes. Indirectly, COVID-19 prevents hip fracture patients from receiving regular medical treatment. With regard to the problems we encounter, we provide clinical recommendations based on existing research evidence and a clinical flowchart for the management of hip fracture patients who are COVID-19 positive. Our study will help clinicians adequately prepare in advance when dealing with such patients and optimize treatment decisions.
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Affiliation(s)
- Hao-Cheng Qin
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhong He
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhi-Wen Luo
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yu-Lian Zhu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
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17
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Lv H, Zhang X, Wang J, Hou Z, Wang H, Li C, Wang W, Chen W, Zhang Y. Short-term effects of COVID-19 on the risk of traumatic fractures in China cities. Sci Rep 2022; 12:6528. [PMID: 35444225 PMCID: PMC9020760 DOI: 10.1038/s41598-022-10531-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/08/2022] [Indexed: 12/21/2022] Open
Abstract
This study aimed to investigate the association between COVID-19 and fracture risk and provide a targeted reference for the world through China’s experience. A nationally representative sample of COVID-19 prevalence areas selected using stratified random sampling was retrospectively analyzed. Age, sex, fracture site, mechanism of injury, and concurrent fractures of traumatic fracture patients in selected hospitals were collected from 10 January to 10 July 2020. The epidemiologic characteristics of traumatic fractures and the association between COVID-19 and fracture risk were explored using descriptive epidemiological methods and a distributed lag nonlinear model. A total of 67,249 patients (52.3% males, 49.4 ± 19.4 years old) with 68,989 fractures were included. The highest proportion of fractures were in the tibia and fibula (14.9%), followed by the femur (13.6%) and ulna and radius (12.5%). Low-energy fractures accounted for 23.3%. With the increase in newly confirmed COVID-19 cases, fracture risk decreased for children, young and middle-aged adults, elderly men, high-energy fractures, and residents in regions with < 1000 cumulative confirmed COVID-19 cases. Fracture risk decreased sharply in all residents except elderly women, for low-energy fractures, and in regions with > 1000 cumulative confirmed COVID-19 cases when newly confirmed COVID-19 cases increased in China. Primary (home) prevention measures are emphasized to prevent traumatic fractures.
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Affiliation(s)
- Hongzhi Lv
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Xiaolin Zhang
- Department of Epidemiology and Statistics, Hebei Medical University, Shijiazhuang, 050017, China
| | - Juan Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Haicheng Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Chao Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Wenjuan Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Wei Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China. .,NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China. .,NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.
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18
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Helal A, Botros D, Qureshi F, Alhreish K, Dutcher L, Teel J, Dawkins J, Rizkalla J. Effects of the COVID-19 pandemic on hip fracture volume, disposition, and readmission rates. Proc AMIA Symp 2022; 35:444-446. [DOI: 10.1080/08998280.2022.2046418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Asad Helal
- Department of Orthopedic Surgery, Baylor University Medical Center, Dallas, Texas
| | - David Botros
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Coptic Medical Association of North America Research Institute
| | - Fahad Qureshi
- School of Medicine, University of Missouri at Kansas City, Kansas City, Missouri
| | - Khalid Alhreish
- Department of Orthopedic Surgery, Texas A&M College of Medicine, Dallas, Texas
| | - Lincoln Dutcher
- Department of Orthopedic Surgery, Baylor University Medical Center, Dallas, Texas
| | - Jordan Teel
- Department of Orthopedic Surgery, Baylor University Medical Center, Dallas, Texas
| | - Jonathon Dawkins
- Department of Orthopedic Surgery, Baylor University Medical Center, Dallas, Texas
| | - James Rizkalla
- Department of Orthopedic Surgery, Baylor University Medical Center, Dallas, Texas
- Coptic Medical Association of North America Research Institute
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da Silva AC, da Silva Santos G, Maluf EMCP, Borba VZC. Incidence of hip fractures during the COVID-19 pandemic in the Brazilian public health care system. Arch Osteoporos 2022; 17:42. [PMID: 35253090 PMCID: PMC8898593 DOI: 10.1007/s11657-022-01078-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/12/2022] [Indexed: 02/03/2023]
Abstract
This study compared the incidence of hip fractures before and during the COVID-19 pandemic in Brazil, aged ≥ 60 years excluding all fractures related to any trauma. There was a significant reduction in the number of hip fractures and the length of hospital stay during the period of social isolation. PURPOSE To compare the incidence of hip fractures before and during the COVID-19 pandemic in Brazil and in the main regions of the country in patients covered by the Brazilian public health care system (SUS). As far as we are aware, no studies have evaluated the impact of COVID-19 pandemic on hip fractures in Brazil. METHODS Descriptive, cross-sectional study in individuals aged ≥ 60 years who presented with a hip fracture before and during the COVID-19 pandemic and received treatment covered by the SUS. The data were collected from the DATASUS electronic database. We calculated the incidence, mortality, lethality, duration of hospitalization, and average reimbursement associated with the treatment of the fractures. RESULTS There was a significant reduction in the incidence of hip fractures among individuals aged ≥ 60 years in Brazil during the period of social isolation due to COVID-19. The observed incidence was 15.58/10,000 inhabitants between March and December 2020 and 16.07/10,000 inhabitants in the same period of 2019 (p < 0.005; main decline observed in the age groups > 70 years). The average length of hospital stay reduced from 8.35 days in 2019 to 7.33 days in 2020, following a similar pattern of reduction across all regions. The Southeast was the only region with a significant reduction in mortality during the pandemic (relative risk 0.90, 95% confidence interval 0.84-0.97, p < 0.005). CONCLUSION During the COVID-19 pandemic in Brazil, the incidence rate of hip fractures and the associated duration of hospital stay decreased among patients aged ≥ 60 years.
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Affiliation(s)
| | | | | | - Victoria Zeghbi Cochenksi Borba
- Department of Internal Medicine, Endocrine Division (SEMPR), Federal University of Paraná, Av. Agostinho Leão Júnior, 285–80030-110, Curitiba (Paraná), Brazil
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20
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Driessen MLS, van Ditshuizen JC, Waalwijk JF, van den Bunt G, IJpma FFA, Reininga IHF, Fiddelers AA, Habets K, Homma PCM, van den Berg MH, Bloemers FW, Schipper IB, Leenen LPH, de Jongh MAC. Impact of the SARS-CoV-2 pandemic on trauma care: a nationwide observational study. Eur J Trauma Emerg Surg 2022; 48:2999-3009. [PMID: 35137249 PMCID: PMC9360332 DOI: 10.1007/s00068-022-01891-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/21/2022] [Indexed: 11/11/2022]
Abstract
Purpose The SARS-CoV-2 pandemic severely disrupted society and the health care system. In addition to epidemiological changes, little is known about the pandemic’s effects on the trauma care chain. Therefore, in addition to epidemiology and aetiology, this study aims to describe the impact of the SARS-CoV-2 pandemic on prehospital times, resource use and outcome. Methods A multicentre observational cohort study based on the Dutch Nationwide Trauma Registry was performed. Characteristics, resource usage, and outcomes of trauma patients treated at all trauma-receiving hospitals during the first (W1, March 12 through May 11) and second waves (W2, May 12 through September 23), as well as the interbellum period in between (INT, September 23 through December 31), were compared with those treated from the same periods in 2018 and 2019. Results The trauma caseload was reduced by 20% during the W1 period and 11% during the W2 period. The median length of stay was significantly shortened for hip fracture and major trauma patients (ISS ≥ 16). A 33% and 66% increase in the prevalence of minor self-harm-related injuries was recorded during the W1 and W2 periods, respectively, and a 36% increase in violence-related injuries was recorded during the INT. Mortality was significantly higher in the W1 (2.9% vs. 2.2%) and W2 (3.2% vs. 2.7%) periods. Conclusion The imposed restrictions in response to the SARS-CoV-2 pandemic led to diminished numbers of acute trauma admissions in the Netherlands. The long-lasting pressing demand for resources, including ICU services, has negatively affected trauma care. Further caution is warranted regarding the increased incidence of injuries related to violence and self-harm. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-022-01891-5.
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Affiliation(s)
| | - Jan C van Ditshuizen
- Trauma Research Unit, Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Job F Waalwijk
- Network of Acute Care Limburg (NAZL), Maastricht, The Netherlands
| | | | - Frank F A IJpma
- Department of Trauma Surgery, University Medical Centre Groningen, P.O Box 30.001, 9700 RB, Groningen, Groningen, The Netherlands
| | - Inge H F Reininga
- Network of Acute Care Northern Netherlands (AZNN), Groningen, The Netherlands
| | | | - Karin Habets
- Network of Acute Care Eastern Netherlands (AZO), Nijmegen, The Netherlands
| | - Paulien C M Homma
- Network of Acute Care Amsterdam (SpoedzorgNet), Amsterdam, The Netherlands
| | | | - Frank W Bloemers
- Department of Surgery, Amsterdam University Medical Centre, location VU, P.O. Box 1081 HV, Amsterdam, The Netherlands
| | - Inger B Schipper
- Department of Trauma Surgery, Leiden University Medical Centre, P.O Box 9600, 2300 RC, Leiden, The Netherlands
| | - Luke P H Leenen
- Department of Surgery, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Mariska A C de Jongh
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, The Netherlands
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21
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Zhao W, Zhao J, Liu T, Liu Z, Liu L, Zhang Y. Incidence and risk factors of preoperative deep venous thrombosis following pelvic and acetabular fractures: a retrospective case–control study. J Orthop Surg Res 2022; 17:77. [PMID: 35123537 PMCID: PMC8818157 DOI: 10.1186/s13018-022-02972-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractThe objective of this study was to investigate the prevalence of preoperative deep venous thrombosis (DVT) in the pelvic cavity and lower extremities following pelvic and acetabular fractures and to identify the risk factors of the occurrence of DVT. Duplex ultrasound (DUS) screening and blood tests were conducted in patients admitted from June 2012 to December 2020 for surgical treatment of pelvic and acetabular fractures. Univariate analyses were performed on data of demographics, comorbidities, time from injury to surgery, injury mechanism, accompanied injury, and laboratory results. The optimal cutoff values of continuous variables with statistical significance were obtained by using the receiver operating characteristic (ROC) curve. A multivariate logistic regression analysis was then employed to examine the independent values in terms of predicting preoperative DVT. A total of 607 patients with pelvic and acetabular fractures were included, among whom 82 (13.5%) patients sustained preoperative DVTs. Specifically, 31.7% (26/82) were diagnosed with proximal DVTs. Fifty-two (63.4%) patients had DVT within 7 days after injury, and 67 (81.7%) patients within 10 days. The multivariate logistic regression analysis identified 6 factors independently associated with the presence of preoperative DVT, including age > 46 years (odds ratio [OR] = 2.94), BMI > 26.73 kg/m2 (OR = 3.91), time from injury to surgery > 9 days (OR = 5.39), associated injury (OR = 7.85), ALB < 32.8 g/L (OR = 2.71) and FIB > 3.095 g/L (OR = 3.34). Despite the modern prophylactic regimen, the preoperative DVT in patients with pelvic and acetabular fractures still draws the attention of orthopaedic surgeons. Better understanding these risk factors can help surgeons refine the risk stratification profile and perform early interdisciplinary management for patients at high risk of DVT.
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22
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Yao M, Wang H, Chen W. Clinical research-When it matters. Injury 2022:S0020-1383(22)00079-1. [PMID: 35144806 DOI: 10.1016/j.injury.2022.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/29/2022] [Indexed: 02/02/2023]
Abstract
Clinical research runs through the entire progress of the science and technology which has been currently and previously applied to the medical field. It has gradually developed into a standardized procedure and played an important role in understanding the etiology and characteristics of diseases. Clinical researchs assess the effectiveness and safety of new/improved diagnostic or therapeutic technologies, implants, instruments, or drug applications, to discover new data and improve potential deficiencies in previous medical knowledge.
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Affiliation(s)
- Mengxuan Yao
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang 050051, Hebei, China; Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei 050051, China
| | - Haicheng Wang
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang 050051, Hebei, China; Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei 050051, China
| | - Wei Chen
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China; NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, Hebei 050051, China.
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Oulianski M, Rosinsky PJ, Fuhrmann A, Sokolov R, Arriola R, Lubovsky O. Decrease in incidence of proximal femur fractures in the elderly population during the Covid-19 pandemic: a case-control study. BMC Musculoskelet Disord 2022; 23:61. [PMID: 35039016 PMCID: PMC8763134 DOI: 10.1186/s12891-022-05016-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 11/29/2021] [Indexed: 11/11/2022] Open
Abstract
Background The World Health Organization classified Covid-19 as a pandemic during the first months of 2020 as lockdown measures were implemented globally to mitigate the increasing incidence of Covid-19-related morbidity and mortality. The purpose of this study was to evaluate the effect of national lockdown measures on proximal femur fracture epidemiology. Our hypothesis was that due to the prolonged period of stay-at-home orders, we would observe a decrease in the incidence of proximal femur fractures during the years 2020–21. Methods A retrospective case–control study of 2784 hip fractures admitted to the emergency department at one hospital between January 1, 2010, and March 31, 2021, was conducted. Cases were stratified weekly, and an analysis was conducted comparing cases occurring during government-imposed lockdown periods of 2020–21 to corresponding periods during 2010–2019. Furthermore, the trend of cases throughout the year of 2020 was observed. Results Of all proximal femur fracture cases included, 2522 occurred between 2010–2019 and 261 during the Covid-19 period. There was no significant difference in age (81.95 vs. 82.09; P = 0.78) or gender (P = 0.12). There was a total decrease of 21.64% in proximal femur fracture per week during the entirety of the Covid-19 pandemic period compared to the previous years (3.64 ± 1.99 vs. 4.76 ± 0.83; P = 0.001). During all three lockdown periods, there was a significant decrease in proximal femur fracture cases per week (3.55 ± 2.60 vs. 4.87 ± 0.95; P = 0.04), and the most pronounced decrease occurred during the third lockdown period (2.89 ± 1.96 vs. 5.23 ± 1.18; P = 0.01). Conclusion We observed a total decrease in the number of proximal femur fractures occurring during the Covid-19 era compared to previous years and specifically a decrease of cases occurring during the government-imposed lockdown periods. The decrease in cases was more pronounced during the second and third lockdown periods.
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Affiliation(s)
- Maria Oulianski
- Department of Orthopedic Surgery, Barzilai Medical Center, Ashkelon, Israel.
| | - Philip J Rosinsky
- Department of Orthopedic Surgery, Barzilai Medical Center, Ashkelon, Israel
| | - Ariel Fuhrmann
- Department of Orthopedic Surgery, Barzilai Medical Center, Ashkelon, Israel
| | - Ruslan Sokolov
- Department of Orthopedic Surgery, Barzilai Medical Center, Ashkelon, Israel
| | - Roberto Arriola
- Department of Orthopedic Surgery, Barzilai Medical Center, Ashkelon, Israel
| | - Omri Lubovsky
- Department of Orthopedic Surgery, Barzilai Medical Center, Ashkelon, Israel
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24
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Management of resources for orthopedic oncology and trauma patients during COVID-19 pandemic: A retrospective cohort study. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh210318027o] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction/Objective. This study aims to evaluate changes in surgical
strategy and orthopedic epidemiology, and to compare the frequency of
surgeries before and during the COVID-19 pandemic. Methods. For periods
from April 1 to May 31 in years 2019 and 2020, retrospective data on patient
demographics and types of orthopedic surgical procedures were obtained from
hospital databases in a tertiary referral hospital. Results. During the
COVID-19 pandemic, the most common orthopedic surgical procedures performed
were trauma surgery (n = 81), while other procedures were referred to
oncology (n = 19), biopsy (n = 11), debridement (n = 10), amputation (n =
6), surgery of dysplastic hip (n = 5) and knee ligament repair (n = 1). The
majority of trauma cases were hip fracture surgeries (n = 23). The mean age
of patients was 70.5 years. Sixty-three patients were female and seventy
were male. Only one patient had a history of COVID-19 infection. In the same
period during the year before the pandemic, 86 patients had trauma surgery,
while 49 had oncological surgery and the mean patient?s age was 54.5.
Sixty-two patients were female, and seventy-three were male in this group.
The number of tumor surgeries before the pandemic was higher compared to the
same period during the pandemic (p < 0.05). Conclusion. During the
pandemic, although all orthopedic surgeries decreased, the rate of
osteoporotic hip fractures surgery was similar as in pre-pandemic state.
This finding emphasizes the increased need to implement preventive measures
regarding hip fractures during lockdown periods. The relation of hip and
spine osteoporotic fractures surgery was not different before and during the
pandemic.
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25
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Özşahin MK, Değer GU, Aydın N. The impact of COVID-19 pandemic in the first 100 days on orthopedic trauma surgery practice, the experience of a university hospital in Istanbul. ULUS TRAVMA ACIL CER 2022; 28:27-32. [PMID: 34967425 PMCID: PMC10443172 DOI: 10.14744/tjtes.2021.23796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/14/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND With the rapid and effective change created by the COVID-19 pandemic in all medical practice, we aimed to evaluate the impact of the first 100 days of the COVID-19 pandemic on the operations performed in a reference university hospital in the field of orthopedics and traumatology. Compare the results with the same period of the previous year and aim to evaluate importance of restrictions. METHODS The operations performed in orthopedics and traumatology clinic between March 18, 2020 (the day we stopped the elective surgeries), and July 1, 2020 (when the normalization process began), were collected from the electronic archive to compare with the same period of 2019. RESULTS Comparing the same periods of the year, it was seen that 102 surgeries were performed in the 2020 COVID-19 period compared to 380 operations performed in 2019. Although most of the operations performed during the COVID-19 period were traumas, the comparison revealed that trauma cases decreased by 25% from 73 to 58 (p<0.001). Among trauma patients operated in the restraint period, decrease in the pediatric group and the increase in patients over 65 years of age had seen statistically significant. Compared to the same period of the previous year, 50% increase seen in amputation cases related to diabetic foot (p<0.001). CONCLUSION The postponement of elective cases due to the COVID-19 pandemic enabled us to manage trauma cases despite decreasing capacity utilization. In addition, it was observed that the transition of schools to online education and the implementation of curfews significantly reduced the number of trauma in the pediatric group. Separation of operating rooms and wards had a huge effect on protection of non-COVID patients. We hope that, in light of this study, we can guide health policies and help other colleagues to manage the possible new waves of the pandemic process or similar processes that may occur in the future.
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Affiliation(s)
- Mahmut Kürşat Özşahin
- Department of Orthopaedics and Traumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul-Turkey
| | - Göker Utku Değer
- Department of Orthopaedics and Traumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul-Turkey
| | - Nuri Aydın
- Department of Orthopaedics and Traumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul-Turkey
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Wang H, Wu W, Han C, Zheng J, Cai X, Chang S, Shi J, Xu N, Ai Z. Prediction Model of Osteonecrosis of the Femoral Head After Femoral Neck Fracture: Machine Learning-Based Development and Validation Study. JMIR Med Inform 2021; 9:e30079. [PMID: 34806984 PMCID: PMC8663504 DOI: 10.2196/30079] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 09/01/2021] [Accepted: 09/28/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The absolute number of femoral neck fractures (FNFs) is increasing; however, the prediction of traumatic femoral head necrosis remains difficult. Machine learning algorithms have the potential to be superior to traditional prediction methods for the prediction of traumatic femoral head necrosis. OBJECTIVE The aim of this study is to use machine learning to construct a model for the analysis of risk factors and prediction of osteonecrosis of the femoral head (ONFH) in patients with FNF after internal fixation. METHODS We retrospectively collected preoperative, intraoperative, and postoperative clinical data of patients with FNF in 4 hospitals in Shanghai and followed up the patients for more than 2.5 years. A total of 259 patients with 43 variables were included in the study. The data were randomly divided into a training set (181/259, 69.8%) and a validation set (78/259, 30.1%). External data (n=376) were obtained from a retrospective cohort study of patients with FNF in 3 other hospitals. Least absolute shrinkage and selection operator regression and the support vector machine algorithm were used for variable selection. Logistic regression, random forest, support vector machine, and eXtreme Gradient Boosting (XGBoost) were used to develop the model on the training set. The validation set was used to tune the model hyperparameters to determine the final prediction model, and the external data were used to compare and evaluate the model performance. We compared the accuracy, discrimination, and calibration of the models to identify the best machine learning algorithm for predicting ONFH. Shapley additive explanations and local interpretable model-agnostic explanations were used to determine the interpretability of the black box model. RESULTS A total of 11 variables were selected for the models. The XGBoost model performed best on the validation set and external data. The accuracy, sensitivity, and area under the receiver operating characteristic curve of the model on the validation set were 0.987, 0.929, and 0.992, respectively. The accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve of the model on the external data were 0.907, 0.807, 0.935, and 0.933, respectively, and the log-loss was 0.279. The calibration curve demonstrated good agreement between the predicted probability and actual risk. The interpretability of the features and individual predictions were realized using the Shapley additive explanations and local interpretable model-agnostic explanations algorithms. In addition, the XGBoost model was translated into a self-made web-based risk calculator to estimate an individual's probability of ONFH. CONCLUSIONS Machine learning performs well in predicting ONFH after internal fixation of FNF. The 6-variable XGBoost model predicted the risk of ONFH well and had good generalization ability on the external data, which can be used for the clinical prediction of ONFH after internal fixation of FNF.
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Affiliation(s)
- Huan Wang
- Department of Medical Statistics, Tongji University School of Medicine, Shanghai, China
| | - Wei Wu
- Department of Spinal Surgery, Shanghai East Hospital, Shanghai, China
| | - Chunxia Han
- Department of Medical Statistics, Tongji University School of Medicine, Shanghai, China
| | - Jiaqi Zheng
- Department of Medical Statistics, Tongji University School of Medicine, Shanghai, China
| | - Xinyu Cai
- Department of Orthopedics, Shanghai Tenth People's Hospital, Shanghai, China
| | - Shimin Chang
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Junlong Shi
- Medical Record Department, Shanghai Ninth People's Hospital, Shanghai, China
| | - Nan Xu
- Department of Radiology, Shanghai East Hospital, Shanghai, China
| | - Zisheng Ai
- Department of Medical Statistics, Tongji University School of Medicine, Shanghai, China
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The effect of physical and social isolation due to the COVID-19 pandemic on the incidence of hip fractures among senior citizens. Geriatr Nurs 2021; 43:21-25. [PMID: 34798310 PMCID: PMC8531412 DOI: 10.1016/j.gerinurse.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 12/04/2022]
Abstract
This study aimed to explore the effects of the lockdown due to the coronavirus disease 2019 pandemic on the incidence and characteristics of hip fracture in older adults. Data from the three-month lockdown period and the corresponding period in the previous year were obtained from the computerized medical records of a large acute-care hospital. No significant differences were observed in the absolute and relative numbers of hip fractures. There were no significant differences in terms of socio-demographic and clinical characteristics, which are considered risk factors for falls. Similarly, there was no difference in the length of time between admission and surgery and the mean length of hospital stay. Compared to the previous year, there was a significantly higher incidence of hip fractures in older adults living alone during the lockdown. Health policy should provide social support and monitoring of healthcare, particularly to older adults living alone.
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28
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Mills S, Ibarzábal-Gil A, Martínez-Diez JM, Pallarés-Sanmartín J, Kalbakdij-Sánchez C, Rubio-Suárez JC, Losantos-García I, Rodríguez-Merchán EC. SARS-CoV-2 outbreak impact on a trauma unit. World J Orthop 2021; 12:751-759. [PMID: 34754831 PMCID: PMC8554347 DOI: 10.5312/wjo.v12.i10.751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/17/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND From February 2020 onwards, our country has been hit by the coronavirus severe acute respiratory syndrome-2 (SARS-CoV-2) infection. At a glance, hospitals became overrun and had to reformulate all the assistance guidelines, focusing on the coronavirus disease 2019. One year after the start of the pandemic, we present the results of a morbimortality study.
AIM To analyze how our department was affected by the outbreak in terms of morbimortality, and to analyze demographic data, admission to hospital-related data, and subgroups analyses for patients with hip fractures and polytrauma.
METHODS We designed a study comparing data from patients who were admitted to our unit due to a lower limb fracture or a high energy trauma during the pandemic (from March to April 2020) to those admitted during the same period in 2019 before the pandemic. during the pandemic situation. Both cohorts completed a minimum of 6 mo of follow-up.
RESULTS The number of patients admitted to hospital in 2020 was nearly half of those in 2019. Hip fractures in the elderly represented 52 out of 73 of the admitted patients. Twenty patients had a positive test result for SARS-CoV-2 infection. Patients with SARS-CoV-2 infection were admitted to the hospital for a longer time than the non-infected (P < 0.001), and had a higher mortality rate during hospitalization and follow-up (P = 0.02). Patients with a hip fracture associated with a severe respiratory syndrome were mostly selected for conservative treatment (P = 0.03).
CONCLUSION Mortality and readmission rates were higher in the 2020 cohort and during follow-up, in comparison with the cohort in 2019.
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Affiliation(s)
- Sarah Mills
- Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain
| | | | | | | | | | | | | | - E Carlos Rodríguez-Merchán
- Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain
- Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research – IdiPAZ (La Paz University Hospital – Autonomous University of Madrid), Madrid, Spain
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[Quantitative and qualitative analysis of the influence of confinement by COVID-19 in fracture patients entered in a traumatology service at a third level hospital]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 65:374-381. [PMID: 34630777 PMCID: PMC7836961 DOI: 10.1016/j.recot.2020.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/14/2020] [Indexed: 12/12/2022] Open
Abstract
Introducción La pandemia por COVID-19 ha supuesto el confinamiento de aproximadamente un tercio de la población mundial, provocando un cambio drástico en las actividades de la vida diaria con enorme impacto sanitario, económico y social. Objetivos El objetivo de este trabajo es presentar las variaciones epidemiológicas en la producción de fracturas en el período de confinamiento obligatorio en nuestra población de referencia. Material y métodos Estudio analítico retrospectivo comparativo de dos grupos de pacientes: Grupo A: personas ingresadas antes del estado de alarma que obligó al confinamiento en el período del 13 enero al 13 de marzo vs. Grupo B: individuos atendidos durante los dos meses de confinamiento, hasta que comenzó la desescalada, período del 13 marzo al 13 mayo. Se registraron variables epidemiológicas, incluyendo edad, antecedentes personales, tipo de fractura, mecanismo de lesión, porcentaje de ambulatorización y estancia hospitalaria. Resultados Se incluyeron un total de 190 pacientes. En el período de pre-confinamiento 112 y en el confinamiento 78 (disminución del 30%). La edad media (p = 0,007) y las caídas en domicilio (p<0,001) fueron mayores en este último grupo. La estancia hospitalaria postoperatoria (p = 0,006) y global (p < 0,001) resultaron significativamente menores en el mismo grupo. No se encontraron diferencias en la localización anatómica de la lesión, el sexo, las comorbilidades, el mecanismo de lesión, la tasa de ambulatorización ni el éxitus. Conclusiones Con base en los resultados de nuestro estudio, el período de confinamiento forzoso por la pandemia de COVID-19 ha producido una drástica disminución del número total de fracturas ingresadas en el servicio de traumatología de un hospital de tercer nivel. Por otro lado, las fracturas osteoporóticas de cadera que requirieron tratamiento quirúrgico no variaron en número y se ha constatado un decremento de la estancia media postoperatoria y global.
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Bub CD, Larsen CG, Heimroth J, Aziz H, Pinpin C, Intravia JM, Goldman A. Hip Fracture Trends and Outcomes During the COVID-19 Pandemic. Orthopedics 2021; 44:293-298. [PMID: 34590943 DOI: 10.3928/01477447-20210819-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Coronavirus disease 2019 (COVID-19) rapidly changed the landscape of health care, particularly in the New York City area. The elderly population is particularly vulnerable to both the novel coronavirus and the effects of a fracture. The goal of this study was to compare trends and outcomes of hip fracture patients during the pandemic. This was a retrospective chart review of hip fracture patients from a suburban academic hospital on Long Island, New York, who presented from March 1 to May 30, 2020. Patient COVID-19 status, demographics, and hospital outcome measures were recorded. Statistical analysis was performed using heteroscedastic t tests for quantitative variables and chi-square tests for qualitative variables. There were 82 patients in the 2020 cohort and 111 in the 2019 control group, representing a 29.9% decrease in cases. The 2020 cohort presented to the hospital an average of 2.77 days after injury compared with 1.15 days for the 2019 control group (P=.0976). Patients in the 2020 cohort were more likely to be discharged home than to rehabilitation (P<.0001) and tended to be discharged with oral anticoagulation (P=.0809). There was no increase in 1-, 3-, or 6-month complications or mortality. During the pandemic, fewer patients were admitted with hip fractures, and the time from injury to presentation doubled. Patients were significantly less likely to be discharged to rehabilitation and more were discharged with oral anticoagulants. Overall, there was no increase in complications, and these data indicate that the authors were successfully able to provide high-quality care to hip fracture patients during the pandemic. [Orthopedics. 2021;44(5):293-298.].
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Toy S, Polat O, Özbay H. Coronavirus disease 2019 pandemic, restriction, and orthopedic trauma: Retrospective observational study. Medicine (Baltimore) 2021; 100:e27166. [PMID: 34477174 PMCID: PMC8415988 DOI: 10.1097/md.0000000000027166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/20/2021] [Indexed: 01/05/2023] Open
Abstract
In 2019, the Coronavirus disease 2019 (Covid-19) was reported in Wuhan, China. Governments in various countries had taken many safeguards. This study investigated the incidence of orthopedic trauma in a rural region epidemiologically and guided source distribution and medical professionals to sustain healthcare systems.Between December 2019 and August 2020, 1651 patients admitted to orthopedics and traumatology clinics with trauma were evaluated in this study. Patients were grouped into 3 groups: pre-covid, restriction, and permitted groups. Age, sex, and fracture types of patients were recorded.The number of patients in the pre-covid period was 629 (38.1%), those were 334 (20.2%) in the restriction period, and 688 (41.7%) patients were admitted in the permitted period. A total of 1203 (72.9%) patients with upper extremity fractures, 383 (23.2%) patients with lower extremity fractures, and 65 (3.9%) patients with axial skeleton and pelvic ring fractures were included in the study. The lowest rates were found in the restriction period when all fractures were evaluated according to the admission periods. There were significant differences between admission dates and the fractures (P < .001).In this study, a decrease in orthopedic trauma rates was observed by half in the restriction period compared with the other 2 periods. Public health precautions had led to a reduction in the incidence of orthopedic trauma in all age groups.
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Matassi F, Piolanti N, Filoni G, Giabbani N, Nulvesu G, Rostagno C, Civinini R, Scaglione M. The New Challenge in the Management of Proximal Femur Fractures during SARS Cov-2 outbreak. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021338. [PMID: 34487092 PMCID: PMC8477100 DOI: 10.23750/abm.v92i4.10965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/28/2020] [Indexed: 11/23/2022]
Abstract
The aim of this study is to evaluate how the spread of Sars-Cov-2 has changed the epidemiology of proximal femur fractures in two major trauma centers in Italy, understanding the workload and the best allocation of the resources for the orthopedics department in such an emergency situation. The rate of patients from January 2019 to April 2020 hospitalized with femoral neck fractures (group A) and trochanteric fractures (group B) were recorded. Demographic data, timing of surgical treatment and the length of stay were recorded. Data show that the number of proximal femur fractures has remained unchanged in the COVID and pre-COVID era (ranging from an average of 91.14/month in the pre-COVID era to 76/month in March and 80/month in April). In our trauma centers, the rate of patients operated on within 48 hours has remained stable (78.19% vs 77.92%), while the length of stay has decreased during the COVID period (8.9 days vs 6.5 days in March and 6.8 days in April). Proximal femur fractures, even during the COVID period, are a constant issue and a new challenge for the healthcare system. The main goals of management are to preserve patients from viral infection, to provide early surgical treatment and fast track protocol for discharge.
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Affiliation(s)
- Fabrizio Matassi
- Orthopaedic Clinic - University of Florence - Largo Palagi, 1 - 50139 - Florence, Italy.
| | - Nicola Piolanti
- Orthopaedic and Trauma Clinic - University of Pisa - Via Paradisa 2 - 56124 - Pisa, Italy.
| | - Gabriele Filoni
- Orthopaedic and Trauma Clinic - University of Pisa - Via Paradisa 2 - 56124 - Pisa, Italy.
| | - Niccolò Giabbani
- Orthopaedic Clinic - University of Florence - Largo Palagi, 1 - 50139 - Florence, Italy.
| | - Gianluca Nulvesu
- Orthopaedic and Trauma Clinic - University of Pisa - Via Paradisa 2 - 56124 - Pisa, Italy.
| | - Carlo Rostagno
- Department of experimental clinical medicine - University of Florence - Largo Palagi, 1 - 50139 - Florence, Italy.
| | - Roberto Civinini
- Orthopaedic Clinic - University of Florence - Largo Palagi, 1 - 50139 - Florence, Italy.
| | - Michelangelo Scaglione
- Orthopaedic and Trauma Clinic - University of Pisa - Via Paradisa 2 - 56124 - Pisa, Italy.
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Jiménez-Telleria I, Urra I, Fernández-Gutiérrez L, Aragon E, Aguirre U, Foruria X, Moreta J. [Thirty-day mortality in patients with a proximal femur fracture during the COVID-19 pandemic in Biscay (Basque Country).]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 66:251-259. [PMID: 34276834 PMCID: PMC8275476 DOI: 10.1016/j.recot.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/27/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives Compare 30-day mortality rate following a proximal femur fracture (PFF) and SARS-CoV-2 infection versus a PFF and no SARS-CoV-2 infection. Design Retrospective comparative study. Setting Three university hospitals in Biscay province (Basque Country, Spain). Patients: 77 patients over 65 years-old with PFF (AO 31-A and 31-B). Intervention Study conducted between 9 March and 15 April 2020. The COVID-19 group included only patients with SARS-CoV-2 infection, confirmed by a positive RT-PCR test. Main outcome measurements 30-day mortality rate and risk factors for mortality. Results Of a total 77 patients, 10 were diagnosed with SARS CoV-2 infection. Mean age was 85 years. Patients with SARS-Cov-2 infection had higher BMI (29.53 kg/m2) compared to patients without infection (24.09 kg/m2) (p = 0.001). No significant differences were found between both groups in terms of the Charlson Comorbidity Index, ASA score, use of oral anticoagulants or presence of cognitive impairment. Seven of the 10 patients in the COVID-19 group developed (viral) pneumonia, as compared to one single case (1/67) of (bacterial) pneumonia in the control group (p < 0.001). Thirty-days mortality was higher (p = 0.03) in COVID-19 patients (40%) than in those in the control group (11.9%). In the multivariate analysis, age ≥91 years-old, ASA class IV and BMI >25 kg/m2 were significant predictors of 30-day mortality. All deaths in the COVID-19 group occurred while the patients were hospitalized. Conclusions SARS CoV-2 infection in patients with a PFF was seen to result in higher rates of early mortality, with COVID-19-related pneumonia being the leading direct cause of mortality.
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Affiliation(s)
| | - Ioar Urra
- Department of Orthopedic Surgery and Trauma, Hospital Galdakao-Usansolo, Bizkaia, Spain
| | | | - Esteban Aragon
- Department of Orthopedic Surgery and Trauma. Hospital Universitario Cruces, Bizkaia, Spain
| | - Urko Aguirre
- Research Network in Health Services in Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC), Research Unit of the Barrualde-Galdakao IHO, Galdakao, Spain
| | - Xabier Foruria
- Department of Orthopedic Surgery and Trauma, Hospital Galdakao-Usansolo, Bizkaia, Spain.,Lower Limb Reconstruction Group. Biocruces Bizkaia Health Research Institute, Hospital Galdakao- Usansolo, Osakidetza, Bizkaia, Spain
| | - Jesús Moreta
- Department of Orthopedic Surgery and Trauma, Hospital Galdakao-Usansolo, Bizkaia, Spain.,Lower Limb Reconstruction Group. Biocruces Bizkaia Health Research Institute, Hospital Galdakao- Usansolo, Osakidetza, Bizkaia, Spain
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COVID-19 Changed the Incidence and the Pattern of Pediatric Traumas: A Single-Centre Study in a Pediatric Emergency Department. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126573. [PMID: 34207263 PMCID: PMC8296402 DOI: 10.3390/ijerph18126573] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/03/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022]
Abstract
The first wave of COVID-19 spread worldwide from March to May 2020. Italy was one of the countries in the world where the lockdown period was most prolonged and restrictive. To date, the impact of prolonged lockdown on pediatric traumas has not fully investigated. This paper aimed to analyze, and compare to 2019, the incidence and the fracture pattern in patients admitted to our pediatric hospital during the total lockdown period. A single-center retrospective study was performed. The data were gathered from the Pediatric Emergency Department (PED) of the Bambino Gesù Children Hospital of Rome (Palidoro). This PED is the pediatric referral center for Rome and the hub for pediatric traumas of the region. Any admission diagnosis for fracture, trauma, sprains and dislocation during the lockdown period (10 March-4 May) were included. The demographic data, diagnosis, type of treatment, fracture segment, bone involvement and time interval between trauma and presentation to the PED were recorded. In 2020, a reduction of total traumas and fractures, compared to 2019 (p < 0.001), occurred (81%). Superior limb and inferior limb fractures decreased in 2020 compared to 2019 (p < 0.05). The identification of pediatric traumas and fractures trend could be useful to reorganize the PED. Epidemiological data from the previous lockdown could be helpful to prepare the healthcare system for new pandemic waves. Moreover, sharing national statistics and correlating those to other countries' protocols, could be helpful to solve problems in case of worldwide emergency situations.
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Oguzkaya S, Misir A, Ozcamdalli M, Eken G, Kizkapan TB, Kurk MB, Uzun E. Impact of the COVID-19 pandemic on orthopedic fracture characteristics in three hospitals in Turkey: A multi-center epidemiological study. Jt Dis Relat Surg 2021; 32:323-332. [PMID: 34145802 PMCID: PMC8343845 DOI: 10.52312/jdrs.2021.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/12/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives
In this study, we present the use of case specific three- dimensional (3D) printed plastic models and custom-made acetabular implants in orthopedic surgery. Materials and methods
Between March 2018 and September 2020, surgeries were simulated using plastic models manufactured by 3D printers on the two patients with pilon fractures. Also, custom-made acetabular implants were used on two patients with an acetabular bone defect for the revision of total hip arthroplasty (THA). Results
More comfortable surgeries were experienced in pilon fractures using preoperative plastic models. Similarly, during the follow-up period, the patients that applied custom-made acetabular implants showed a fixed and well-positioning in radiographic examination. These patients did not experience any surgical complications and achieved an excellent recovery. Conclusion
Preoperative surgical simulation with 3D printed models can increase the comfort of fracture surgeries. Also, custom-made 3D printed acetabular implants can perform an important task in patients treated with revision THA surgery due to severe acetabular defects.
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Affiliation(s)
- Sinan Oguzkaya
- Sarkışla Devlet Hastanesi Ortopedi ve Travmatoloji Kliniği, 58400 Sarkışla, Sivas, Türkiye.
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Oguzkaya S, Misir A, Ozcamdalli M, Eken G, Kizkapan TB, Kurk MB, Uzun E. Impact of the COVID-19 pandemic on orthopedic fracture characteristics in three hospitals in Turkey: A multi-center epidemiological study. Jt Dis Relat Surg 2021. [PMID: 34145807 PMCID: PMC8343834 DOI: 10.52312/jdrs.2021.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives
The aim of this study was to evaluate the impact of novel coronavirus-2019 (COVID-19) on the epidemiological characteristics of orthopedic fractures. Patients and methods
A total of 2,960 patients (1,755 males, 1,205 females; mean age: 39.6 years; range, 1 to 98 years) with orthopedic fractures were included in the study: 552 patients during the pandemic period (March 10th and July 1st, 2020) and 1,158 control patients in the same period 2019 and 1,250 control patients in 2018. Epidemiological characteristics, injury mechanisms, fracture locations and treatment details of the patients were analyzed and compared between 2018, 2019 and 2020 for adult and pediatric populations. Results
Of a total of 552 patients, 485 were adults and 67 were pediatric patients. In the control groups, of 1,158 patients (2019), 770 were adults and 378 were pediatric patients and, of 1,250 patients (2018), 857 were adults and 393 were pediatric patients. The proportion of proximal femur and hand fractures significantly increased during the pandemic period (p=0.025 and p=0.038, respectively). The most frequent surgical indication in the pandemic period was proximal femoral fracture. The proportion of home accidents as an injury mechanism significantly increased in the pandemic period compared to 2018 and 2019 (48.5% vs. 18.6% and 20.6%, respectively; p=0.000). The proportion of female pediatric patients significantly increased during the pandemic period compared to 2018 and 2019 (44.8% vs. 25.4% and 27.2%, respectively, p=0.004). The proportion of forearm fractures (p=0.001) also increased, and the proportion of tibia-fibula fractures (p=0.03) decreased. The most frequent surgical indication in pediatric patients was distal humeral fracture in both groups. Conclusion
During the pandemic period, proximal femoral fractures in the elderly remained a concern. In-home preventative strategies may be beneficial to reduce the incidence of hip fractures in the elderly.
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Affiliation(s)
- Sinan Oguzkaya
- Sarkışla Devlet Hastanesi Ortopedi ve Travmatoloji Kliniği, 58400 Sarkışla, Sivas, Türkiye.
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Skibicki HE, Post ZD, Brustein JA, Ong AC, Orozco FR, Ponzio DY. Incidence of COVID-19 After Nonelective Hip and Knee Surgery During the Peak of the Pandemic: The New Jersey Experience. Orthopedics 2021; 44:180-186. [PMID: 34039215 DOI: 10.3928/01477447-20210416-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In an attempt to preserve essential equipment and health care system capacity and slow the spread of coronavirus disease 2019 (COVID-19) infection, Governor Murphy suspended all elective surgeries performed in New Jersey from March 27, 2020, through May 25, 2020. The objective of this study was to determine the incidence of postoperative COVID-19 infection following nonelective hip and knee surgery during the peak of the COVID-19 pandemic in New Jersey during this time. A retrospective cohort of 149 patients who underwent nonelective hip and knee surgery from March 27, 2020, through May 25, 2020, at 2 institutions was identified. The cohort was divided into hip fracture and non-fracture patients to compare the postoperative experience of these patient populations. The primary outcome was the incidence of postoperative COVID-19 infection diagnosed via severe acute respiratory syndrome coronavirus 2 nasopharyngeal real-time reverse transcription polymerase chain reaction. Secondary outcomes included length of stay, discharge disposition, postoperative complications, and mortality rate. A total of 149 patients underwent nonelective hip and knee surgeries, including 76 hip fracture cases and 73 nonelective hip and knee arthroplasty cases. A postoperative diagnosis of COVID-19 was made for 5 (6.6%) of 76 hip fracture patients, and 2 of the 5 died secondary to COVID-19. There were no infections in the arthroplasty cohort. This study describes a low incidence of COVID-19 infection after nonelective hip and knee surgery during the surge of the COVID-19 pandemic in New Jersey. Patients who underwent hip fracture surgery had an increased incidence of postoperative COVID-19 infection. [Orthopedics. 2021;44(3):180-186.].
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Faldini C, Mazzotti A, Arceri A, Broccoli E, Barbagli E, Di Martino A. Covid-19 orthopedic trauma patients characteristics and management during the first pandemic period: report from a single institution in Italy. Musculoskelet Surg 2021; 106:407-426. [PMID: 34075546 PMCID: PMC8169387 DOI: 10.1007/s12306-021-00715-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/24/2021] [Indexed: 01/01/2023]
Abstract
Purpose COVID-19 disease is a declared pandemic, affecting all aspects of healthcare, including orthopedics. The aim of this study is to describe the COVID-19 orthopedic trauma patients characteristics and management in a dedicated Orthopedic and Traumatology Hospital in Italy during the first pandemic period. Material and methods A cohort of 25 consecutive patients with suspected or confirmed COVID-19 infection were retrospectively analyzed. Health system rearrangement, patients’ clinical presentation, diagnostic tools role, laboratory finding, treatment and outcomes were evaluated. Results Health system rearrangement was fast. There was no clear prevalence of comorbidity or surgery type between confirmed and suspected COVID-19 cases. Nine positive swabs tests and 14 cases with only suspected CT scan findings were recorded. Several laboratory changes have been reported since the onset of symptoms: anemia, leukocytosis, lymphopenia, coagulation abnormalities, alkaline phosphatase, liver enzymes and C-reactive protein alterations. Nineteen patients were treated by oxygen supplement, three patients were administered antivirals, eight antibiotic therapy, and nine hydroxychloroquine. The number of discharges reported in this study was greater than 52% and the number of deaths reached 20%. Conclusion To our experience, the development of patient management algorithms allows the differentiation of the clinical pathways of negative and suspected/positive patients, reducing exposure, and virus spreading. The execution of swabs on all patients allows an early diagnosis and a more adequate management. Considering the different therapy patterns used, there were no significant differences, but anti-thromboembolic prophylaxis administered to all the orthopedic patients may have contributed to complications and mortality rates reduction.
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Affiliation(s)
- C Faldini
- 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123, Bologna, Italy
| | - A Mazzotti
- 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - A Arceri
- 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - E Broccoli
- 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.,Istituto Ortopedico Rizzoli Covid-Ward, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - E Barbagli
- Istituto Ortopedico Rizzoli Covid-Ward, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - A Di Martino
- 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123, Bologna, Italy
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González-Martín D, Álvarez-De la Cruz J, Martín-Vélez P, Boluda-Mengod J, Pais-Brito JL, Herrera-Pérez M. Quantitative and qualitative analysis of the influence of confinement by COVID-19 in fracture patients entered in a traumatology service at a third level hospital. ACTA ACUST UNITED AC 2021. [PMID: 34630777 PMCID: PMC8148574 DOI: 10.1016/j.recote.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction The COVID-19 pandemic has led to
the confinement of approximately one third of the world population,
causing a drastic change in the activities of daily life with many
repercussions at the health, economic and social levels. Objectives The objective of the present work
is to present the epidemiological variations in the production of
fractures in the period of mandatory confinement in our reference
population. Methods Analytical retrospective
comparative study of two groups of patients: Group A: patients admitted
before the state of alarm that forced confinement in the period from
January 13 to March 13 compared to Group B: patients admitted in the two
months of confinement, until the de-escalation period began, March 13-May
13. Epidemiological variables including age, personal history, type of
fracture, mechanism of injury, outpatient rate, and hospital stay were
recorded. Results A total of 190 patients were
included. 112 in the pre-confinement period and 78 in the confinement
(30% decrease). The mean age (p = 0.007) and falls at home (p < 0.001)
were higher in the confinement group. The postoperative (p = 0.006) and
overall (p < 0.001) hospital stay were significantly less in the
confinement group. No differences were found in the anatomical location
of the lesion, sex, comorbidities, mechanism of injury, outpatient rate,
or death. Conclusions Based on the results of our study,
the period of forced confinement due to the COVID-19 pandemic has
produced a drastic decrease in the total number of fractures admitted to
the traumatology service of a third level hospital. On the other hand,
osteoporotic hip fractures have not varied in their incidence and a
decrease in the average postoperative and overall stay has been
observed.
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Affiliation(s)
- D González-Martín
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, Tenerife, Spain
| | - J Álvarez-De la Cruz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, Tenerife, Spain
| | - P Martín-Vélez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, Tenerife, Spain
| | - J Boluda-Mengod
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, Tenerife, Spain
| | - J L Pais-Brito
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, Tenerife, Spain.,Facultad de Medicina, Universidad de La Laguna, Tenerife, Spain
| | - M Herrera-Pérez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, Tenerife, Spain.,Facultad de Medicina, Universidad de La Laguna, Tenerife, Spain
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Tripathy SK, Varghese P, Panigrahi S, Panda BB, Srinivasan A, Sen RK. Perioperative mortality and morbidity of hip fractures among COVID-19 infected and non-infected patients: A systematic review and meta-analysis. Chin J Traumatol 2021:S1008-1275(21)00088-2. [PMID: 34154865 PMCID: PMC8135192 DOI: 10.1016/j.cjtee.2021.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/31/2021] [Accepted: 04/30/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Hip fractures among elderly patients are surgical emergencies. During COVID-19 pandemic time, many such patients could not be operated at early time because of the limitation of the medical resources, the risk of infection and redirection of medical attention to a severe infective health problem. METHODS A search of electronic databases (PubMed, Medline, CINAHL, EMBASE and the Cochrane Central Register of Controlled Trials) with the keywords "COVID", "COVID-19″, "SARS-COV-2", "Corona", "pandemic", "hip fracture", "trochanteric fracture" and "neck femur fracture" revealed 64 studies evaluating treatment of hip fracture in elderly patients during COVID-19 pandemic time. The 30-day mortality rate, inpatient mortality rate, critical care/special care need, readmission rate and complications rate in both groups were evaluated. Data were analyzed using Review Manager (RevMan) V.5.3. RESULTS After screening, 7 studies were identified that described the mortality and morbidity in hip fractures in both COVID-19 infected (COVID-19 +) and non-infected (COVID-19 -) patients. There were significantly increased risks of 30-day mortality (32.23% COVID-19 + death vs. 8.85% COVID-19 - death) and inpatient mortality (29.33% vs. 2.62%) among COVID-19 + patients with odds ratio (OR) of 4.84 (95% CI: 3.13-7.47, p < 0.00001) and 15.12 (95% CI: 6.12-37.37, p < 0.00001), respectively. The COVID-19 + patients needed more critical care admission (OR = 5.08, 95% CI: 1.49-17.30, p < 0.009) and they remain admitted for a longer time in hospital (MD = 3.6, 95% CI: 1.74-5.45, p = 0.0001); but there was no difference in readmission rate between these 2 groups. The risks of overall complications (OR = 17.22), development of pneumonia (OR = 22.25), and acute respiratory distress syndrome/acute respiratory failure (OR = 32.96) were significantly high among COVID-19 + patients compared to COVID-19 - patients. CONCLUSIONS There are increased risks of the 30-day mortality, inpatient mortality and critical care admission among hip fracture patients who are COVID-19 +. The chances of developing pneumonia and acute respiratory failure are more in COVID-19 + patients than in COVID-19 ‒ patients.
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Affiliation(s)
- Sujit Kumar Tripathy
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, 751019, India.
| | - Paulson Varghese
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
| | - Sibasish Panigrahi
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
| | - Bijnya Birajita Panda
- Department of Ophthalmology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, 753007, India
| | - Anand Srinivasan
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
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Kalem M, Kocaoğlu H, Merter A, Karaca MO, Özbek EA, Kınık HH. Effects of COVID-19 pandemic curfew on orthopedic trauma in a tertiary care hospital in Turkey. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2021; 55:191-195. [PMID: 34100357 PMCID: PMC10566346 DOI: 10.5152/j.aott.2021.20263] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/26/2020] [Accepted: 10/06/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study aimed to investigate whether various curfew practices affect trauma prevalence, epidemiological differences among the population admitted to hospital because of trauma, and treatment practices used after trauma. METHODS Patients who suffered from fractures or soft-tissue trauma between March 21, 2020, and June 1, 2020, (group pandemic) and during the same period in 2019 (control group) were included in our single-center retrospective study. Each group was also divided into 3 subgroups according to the age of patients (≤ 20 years, 21-64 years, and ≥ 65 years). Data including anatomical region subjected to trauma, place of admission, mechanism of trauma, location of trauma, mode of treatment, type of surgery (if performed), duration of hospitalization (if hospitalized), time elapsed until surgery, and duration of postoperative hospitalization were collected and compared between groups. RESULTS A total of 361 patients were admitted to the hospital with new trauma during the pandemic, and 708 patients had been admitted during the same period in 2019. The number of admissions decreased significantly by 50.9% (P < 0.001). The mechanism of trauma that occurred with low energy was significantly increased in the pandemic group (73.9%) compared with the control group (47.6%) (P < 0.001). Similarly, the distribution of trauma throughout the skeletal system, especially in the upper extremity, was significantly increased in the pandemic group (49.9% vs. 30.5%, P < 0.001). However, there was no significant decrease in individuals aged above 65 years (P = 0.115). Similar to the general outlook, the 3 groups differed in terms of the mechanism of trauma, location of trauma, and distribution of the anatomical region subjected to trauma (P < 0.001). Majority of the patients received inpatient treatment in all 3 groups (P < 0.001). CONCLUSION The results of this study showed that the pandemic dramatically reduced the number of hospital admissions related to orthopedic trauma. The rate of low energy, upper extremity traumas that occurred indoors increased during the pandemic period compared with that of the previous year. However, the rate of hospital admissions did not differ in the ≥65-year-old subgroup during the pandemic period compared with that of the previous year.
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Affiliation(s)
- Mahmut Kalem
- Department of Orthopedics and Traumatology, İbn'i Sina Training and Research Hospital, Ankara University, School of Medicine, Ankara, Turkey
| | - Hakan Kocaoğlu
- Department of Orthopedics and Traumatology, İbn'i Sina Training and Research Hospital, Ankara University, School of Medicine, Ankara, Turkey
| | - Abdullah Merter
- Department of Orthopedics and Traumatology, İbn'i Sina Training and Research Hospital, Ankara University, School of Medicine, Ankara, Turkey
| | - Mustafa Onur Karaca
- Department of Orthopedics and Traumatology, İbn'i Sina Training and Research Hospital, Ankara University, School of Medicine, Ankara, Turkey
| | - Emre Anıl Özbek
- Department of Orthopedics and Traumatology, İbn'i Sina Training and Research Hospital, Ankara University, School of Medicine, Ankara, Turkey
| | - Hüseyin Hakan Kınık
- Department of Orthopedics and Traumatology, İbn'i Sina Training and Research Hospital, Ankara University, School of Medicine, Ankara, Turkey
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Akalın Y, Ulusaloglu AC, Avci O, Cevik N, Guler BO, Ozturk A. A COMPARISON OF ORTHOPAEDIC TRAUMA CASES OPERATED ON DURING THE COVID-19 PANDEMIC WITH DIFFERENT PERIODS: A SINGLE CENTRE STUDY. SANAMED 2021. [DOI: 10.24125/sanamed.v16i1.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Salottolo K, Caiafa R, Mueller J, Tanner A, Carrick MM, Lieser M, Berg G, Bar-Or D. Multicenter study of US trauma centers examining the effect of the COVID-19 pandemic on injury causes, diagnoses and procedures. Trauma Surg Acute Care Open 2021; 6:e000655. [PMID: 33884307 PMCID: PMC8023757 DOI: 10.1136/tsaco-2020-000655] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/12/2021] [Accepted: 03/12/2021] [Indexed: 01/01/2023] Open
Abstract
Background The COVID-19 pandemic resulted in nationwide social distancing and shelter-in-place orders meant to curb transmission of the SARS-CoV-2 virus. The effect of the pandemic on injury patterns has not been well described in the USA. The study objective is to determine the effect of the COVID-19 pandemic on the distribution and determinants of traumatic injuries. Methods This retrospective multi-institutional cohort study included all hospital admissions for acute traumatic injury at six community level I trauma centers. Descriptive statistics were used to compare injury causes, diagnoses and procedures over two similar time periods: prepandemic (March 11–June 30, 2019) and pandemic (March 11–June 30, 2020). Results There were 7308 trauma patients included: 3862 (53%) prepandemic and 3446 (47%) during the pandemic. Cause of injury significantly differed by period (p<0.001). During the pandemic, there were decreases in motor vehicle crashes (from 17.0% to 14.0%, p<0.001), worksite injuries (from 5.2% to 4.1%, p=0.02), pedestrian injuries (from 3.0% to 2.2%, p=0.02) and recreational injuries (from 3.0% to 1.7%, p<0.001), while there were significant increases in assaults (6.9% to 8.5%, p=0.01), bicycle crashes (2.8% to 4.2%, p=0.001) and off-road vehicle injuries (1.8% to 3.0%, p<0.001). There was no change by study period in falls, motorcycle injuries, crush/strikes, firearm and self-inflicted injuries, and injuries associated with home-improvement projects. Injury diagnoses differed between time periods; during the pandemic, there were more injury diagnoses to the head (23.0% to 27.3%, p<0.001) and the knee/leg (11.7% to 14.9%, p<0.001). There were also increases in medical/surgical procedures (57.5% to 61.9%, p<0.001), administration of therapeutics/blood products (31.4% to 34.2%, p=0.01) and monitoring (11.0% to 12.9%, p=0.01). Discussion Causes of traumatic injury, diagnoses, and procedures were significantly changed by the pandemic. Trauma centers must adjust to meet the changing demands associated with altered injury patterns, as they were associated with increased use of hospital resources. Level of evidence III (epidemiological).
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Affiliation(s)
- Kristin Salottolo
- Department of Trauma Research, Swedish Medical Center, Englewood, Colorado, USA
| | - Rachel Caiafa
- Trauma Services Department, St Anthony Hospital & Medical Campus, Lakewood, Colorado, USA
| | - Jalina Mueller
- Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA
| | - Allen Tanner
- Trauma Services Department, Penrose Hospital, Colorado Springs, Colorado, USA
| | | | - Mark Lieser
- Department of Trauma Services, Research Medical Center, Kansas City, Missouri, USA
| | - Gina Berg
- Trauma Services Department, Wesley Medical Center, Wichita, Kansas, USA
| | - David Bar-Or
- Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA
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Gaertner B, Fuchs J, Möhler R, Meyer G, Scheidt-Nave C. Older people at the beginning of the COVID-19 pandemic: A scoping review. JOURNAL OF HEALTH MONITORING 2021; 6:2-37. [PMID: 35586562 PMCID: PMC8832372 DOI: 10.25646/7857] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/12/2021] [Indexed: 12/23/2022]
Abstract
This scoping review focuses on evidence gaps regarding the effects on health, social participation and life contexts of older people at the beginning of the COVID-19 pandemic. It is based on a systematic search strategy of the international literature covering a period between December 2019 and June 2020. The review is supplemented by a search of the websites of selected organisations in Germany (cut-off date: 29 June 2020). Search hits were differentiated by types of publication (empirical study, review, discussion paper). The contents were summarised in tabular form according to topic. The publications mainly discussed the high risks of suffering severe courses of COVID-19 faced by older people, specifically those belonging to certain subgroups. In addition, further main topics were the pandemic’s indirect impacts on physical and mental health, physical and cognitive functions and participation in society. Social isolation, loneliness, reduced levels of physical activity and difficulties in maintaining care were discussed as major health risks. Ageism was an issue that was addressed across all of the identified topics. The publications highlighted the need, but also the opportunity, for raising public awareness of the needs of older people in various life contexts. Publications pointed to the urgent need for research into the biological and social causes of older peoples’ high infection risk and how measures could be adapted in a differentiated manner (infection prevention and control measures, social support, medical and nursing care).
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Affiliation(s)
- Beate Gaertner
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Judith Fuchs
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Ralph Möhler
- Heinrich Heine University Düsseldorf, Institute for Health Services Research and Health Economics.,Bielefeld University, School of Public Health, Department of Health Services Research and Nursing Science
| | - Gabriele Meyer
- Martin Luther University Halle-Wittenberg, Institute for Health and Nursing Science
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Smart homes for the older population: particularly important during the COVID-19 outbreak. Reumatologia 2021; 59:41-46. [PMID: 33707795 PMCID: PMC7944953 DOI: 10.5114/reum.2021.103939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/10/2021] [Indexed: 11/17/2022] Open
Abstract
Osteoporosis, one of the leading causes of disability in older adults, significantly reduces the quality of life and leads to loss of independence. Dynamic development of “smart” solutions based on artificial intelligence more and more commonly applied in older people’s houses may be an answer to the above issues. The aim of this study is to present selected “smart home” solutions for the diagnosis and prevention of falls in the older population through a literature review. The conducted meta-analysis based on a review of the scientific literature available in English and Polish in the Medline/PubMed, Embase, Scopus, and GBL databases was undertaken from 01.01.2015 to 01.10.2020 with the string search method using key words. According to the authors of this study, the development of new technology based on artificial intelligence allows older people to live independently, which contributes to a higher level of life satisfaction and quality.
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Predicting 30-Day and 180-Day Mortality in Elderly Proximal Hip Fracture Patients: Evaluation of 4 Risk Prediction Scores at a Level I Trauma Center. Diagnostics (Basel) 2021; 11:diagnostics11030497. [PMID: 33799724 PMCID: PMC8002141 DOI: 10.3390/diagnostics11030497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/01/2021] [Accepted: 03/07/2021] [Indexed: 12/21/2022] Open
Abstract
This study evaluated the use of risk prediction models in estimating short- and mid-term mortality following proximal hip fracture in an elderly Austrian population. Data from 1101 patients who sustained a proximal hip fracture were retrospectively analyzed and applied to four models of interest: Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM), Charlson Comorbidity Index, Portsmouth-POSSUM and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP®) Risk Score. The performance of these models according to the risk prediction of short- and mid-term mortality was assessed with a receiver operating characteristic curve (ROC). The median age of participants was 83 years, and 69% were women. Six point one percent of patients were deceased by 30 days and 15.2% by 180 days postoperatively. There was no significant difference between the models; the ACS-NSQIP had the largest area under the receiver operating characteristic curve for within 30-day and 180-day mortality. Age, male gender, and hemoglobin (Hb) levels at admission <12.0 g/dL were identified as significant risk factors associated with a shorter time to death at 30 and 180 days postoperative (p < 0.001). Among the four scores, the ACS-NSQIP score could be best-suited clinically and showed the highest discriminative performance, although it was not specifically designed for the hip fracture population.
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Gawronska K, Lorkowski J. Falls as One of the Atypical Presentations of COVID-19 in Older Population. Geriatr Orthop Surg Rehabil 2021; 12:2151459321996619. [PMID: 33680533 PMCID: PMC7900839 DOI: 10.1177/2151459321996619] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 01/21/2021] [Accepted: 01/29/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: Studies revealed COVID-19 atypical symptoms such as falls, delirium,
confusion, dizziness, unusual fatigue in older patients. Falls in the older
population and their consequences are one of the leading causes of
disability; they significantly reduce the quality of life and lead to loss
of independence and impaired social functioning. The aim of this study is to
present the possible correlation between COVID-19 and diseases of the
musculoskeletal system, in particular the occurrence of fall-related
injuries. Significance: This article highlights the importance of falls as one of the atypical
symptoms of COVID-19 infection in older adults, which is not directly
associated with infection and could be misinterpreted. Methods: The conducted meta-analysis is based on a review of the scientific literature
available in English, French, Dutch, Polish in the PubMed/MEDLINE, Cochrane
Library, Embase, Scopus, PEDro, GBL databases from December 1, 2019 to July
30, 2020, covering Clinical Trial, Randomized Controlled Trial,
Meta-Analysis, Systematic Reviews and Case Reports. The following keywords
were taken into account: fall, (hip/pertrochanteric/proximal femur)
fracture, aged and COVID-19. Twenty-seven references were accepted for final
analysis. Results: It was found that symptoms such as falls observed in the older adults can be
associated with COVID-19 infection. Falls and slips are also the most common
mechanism for hip fracture during the pandemic outbreak. Conclusions: According to authors of this study, atypical presentations of COVID-19 should
be considered when screening and testing the people at increased risk due to
their age. However, further prospective studies are urgently needed to
investigate the possible correlation between COVID-19 and falls in older
adults.
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Affiliation(s)
- Karolina Gawronska
- Rehabilitation Centre of the MSWiA Central Clinical Hospital in Warsaw, Warsaw, Poland
| | - Jacek Lorkowski
- Clinical Department of Orthopedics, Traumatology and Sports Medicine of the MSWiA Central Clinical Hospital in Warsaw, Warsaw, Poland.,Medical University of Mazovia, Warsaw, Poland
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Schoeneberg C, Eschbach DA, Friess T, Lendemans S, Hoefer C, Ruchholtz S. Effect of the COVID-19 Pandemic in German Trauma Centres and Geriatric Trauma Centres DGU. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 159:209-215. [PMID: 33524995 PMCID: PMC8043671 DOI: 10.1055/a-1333-4099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The COVID 19 pandemic is a major challenge to all social systems, particularly the healthcare system. Within an international study, German Trauma Centres DGU and Geriatric Trauma Centres DGU have been questioned about their situation. METHOD The questionnaire was translated from English into German and sent to all contacts. The evaluation was performed descriptively. RESULTS 71 of 692 centres participated in this study. Government instructions to avoid elective treatments have been adhered to by 68% of the hospitals, and the remaining performed only urgent elective treatments. There was also a decline in the number of traumatological patients. In more than 90% of the hospitals, only 0 - 4% of all patients treated for proximal femur fracture were tested positive for COVID-19. It appears that 84% of these hospitals have or will have financial deficits. Almost all hospitals were organised and ready to fight the pandemic with their personal and/or infrastructural resources they possess. CONCLUSION Our questionnaire shows that the pandemic had an enormous effect on Trauma Centres DGU and Geriatric Trauma Centres DGU. The hospitals expect financial losses. Almost all the hospitals have provided personal and infrastructural resources to be used in the fight against the pandemic with a better outcome in Germany in comparison with international standards.
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Affiliation(s)
- Carsten Schoeneberg
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital Steele, Essen, Germany
| | - Daphne-Asimenia Eschbach
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Thomas Friess
- Project Coordination Geriatric Trauma Centre, DGU Bochum, Germany
| | - Sven Lendemans
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital Steele, Essen, Germany
| | | | - Steffen Ruchholtz
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
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Ojeda-Thies C, Cuarental-García J, Ramos-Pascua LR. Decreased volume of hip fractures observed during COVID-19 lockdown. Eur Geriatr Med 2021; 12:759-766. [PMID: 33481186 PMCID: PMC7820835 DOI: 10.1007/s41999-020-00447-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/28/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The aim was to study the incidence and characteristics of fragility hip fractures admitted during COVID-19 lockdown. MATERIALS AND METHODS We analysed socio-demographic and baseline characteristics of patients suffering fragility hip fractures between March 1st and May 1st 2020, period most affected by COVID-19 confinement measures. Cases (n = 64) were compared with controls (n = 172) from corresponding periods in 2018 and 2019. Poisson Generalised Linear Model regression analysis was performed to compare daily case counts, and LOESS curves compared time series. RESULTS No differences were found regarding age or gender distributions, pre-fracture living, ambulatory, functional or cognitive status. More patients in 2020 had a high-risk ASA score. Fewer cases [Reduction = 26% (95% CI 1-44%)] were admitted in 2020. The reduction seemed to correspond with confinement. CONCLUSIONS Approximately, one quarter less fragility hip fractures were admitted to our hospital during lockdown. Patients' baseline status and socio-demographic characteristics were similar.
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Affiliation(s)
- Cristina Ojeda-Thies
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Avda Córdoba s/n, 28041, Madrid, Spain.
| | - Javier Cuarental-García
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Avda Córdoba s/n, 28041, Madrid, Spain
| | - Luis Rafael Ramos-Pascua
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Avda Córdoba s/n, 28041, Madrid, Spain.,Department of Surgery, School of Medicine, Complutense University of Madrid, Madrid, Spain
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50
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Tripathy SK, Varghese P, Panigrahi S, Panda BB, Velagada S, Sahoo SS, Naik MA, Rao SK. Thirty-day mortality of patients with hip fracture during COVID-19 pandemic and pre-pandemic periods: A systematic review and meta-analysis. World J Orthop 2021; 12:35-50. [PMID: 33520680 PMCID: PMC7814308 DOI: 10.5312/wjo.v12.i1.35] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/05/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Timely intervention in hip fracture is essential to decrease the risks of perioperative morbidity and mortality. However, limitations of the resources, risk of disease transmission and redirection of medical attention to a more severe infective health problem during coronavirus disease 2019 (COVID-19) pandemic period have affected the quality of care even in a surgical emergency.
AIM To compare the 30-d mortality rate and complications of hip fracture patients treated during COVID-19 pandemic and pre-pandemic times.
METHODS The search of electronic databases on 1st August 2020 revealed 45 studies related to mortality of hip fracture during the COVID-19 pandemic and pre-pandemic times. After careful screening, eight studies were eligible for quantitative and qualitative analysis of data.
RESULTS The pooled data of eight studies (n = 1586) revealed no significant difference in 30-d mortality rate between the hip fracture patients treated during the pandemic and pre-pandemic periods [9.63% vs 6.33%; odds ratio (OR), 0.62; 95%CI, 0.33, 1.17; P = 0.14]. Even the 30-d mortality rate was not different between COVID-19 non-infected patients who were treated during the pandemic time, and all hip fracture patients treated during the pre-pandemic period (OR, 1.03; 95%CI, 0.61, 1.75; P = 0.91). A significant difference in mortality rate was observed between COVID-19 positive and COVID-19 negative patients (OR, 6.99; 95%CI, 3.45, 14.16; P < 0.00001). There was no difference in the duration of hospital stay (OR, -1.52, 95%CI, -3.85, 0.81; P = 0.20), overall complications (OR, 1.62; P = 0.15) and incidence of pulmonary complications (OR, 1.46; P = 0.38) in these two-time frames. Nevertheless, the preoperative morbidity was more severe, and there was less use of general anesthesia during the pandemic time.
CONCLUSION There was no difference in 30-d mortality rate between hip fracture patients treated during the pandemic and pre-pandemic periods. However, the mortality risk was higher in COVID-19 positive patients compared to COVID-19 negative patients. There was no difference in time to surgery, complications and hospitalization time between these two time periods.
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Affiliation(s)
- Sujit Kumar Tripathy
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Paulson Varghese
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar 751019, India
| | - Sibasish Panigrahi
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar 751019, India
| | | | - Sandeep Velagada
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar 751019, India
| | | | - Monappa A Naik
- Department of Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka 576104, India
| | - Sharath K Rao
- Department of Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, Manipal 576104, India
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