Proximal femur fractures in COVID-19 emergency: the experience of two Orthopedics and Traumatology Departments in the first eight weeks of the Italian epidemic

Proximal femur fractures in COVID-19 emergency: the experience of two Orthopedics and Traumatology Departments in the first eight weeks of the Italian epidemic

Authors

  • Pietro Maniscalco Orthopedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
  • Erika Poggiali Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
  • Fabrizio Quattrini Orthopedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
  • Corrado Ciatti Orthopedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
  • Andrea Magnacavallo Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
  • Andrea Vercelli Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
  • Marco Domenichini Orthopedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
  • Enrico Vaienti Orthopedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
  • Francesco Pogliacomi Orthopedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
  • Francesco Ceccarelli Orthopedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy

Keywords:

Coronavirus, Elderly patient, Proximal femur fracture, CoVID-19, Italian outbreak

Abstract

Introduction: CoVID-19 (Coronavirus disease) is a worldwide infection which is causing millions of deaths. A significant number of elderly patients require hospitalization and develop serious and sometimes life-threatening complications. The aim of this study is to evaluate the preliminary impact (8 weeks) of CoVID-19, focusing on proximal femur fractures, analyzing data and results compared to the same period of 2019. Materials and methods: From February 22nd to April 18th, 2020 we surgically treated 121 proximal femur fractures (61 in Piacenza; 60 in Parma, 16 male, 44 female, mean age 81.1). In the same period of 2019, we treated 169 proximal femur fractures (90 in Piacenza, 33 male, 57 female, mean age 81.9; 79 in Parma, 29 males, 50 female, mean age 80.2). We had 21/61 (34.4%) patients resulted positive for COVID-19 and 11/61 in Parma (18.3%), based on nasal-pharyngeal swab, chest CT scan and/or lung US findings. Results: The incidence of proximal femur fractures had a significant reduction during CoVID-19 spread in Piacenza and Parma. Authors have noticed an elevated number of deaths within 21 days after surgery. Piacenza: 4 cases in 2019 (4.4%) and 11 in 2020 (18.0%), of which 9 cases CoVID positive. In Parma in 2019 two deaths were encountered; in 2020 6 patients died and 5 cases were CoVID positive. Conclusion: In the first two months of the Italian epidemic, in the cities of Piacenza and Parma over 80% of deaths have occurred in patients over 70 years old. Even if preliminary, our study shows a significant increase in death in elderly patients surgically treated for proximal femur fractures, particularly in the Piacenza Hospital.

References

Lu H et al, Oubreak of pneumonia of unkwown etiology in Wuhan China: the mistery and the miracle. J Med Virol 2020. Jan 16

Carlos et al. Novel Wuhan (2019 nCoV) coronavirus. Am J Resp Crit Care Med 2020; 201: P7-8.

Chih-Cheng Lai et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J of Antimic Agents, 20, 2020; 7:4

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

Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020 Feb 28. doi: 10.1056/NEJMoa2002032 [Epub ahead of print]

Jin X, Lian J, Hu J, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut 2020 Mar 24. pii: gutjnl-2020-320926. doi: 10.1136/gutjnl-2020-320926 [Epub ahead of print].

Poggiali E, Ramos PM, Bastoni D, Vercelli A, Magnacavallo A. Abdominal pain: a real challenge in novel COVID-19 infection. EJCRIM 2020;7: doi:10.12890/2020_001632

American Academy of Otolaryngology-Head and Neck Surgery. Coronavirus disease 2019: resources. Available from https://www.entnet.org/content/coronavirus-disease2019-resources (accessed 23 March 2020).

Giacomelli A, Pezzati L, Conti F, et al. Self-reported olfactory and taste disorders in SARS-CoV-2 patients: a cross-sectional study. Clin Infect Dis 2020 Mar 26. doi: 10.1093/cid/ciaa330 [Epub ahead of print].

World Health Organization. Novel coronavirus (2019-nCov): situation report, 2. 22 January 2020. Available from https://apps.who.int/iris/handle/10665/330761 (accessed 2 April 2020)

Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19. N Engl J Med 2020 Mar 18. doi: 10.1056/ NEJMoa2001282

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

Luigi Palmieri, Xanthi Andrianou, Pierfrancesco Barbariol, et al. Caratteristiche dei pazienti deceduti positivi all’infezione da SARS-CoV-2 in Italia. EpiCentro - Istituto Superiore di Sanità. 2020 April 23.

M.E. Muller, S. Nazarian, P. Koch, J. Schatzker The comprehensive classification of fractures of long bones Springer, Berlin. 1990

Garden RS. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br. 1961;43:647–663.

Pauwels F. Der Schenkelhalsbruch, ein mechanisches problem. Stuttgart: F. Enke; 1935.

Jensen JS: Classification of trochanteric fractures. Acta Orthop Scand 1980;51:803–810

Danila Oldani, Pietro Maniscalco. Preliminary experience with EBA ONE intramedullary nail for the tratment of pertrochanteric fractures. Acta Biomedica. 2019; Vol 90, Supplement 12:86-90

Danila Oldani, Pietro Maniscalco. Preliminary experience with MEDGAL DHS for treatment of proximal femoral fractures. Acta Biomedica. 2019; Vol 90, Supplement 12:82-85

Caforio M, Maniscalco P, Colombo M, Calori GM. Long endomedullary nail in proximal third humeral shaft fractures. Injury. 2016 Oct;47 Suppl 4:S64-S70. doi: 10.1016/j.injury.2016.07.037. Epub 2016 Aug 6. PubMed PMID: 27507546.

Ruffilli A, Traina F, Pilla F, et al. Marchetti Vincenzi elastic retrograde nail in the treatment of humeral shaft fractures: review of the current literature. Musckoloskelet Surg. 2015 Dec;99(3):201-9.

Rivera F, Leonardi F, Maniscalco P, Caforio M, Capelli R, Molinari G, Esopi P. Uncemented fully hydroxyapatite-coated hip stem for intracapsular femoral neck fractures in osteoporotic elderly patients: a multicenter study. Arthroplast Today. 2015 Aug 28;1(3):81-84. doi: 10.1016/j.artd.2015.02.002. eCollection 2015 Sep. PubMed PMID: 28326377; PubMed Central PMCID: PMC4956684.

Rebuzzi E, Pannone A, Schiavetti S, et al. IMHS clinical experience in the treatment of peritrochanteric fractures. The results of a multicentric Italian study of 981 cases. Injury. 2002 Jun;33(5):407-12.

Maniscalco P, Benazzo F, Ruggieri P, Di Maggio B. CIO: 360° in trauma care. Injury. 2019 Aug;50 Suppl 4:S1.

UrbiStat AdminStat Italia. https://ugeo.urbistat.com

Dipartimento della Protezione Civile. COVID-19 Italia - Monitoraggio della situazione. opendatadpc.maps.arcgis.com/apps/opsdashboard/index.html#/b0c68bce2cce478eaac82fe38d4138b1

Downloads

Published

11-05-2020

Issue

Section

ORIGINAL INVESTIGATIONS/COMMENTARIES - SPECIAL COVID19

How to Cite

1.
Maniscalco P, Poggiali E, Quattrini F, Ciatti C, Magnacavallo A, Vercelli A, et al. Proximal femur fractures in COVID-19 emergency: the experience of two Orthopedics and Traumatology Departments in the first eight weeks of the Italian epidemic. Acta Biomed [Internet]. 2020 May 11 [cited 2024 Oct. 10];91(2):89-96. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/9636