Impact of Sars-Cov-2 pandemic on hip fractures: Clinical and radiographic outcomes.

Abstract

<b>Introduction:</b> Hip fractures affecting older people are at a higher risk of complications during the SARS-CoV-2 pandemic. The aim of this study is to provide data about proximal femoral fractures management and early outcomes during COVID-19 pandemic compared to the same period in 2019. <b>Material and Methods:</b> Retrospective and comparative study performed in two different periods were analyzed: from March 15, 2020, to April 30, 2020 (the first six weeks of Spain´s current confinement) and the same period in 2019. Data regarding demographics (age and sex, housing), type of fracture, surgical performance, early outcomes (at 30 days), and at 1-year follow-up were collected. A total of 146 patients were evaluated, 89 in 2019 and 57 in 2020. <b>Results:</b> Despite the drop ∼35.6% in hip fractures during SARS-CoV-2 period, distribution (age (<i>P</i> = 0.985), sex (<i>P</i> = 0.43), housing (<i>P</i> = 0.61), type of fracture (<i>P</i> = 0.41)) and Charlson comorbidity index (<i>P</i> = 0.12) were similar to a 2019 period. Surgical performance did not worsen in spite of the tough situation and the use of personal protective equipment, improving in some radiological variables (tip-to-apex and calcar reduction). In terms of postoperative outcomes, although there is a tendency to a short-term mortality increase (from 3.4% to 5.2%, <i>P</i> = 0.22), there were no differences at 1-year follow-up (20.2% in 2019 and 20.4% in 2020, <i>P</i>=0.587). In the same line, although in both groups the patients lost functionality at 1 year, there were no significant differences (<i>P</i> = 0.42). <b>Conclusion:</b> Even in challenging times, protocols and adequate organization ensure proper outcomes, reaching satisfying clinical and surgical outcomes during the COVID-19 pandemic, despite an increasing trend in short term mortality not seen at 1-year follow-up.