Delayed Fixation of Hip Fractures and Shortterm Outcome in Coronavirus Positive Patients: A Prospective Cohort Study

Abstract

Introduction: Coronavirus Disease-19 (COVID-19) affected the healthcare system worldwide. The golden rules of fracture fixation and early mobilisation of patients was not strictly followed, because of fear of spread of the disease among the patients and healthcare workers. Early surgery and prompt postoperative ambulation improves outcomes for patients with hip fractures, but the morbidity and mortality were high in the patients who were operated upon, when having an active infection of COVID-19 virus. Aim: To study the short-term outcome of delayed fixation of hip fractures in coronavirus positive patient in terms of postoperative infection, union at the fracture, deep vein thrombosis and mortality. Materials and Methods: This was a prospective cohort study carried out in Government Medical College, Srinagar, Kashmir, India from April 2020 to September 2020. Delayed surgery using different methods of fixation was performed in patients with hip fractures who had active COVID-19 infection. The patients were followed for a period of six months. Short-term mortality and complications if any were recorded. Results were expressed in terms of frequency and percentages and analysed by Microsoft Excel 2016. Results: Among the 24 operated patients, males were 9 (37.5%) and females were 15 (62.5%). Of the total, 14 (58.33%) were intertrochanteric fractures, 6 (25%) were femoral neck fractures and 4 (16.67%) were subtrochanteric fractures. Dynamic hip screw was used to treat 15 (62.5%) patients. Age ranged from 39 to 82 years mean age was 51.04 years. Majority of patients, 16 (66.67%) sustained hip fractures after a low velocity fall from standing height. Delay in surgery was 15 to 21 days (Average-18.25 days). Two elderly patients died after 14 weeks of follow-up due to causes else than respiratory failure. Three patients developed superficial infection which settled with oral antibiotics. No case of deep venous thrombosis, pulmonary thrombo embolism was observed in the present study. Conclusion: Despite the delay, the mortality rate in the early postoperative period was less. The present study findings suggest that hip fracture patients who present with COVID-19 infection can safely undergo delayed surgical intervention after appropriate medical optimisation.

Keywords

• coronavirus disease-19
• dynamic hip screw
• mortality
• pandemic