Should we operate on all patients with COVID-19 and proximal femoral fractures? An analysis of thirty, sixty, and ninety day mortality rates based on patients’ clinical presentation and comorbidity: a multicentric study in Northern Italy

Introduction: Proximal femoral fractures with severe outcome are most common in the increasing group of elderly patients. Aim: Based on the regular data gathered by the EuroHOPE research, the most important aspects and results of the treatment of proximal femoral fractures were studied. Method: Data of hospital admissions due to proximal femoral fractures were analyzed. Results: There was a slight increase in the number of hospitalized patients between 2004 and 2009 in Hungary. 88% of the patients received operative treatment, 41% suffered femoral neck fractures. Mortality rates did not change significantly in the analyzed period. Standardized annual mortality rates for patients who had suffered a femoral neck fracture were 28% when prosthesis was implanted; this result was somewhat more favorable than in case of other surgical procedures. Annual mortality rates were higher in the peritrochanteric fracture group where intramedullary nailing was performed (36%). The ratio of operated patients did not differ significantly from international results. Mortality rates in Hungary were significantly less favorable. 30 day standardized mortality rate was 13.6% in 2008, twice as high as the rate in Finland, The Netherlands, Norway, Scotland and Sweden. The 40% mortality rate calculated for 365 days was significantly higher than international results. Conclusion: To define the measures needed to improve results, systematic analysis of both in-hospital treatment protocols, and follow-up treatment is necessary. Orv. Hetil., 2016, 157(41), 1642–1648.

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Dedicated Hip Fracture Lists: Improving the Service Received by Orthopaedic Trauma Patients

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363513x13500508919934 ◽

2013 ◽

Vol 95 (3) ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

SZ Basheer ◽

DI Wood ◽

K Shepherd ◽

JC McGregor-Riley

Keyword(s):

Hip Fracture ◽

Elderly Patients ◽

Hip Fractures ◽

Femoral Fractures ◽

Mortality Rates ◽

Trauma Patients ◽

Orthopaedic Trauma ◽

Proximal Femoral Fractures ◽

One Year ◽

The Uk

Proximal femoral fractures are the most common injury resulting in acute admission to an orthopaedic trauma ward. Up to 75,000 hip fractures occur per year in the UK and this is projected to rise to around 100,000 per year by 2020. These fractures occur most frequently in frail, elderly patients who have significant co-morbidities and they are consequently associated with high mortality rates of 5–10% at one month and up to 30% at one year following injury.

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Necrosis avascular

Studies in the Economic History of Southern Africa ◽

10.22201/fm.24484865e.2020.63.2.03 ◽

2020 ◽

Vol 63 (2) ◽

pp. 18-23

Author(s):

Alejandro Jardón Gómez ◽

Ana Cristina King ◽

Carlos Pacheco Díaz

Keyword(s):

Femoral Head ◽

Avascular Necrosis ◽

Femoral Fracture ◽

Open Fracture ◽

Clinical Presentation ◽

Femoral Fractures ◽

Proximal Femoral Fracture ◽

Young Population ◽

Steroid Use

The clinical presentation of a proximal femoral fracture is completely different between young and adult patients. Unlike closed proximal femoral fractures, the incidence of exposed fractures is found in the young population between 15 and 30 years of age. Osteonecrosis of the femoral head is one the complications we can find in this type of fractures. Avascular necrosis (AVN or osteonecrosis) is defined as the interruption of blood supply to the femoral head due to trauma, infectionalcohol or steroid use, resulting in bone necrosis, joint collapse and osteoarthrosis. The treatment will depend on the clinical presentation, age of the patient and when the diagnosis is made. This is a case report of a 16-year-old patient with a gunshot wound on the hip. Surgical cleansing and closed reduction plus internal fixation with a nail in the center of the spine were performed. A 3-year clinical and radiographic follow up was made, observing the evolution of the fracture and the subsequent avascular necrosis that the patient presented. Key words: Proximal femoral fracture; hip; avascular necrosis (AVN, osteonecrosis); open fracture; osteoarthritis.

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Regional differences in mortality rates during the COVID-19 epidemic in Italy

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2020.486 ◽

2020 ◽

pp. 1-22

Author(s):

Danila Azzolina ◽

Giulia Lorenzoni ◽

Luciano Silvestri ◽

Ilaria Prosepe ◽

Paola Berchialla ◽

...

Keyword(s):

Regional Differences ◽

Southern Italy ◽

Meta Analysis ◽

Analysis Data ◽

Mortality Rates ◽

Northern Italy ◽

Admission Rates ◽

Considerable Impact ◽

The Difference ◽

Disease Diffusion

Abstract Objective The COVID-19 outbreak started in Italy on February 20th, 2020, and has resulted in many deaths and intensive care unit (ICU) admissions. This study aimed to illustrate the epidemic COVID-19 growth pattern in Italy by considering the regional differences in disease diffusion during the first three months of the epidemic. Study design and methods Official COVID-19 data were obtained from the Italian Civil Protection Department of the Council of Ministers Presidency. The mortality and ICU admission rates per 100 000 inhabitants were calculated at the regional level and summarized via a Bayesian multilevel meta-analysis. Data were retrieved until April 21st, 2020. Results The highest cumulative mortality rates per 100 000 inhabitants were observed in northern Italy, particularly in Lombardia (85.3, 95% credibility intervals [CI] 75.7–94.7). The difference in the mortality rates between northern and southern Italy increased over time, reaching a difference of 67.72 (95% CI = 66–67) cases on April 2nd. Conclusions Northern Italy showed higher and increasing mortality rates during the first three months of the epidemic. The uncontrolled virus circulation preceding the infection spreading in southern Italy had a considerable impact on system burnout. This experience demonstrates that preparedness against the pandemic is of crucial importance to contain its disruptive effects.

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