Department of Orthopaedics and Traumatology, Humanitas Gavazzeni, Bergamo, Italy.
IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
J Bone Joint Surg Am. 2020 Jun 17;102(12):e58. doi: 10.2106/JBJS.20.00617.
From February 20 to April 2020, the coronavirus SARS (severe acute respiratory syndrome)-CoV-2 spread in northern Italy, drastically challenging the care capacities of the national health care system. Unprepared for this emergency, hospitals have quickly reformulated paths of assistance in an effort to guarantee treatment for infected patients. Orthopaedic departments have been focused on elderly traumatology, especially the treatment of femoral neck fractures in patients with coronavirus disease-2019 (COVID-19). The purpose of the present study was to evaluate the orthopaedic management strategy for femoral fragility fractures in COVID-19-positive patients with the hypothesis that operative treatment may contribute to the overall stability of the patient.
Sixteen patients affected by proximal femoral fracture and a recent history of fever, shortness of breath, and desaturation were admitted to the emergency room. Thoracic computed tomography (CT) and oropharyngeal swabs confirmed that they were positive for COVID-19, requiring hospitalization and prophylaxis with low-molecular-weight heparin.
Three patients died before surgery because of severe respiratory insufficiency and multiple-organ-failure syndrome. Ten patients underwent surgery on the day after admission, whereas 3 patients had suspended their use of direct thrombin inhibitors and needed surgery to be delayed until the third day after admission. In all patients except 1, we noted an improvement in terms of O2 saturation and assisted respiration. In 9 patients, hemodynamic and respiratory stability was observed at an average of 7 days postoperatively. Four patients who underwent surgical treatment died of respiratory failure on the first day after surgery (1 patient), the third day after surgery (2 patients), or the seventh day after surgery (1 patient).
We noted a stabilization of respiratory parameters in 12 COVID-19-positive patients who underwent surgery treatment of proximal femoral fractures. We believe that in elderly patients with COVID-19 who have proximal femoral fractures, surgery may contribute to the overall stability of the patient, seated mobilization, improvement in physiological ventilation, and general patient comfort in bed.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
从 2020 年 2 月 20 日至 4 月，冠状病毒 SARS（严重急性呼吸综合征）-CoV-2 在意大利北部传播，这对国家医疗保健系统的护理能力构成了巨大挑战。由于对这种紧急情况毫无准备，医院迅速重新制定了援助途径，以确保对感染患者的治疗。矫形外科部门专注于老年创伤学，特别是治疗 2019 年冠状病毒病（COVID-19）阳性患者的股骨颈骨折。本研究的目的是评估 COVID-19 阳性股骨脆弱性骨折患者的矫形管理策略，假设手术治疗可能有助于患者整体稳定。
16 名患有股骨近端骨折且有近期发热、呼吸急促和低氧血症病史的患者被收入急诊室。胸部计算机断层扫描（CT）和咽拭子确认他们 COVID-19 检测呈阳性，需要住院治疗，并使用低分子量肝素进行预防。
由于严重呼吸功能不全和多器官功能衰竭综合征，有 3 名患者在手术前死亡。10 名患者在入院后第 1 天接受了手术，而 3 名患者已停止使用直接凝血酶抑制剂，需要将手术推迟至入院后第 3 天。除 1 名患者外，我们注意到所有患者的 O2 饱和度和辅助呼吸均有所改善。在 9 名患者中，术后平均 7 天观察到血流动力学和呼吸稳定。4 名接受手术治疗的患者在手术后第 1 天（1 名患者）、第 3 天（2 名患者）或第 7 天（1 名患者）因呼吸衰竭死亡。
我们注意到 12 名接受股骨近端骨折手术治疗的 COVID-19 阳性患者呼吸参数稳定。我们认为，对于患有 COVID-19 的股骨近端骨折老年患者，手术可能有助于患者整体稳定、坐立移动、改善生理通气以及患者在床上的总体舒适度。
预后 IV 级。有关完整的证据水平说明，请参见作者说明。
