Patralekh Mohit Kumar, Jain Vijay Kumar, Iyengar Karthikeyan P, Upadhyaya Gaurav Kumar, Vaishya Raju
Department of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110 029, India.
Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India.
J Clin Orthop Trauma. 2021 Jul;18:80-93. doi: 10.1016/j.jcot.2021.03.023. Epub 2021 Apr 20.
Concerns have been raised about the escalated mortality in patients of proximal femoral fractures (PPFs) with COVID-19. A meta-analysis to evaluate the mortality in patients with PPFs managed during the current COVID-19 pandemic was conducted.
A systematic review and meta-analysis of all published studies were conducted with a search on PubMed, Scopus, Web of Science, and Cochrane Library databases using appropriate keywords from January 01, 2020 to January 29, 2021.
35 relevant studies reporting 4255 patients with hip fracture in the current ongoing pandemic, out of which 692 patients were COVID-19 positive. Twenty studies reported mortality and other relevant statistics on hip fracture patients with and without COVID-19 (4123 hip fracture patients in the year 2020-21, out of which 560 had or were suspected of having COVID -19). A meta-analysis of mortality statistics in patients with and without COVID revealed increased odds of mortality among COVID patients [odds ratio (OR) 6.31, 95% confidence interval (CI) [5.09, 7.83] and meta-analysis on the subgroup of surgically treated patients also showed markedly increased mortality risk among those with COVID-19 (OR) 5.99, 95% CI [3.88,9.24].
The mortality risk is markedly increased in hip fracture with concomitant COVID-19 as compared to those without it. This increased risk persisted in those managed surgically. It could be due to the inflammation induced by the fracture or surgery for fracture fixation, further exacerbating inflammation, leading to cytokine storm. It is imperative that such patients are informed regarding increased mortality risk during the consent and shared decision-making process.
对于新型冠状病毒肺炎（COVID-19）合并股骨近端骨折（PPF）患者死亡率上升的问题，人们已有所关注。本研究进行了一项荟萃分析，以评估在当前COVID-19大流行期间接受治疗的PPF患者的死亡率。
使用适当的关键词，对2020年1月1日至2021年1月29日期间在PubMed、Scopus、科学网和考克兰图书馆数据库中检索到的所有已发表研究进行系统评价和荟萃分析。
35项相关研究报告了当前大流行期间4255例髋部骨折患者，其中692例患者COVID-19呈阳性。20项研究报告了有或无COVID-19的髋部骨折患者的死亡率及其他相关统计数据（2020 - 2021年有4123例髋部骨折患者，其中560例确诊或疑似感染COVID-19）。对有或无COVID患者的死亡率统计进行的荟萃分析显示，COVID患者的死亡几率增加[比值比（OR）6.31，95%置信区间（CI）[5.09，7.83]，对手术治疗患者亚组的荟萃分析也显示，COVID-19患者的死亡风险显著增加（OR）5.99，95% CI [3.88，9.24]。
与未合并COVID-19的髋部骨折患者相比，合并COVID-19的髋部骨折患者的死亡风险显著增加。这种增加的风险在接受手术治疗的患者中持续存在。这可能是由于骨折或骨折内固定手术引起的炎症，进一步加剧了炎症反应，导致细胞因子风暴。在知情同意和共同决策过程中，必须告知此类患者死亡风险增加的情况。
