The epidemiology of proximal femur fractures during COVID-19 emergency in Italy: a multicentric study.

BACKGROUND AND AIM: After the first Italian case of Covid-19, the Government imposed the complete closure of all areas involved by the spread of the virus to contain transmissions. There was a massive reorganization of Hospitals, a stop of all elective activities and a convertion of many hospitals in "Covid Centers''. AITOG (Associazione Italiana Traumatologia e Ortopedia Geriatrica) conducted a retrospective study on all proximal femur fractures surgeries that occurred in this period, to find out whether the pandemic and the correlated lockdown somehow changed the incidence of these events.  Methods: 10 Italian orthopedic centers were involved in the study. Considering the geographic location, three groups were created (North, Centre and South). The considered period is the Italian "Phase 1" (February 23rd - May 3rd 2020). RESULTS: the cohort is composed of 412 patients, 116 male and 296 female (mean age 81.1 ± 9.1 years). The same period of 2019 has been used as control group, with 558 patients, 156 male and 402 female (mean age 84.2 ± 8.0 years). In 2020 we counted 323 (78.4%) fractures occurred at home, 61 (14.8%) in retirement houses and 28 (6.8%) in different locations. We mainly treated fractures with intramedullary nails (n.237 57.5%). Among all patients we had 46 (11.1%) Covid-19 positive. The mortality rate within 30 days was of 51 patients (12.4%); 23 of these died because of complications related to Covid-19 while 31 of  these were in treatment with anticoagulant/antiaggregant. CONCLUSIONS: AITOG analysis demonstrates a decrease in surgical interventions for proximal femur fractures from 2019 to 2020, a reduction in patients mean age and an increase in trauma occurred in domestic environment. We also registered a consistent difference between the North, Center and South of the Country.

The psychological and clinical impact of the COVID-19 pandemic on orthopaedic patients: An Italian gender-specific analysis.

This observational study aims to assess the impact of the COVID-19 pandemic on orthopaedic patients' psychology and clinical management, focusing on gender differences in the following items: (1) pain perception and therapeutic compliance during the pandemic, compared with the pre-pandemic period; (2) relationship doctorpatient (considering both general practitioners and orthopaedic surgeons); (3) patient referral to Orthopaedic emergency room. An Ad Hoc online questionnaire was developed and administered to patients referring to Orthopaedic emergency departments and Orthopaedic outpatient departments throughout Italy, between March and April 2020. The patients' psychological status during the pandemic was evaluated, mainly focusing on the following aspects, i.e., the fear of contracting the COVID-19 infection, the perceived risk of COVID-19 contagion and the compliance with the COVID-19 restrictions. Differences between genders were also assessed. 782 patients finally took part in the present study. A significant decrease of general practitioner and Orthopaedic surgeon clinical referral was recorded during the lockdown period, compared with pre-COVID period (p<0.001; p=0.031). Nonetheless, the number of phone calls to the general practitioner did not undergo substantial differences (p=0.093), compared to patients' the phone consult with orthopaedic surgeons (p=0.042). A significant correlation was found between the fear of COVID-19 contagion the perceived risk of contracting the infection (p<0.001). The COVID pandemic significantly impacted on orthopaedic patients' psychology and perception of the disease. During the lockdown, patients gave a higher priority to the pandemic event and significantly reduced the treatment of their orthopaedic disease.

The orthopaedic and traumatology scenario during Covid-19 outbreak in Italy: chronicles of a silent war.

BACKGROUND: From February 21, the day of hospitalisation in ICU of the first diagnosed case of Covid-19, the social situation and the hospitals' organisation throughout Italy dramatically changed. METHODS: The CIO (Club Italiano dell'Osteosintesi) is an Italian society devoted to the study of traumatology that counts members spread in public and private hospitals throughout the country. Fifteen members of the CIO, Chairmen of 15 Orthopaedic and Trauma Units of level 1 or 2 trauma centres in Italy, have been involved in the study. They were asked to record data about surgical, outpatients clinics and ER activity from the 23rd of February to the 4th of April 2020. The data collected were compared with the data of the same timeframe of the previous year (2019). RESULTS: Comparing with last year, overall outpatient activity reduced up to 75%, overall Emergency Room (ER) trauma consultations up to 71%, elective surgical activity reduced up to 100% within two weeks and trauma surgery excluding femoral neck fractures up to 50%. The surgical treatment of femoral neck fractures showed a stable reduction from 15 to 20% without a significant variation during the timeframe. CONCLUSIONS: Covid-19 outbreak showed a tremendous impact on all orthopaedic trauma activities throughout the country except for the surgical treatment of femoral neck fractures, which, although reduced, did not change in percentage within the analysed timeframe.