Has the COVID lockdown altered the incidence and management of fragility fractures in older adults? Case-control study at a French University Hospital.

INTRODUCTION: In France, a national lockdown related to the COVID-19 pandemic was imposed from March 17 to May 11, 2020, drastically changing our professional and organizational practices. We were interested on the impact of the lockdown on fragility fractures in older adults (65 years and older). The primary objective of this study was to evaluate the incidence of peripheral and pelvic fragility fractures during the lockdown. The secondary objectives were to carry out an epidemiological analysis of the fractures, treatments and hospitalization data. HYPOTHESIS: The main hypothesis was that the number of peripheral and pelvic fragility fractures was lower during the lockdown in 2020 than in the same (non-lockdown) period in 2019. MATERIALS AND METHODS: We retrospectively collected epidemiological (age, sex), clinical (type of fracture, treatment) and hospitalization data from patients 65 years and older who came to the emergency room because of a peripheral and/or pelvic fracture between March 17 and May 11 of the years 2019 and 2020. RESULTS: We included 192 patients in 2019 and 157 patients in 2020. The mean age and sex ratio were not statistically different. The number of peripheral and/or pelvic fragility fractures decreased by 16%. The share of patients treated surgically was similar in both years (46% in 2019; 51% in 2020 (p=0.47)). The number of proximal femur fractures dropped by 21%. The mean time to surgery for these fractures was shorter in 2020 (p=0.02) although the mean length of hospital stay was unchanged (p=0.72) The mortality rate of patients hospitalized for fragility fractures did not increase significantly (p=0.51). DISCUSSION: We observed a reduction in the number of peripheral and pelvic fragility fractures in patients 65 years and older during the lockdown. To ensure that we met our goals of optimal care for proximal femur fractures, a general reorganization of the operating room was necessary. The continued availability of fully functional technical facilities despite this health crisis was crucial to being able to treat these fractures and to prevent increased mortality. LEVEL OF EVIDENCE: III, case-control study.

Le confinement a-t-il modifié l’incidence et la prise en charge des fractures de fragilité périphériques et du bassin du sujet âgé ? Étude cas-témoin d’un centre hospitalo-universitaire français☆ Has the COVID lockdown altered the incidence and management of fragility fractures in older adults? Case-control study at a French University Hospital

Introduction En France, un confinement national lié à la pandémie de COVID-19 a été décrété du 17 mars au 11 mai 2020, bouleversant nos pratiques professionnelles et organisationnelles. Nous nous sommes intéressés aux conséquences du confinement sur les fractures de fragilité chez les sujets de 65 ans et plus. L’objectif principal était d’évaluer l’incidence des fractures de fragilité périphériques et du bassin pendant la période de confinement. Les objectifs secondaires étaient de réaliser une analyse épidémiologique des fractures, des traitements et des données d’hospitalisation. Hypothèse L’hypothèse principale était que le nombre de fractures de fragilité périphériques et du bassin avait diminué pendant le confinement, comparativement à une période non confinée. Matériel et méthodes Nous avons recueilli rétrospectivement les données épidémiologiques (âge, sexe), cliniques (types de fractures, traitements) et d’hospitalisation des patients de plus de 65 ans consultant aux urgences traumatologiques pour une fracture périphérique et/ou du bassin, du 17 mars au 11 mai des années 2019 et 2020. Résultats Cent quatre-vingt-douze patients étaient inclus en 2019 contre 157 en 2020. L’âge moyen et le sex-ratio n’étaient statistiquement pas différents. Le nombre de fractures de fragilité périphériques et du bassin a baissé de 16,3 %. Le taux de prise en charge chirurgicale était comparable (46,3 % en 2019 ;50,9 % en 2020 [p = 0,47]). Le nombre de fractures du fémur proximal a diminué de 20,6 %. Le délai préopératoire moyen de ces fractures était plus court en 2020 (p = 0,02) tandis que la durée moyenne d’hospitalisation était inchangée (p = 0,72). Le taux de mortalité des patients hospitalisés pour des fractures de fragilité n’augmentait pas de manière significative (p = 0,51). Discussion Nous avons observé une diminution des fractures de fragilité périphériques et du bassin chez les patients de plus de 65 ans durant le confinement. Afin d’assurer notre mission de prise en charge optimale des fractures du fémur proximal, une réorganisation globale du bloc opératoire a été nécessaire. Le maintien d’un plateau technique fonctionnel malgré cette situation de crise a été fondamental pour poursuivre la prise en charge de ces fractures et ainsi éviter une surmortalité significative. Niveau de preuve III, étude cas-témoin.

Prone Positioning for Severe Acute Respiratory Distress Syndrome in COVID-19 Patients by a Dedicated Team: A Safe and Pragmatic Reallocation of Medical and Surgical Work Force in Response to the Outbreak.

OBJECTIVE: The aim of this study was to define whether rapidly reallocating health care workers not experienced with PP for performing PP in ICU is feasible and safe. SUMMARY BACKGROUND DATA: In the setting of severe acute respiratory distress syndrome (ARDS), the use of prone and supine positioning procedures (PP) has been associated with improved oxygenation resulting in decreased mortality. Nevertheless, applying PP is time consuming for ICU staffs that are at risk of mental of physical exhaustion, especially with the constant surge of admitted COVID-19 patients with severe ARDS. METHODS: This prospective cohort study conducted at a single regional university hospital between March 27 and April 15, 2020. Among 117 patients admitted to ICU, 67 patients (57.3%) presented with proven SARS-CoV-2 infection with severe ARDS requiring PP. After accelerated simulation training, 109 volunteers including surgeons, physicians, nurses and physiotherapists, multiple dedicated teams performed daily multiple PP following a systematic checklist. Patient demographics and PP data were collected. Patient safety and health care workers safety were assessed. RESULTS: Among 117 patients admitted to ICU, 67 patients (57.3%) required PP. Overall, 53 (79%) were male, with a median age of 68.5 years and median body mass index of 29.3 kg/m. A total of 384 PP were performed. Overall, complication occurred in 34 PP (8.8%) and led to PP cancelation in 4 patients (1%). Regarding health care workers safety, four health care workers presented with potential COVID-19 related symptoms and none was positive. CONCLUSIONS: To overcome the surge of critically ill COVID-19 patients, reallocating health care workers to targeted medical tasks beyond their respective expertise such as PP was safe.