ABSTRACT
INTRODUCTION: The COVID-19 pandemic presented extraordinary challenges to the UK healthcare system. This study aimed to assess the impact of the COVID-19 lockdown on the epidemiology, treatment pathways and 30-day mortality rates of hip fractures. Outcomes of COVID-19 positive patients were compared against those who tested negative. METHODS: An observational, retrospective, multicentre study was conducted across six hospitals in the South East of England. Data were retrieved from the National Hip Fracture Database and electronic medical records. Data was collected for the strictest UK lockdown period (period B=23 March 2020-11 May 2020), and the corresponding period in 2019 (period A). RESULTS: A total of 386 patients were admitted during period A, whereas 381 were admitted during period B. Despite the suspension of the 'Best Practice Tariff' during period B, time to surgery, time to orthogeriatric assessment, and 30-day mortality were similar between period A and B. The length of inpatient stay was significantly shorter during period B (11.5 days vs 17.0 days, p<0.001). Comparison of COVID-19 positive and negative patients during period B demonstrated that a positive test was associated with a significantly higher rate of 30-day mortality (53.6% vs 6.7%), surgical delay >36h (46.4% vs 30.8%, p=0.049), and increased length of inpatient stay (15.8 vs 11.7 days, p=0.015). CONCLUSIONS: The COVID-19 lockdown did not alter the epidemiology of hip fractures. A substantially higher mortality rate was observed among patients with a COVID-19 positive test. These findings should be taken into consideration by the healthcare policymakers while formulating contingency plans for a potential 'second wave'.
Subject(s)
COVID-19/prevention & control , Communicable Disease Control , Hip Fractures/epidemiology , Length of Stay/statistics & numerical data , Mortality , Public Policy , Time-to-Treatment/statistics & numerical data , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip , Bone Screws , COVID-19/complications , Cohort Studies , England/epidemiology , Female , Fracture Fixation, Internal , Fracture Fixation, Intramedullary , Hemiarthroplasty , Hip Fractures/complications , Hip Fractures/surgery , Humans , Male , Reoperation , SARS-CoV-2ABSTRACT
Previous studies have looked at early follow-up of the Graf ligament stabilisation system. We present mid- to long-term results of this procedure. A retrospective review of Graf ligaments inserted since 1993 was undertaken. A total of 51 patients were reviewed. Pre-operative Oswestry Disability Index scores were compared to post-operative scores recorded via a postal questionnaire. There were 28 men and 23 women. The average age was 41 years (range, 2267 years). The mean pre-operative score was 46 (range, 22-78), the mean follow-up time was 51 months (range, 23-84 months) and the mean post-operative score was 40 (range, 0-82). There were 12 complications (4 requiring further surgery), and seven patients went on to require bony fusion procedures. Forty one per cent of the group would choose not to have the operation again. Longer-term results of this technique are not as encouraging as earlier studies. The continued use of this procedure should be viewed with caution.
Subject(s)
Joint Instability/surgery , Orthopedic Fixation Devices , Spinal Diseases/surgery , Adult , Aged , Equipment Failure , Female , Follow-Up Studies , Humans , Male , Middle Aged , Orthopedic Fixation Devices/adverse effects , Reoperation , Retrospective StudiesABSTRACT
The case of a 75-year-old woman treated by 1-stage exchange arthroplasty for fungal infection of a total knee arthroplasty is reported.
