[PROXIMAL FEMUR FRACTURES IN A TERTIARY HOSPITAL DURING THE COVID-19 PANDEMIC].

INTRODUCTION: A larger number of proximal hip fractures occur outdoors rather than within a patient's home. BACKGROUND: At the beginning of 2020, Covid-19 was classified as a global pandemic. Elderly patients are at risk for both occurrences of osteoporotic proximal hip fractures and for increased morbidity and mortality due to infection with Covid-19. Lockdown measures were implemented to decrease the rising incidence of Covid-19. The effect of these measures on hip fracture epidemiology is unknown. OBJECTIVES: This study aimed to evaluate the effect of national lockdown measures on proximal hip fracture epidemiology. METHODS: Data on patients with proximal hip fractures admitted between January 2019 and December 2020 were collected retrospectively. Cases were stratified weekly. Information was compared, between government imposed lockdown periods during 2020, to corresponding periods during 2019. The trend of cases throughout the year 2020 was observed. RESULTS: Of 477 cases included, 259 occurred in 2019 and 218 in 2020. There was no significant difference in age, gender, and primary residence. There was a decrease of 20.45% in proximal hip fracture per week during the entirety of the Covid-19 period compared to 2019 (3.89 ± 2.13 vs. 4.89 ± 2.00; p= 0.02), and a 15.95% decrease during the entire year of 2020 (4.11 ± 2.33 vs. 4.89 ± 1.99; p= 0.07). The most pronounced decrease occurred during the second lockdown period (4.6±1.67 vs. 2.40±1.82; p=0.04). CONCLUSIONS: There was a significant decrease in the number of proximal hip fractures during the Covid-19 pandemic, specifically occurring during the government imposed lockdowns. DISCUSSION: The surrounding environment affects the risk of having a hip fracture in the elderly population, avoiding going out decreases the probability for a femoral neck fracture.

Decrease in incidence of proximal femur fractures in the elderly population during the Covid-19 pandemic: a case-control study.

BACKGROUND: The World Health Organization classified Covid-19 as a pandemic during the first months of 2020 as lockdown measures were implemented globally to mitigate the increasing incidence of Covid-19-related morbidity and mortality. The purpose of this study was to evaluate the effect of national lockdown measures on proximal femur fracture epidemiology. Our hypothesis was that due to the prolonged period of stay-at-home orders, we would observe a decrease in the incidence of proximal femur fractures during the years 2020-21. METHODS: A retrospective case-control study of 2784 hip fractures admitted to the emergency department at one hospital between January 1, 2010, and March 31, 2021, was conducted. Cases were stratified weekly, and an analysis was conducted comparing cases occurring during government-imposed lockdown periods of 2020-21 to corresponding periods during 2010-2019. Furthermore, the trend of cases throughout the year of 2020 was observed. RESULTS: Of all proximal femur fracture cases included, 2522 occurred between 2010-2019 and 261 during the Covid-19 period. There was no significant difference in age (81.95 vs. 82.09; P = 0.78) or gender (P = 0.12). There was a total decrease of 21.64% in proximal femur fracture per week during the entirety of the Covid-19 pandemic period compared to the previous years (3.64 ± 1.99 vs. 4.76 ± 0.83; P = 0.001). During all three lockdown periods, there was a significant decrease in proximal femur fracture cases per week (3.55 ± 2.60 vs. 4.87 ± 0.95; P = 0.04), and the most pronounced decrease occurred during the third lockdown period (2.89 ± 1.96 vs. 5.23 ± 1.18; P = 0.01). CONCLUSION: We observed a total decrease in the number of proximal femur fractures occurring during the Covid-19 era compared to previous years and specifically a decrease of cases occurring during the government-imposed lockdown periods. The decrease in cases was more pronounced during the second and third lockdown periods.