Mortality Rates of Patients with Proximal Femoral Fracture in a Worldwide Pandemic: Preliminary Results of the Spanish HIP-COVID Observational Study.

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), in December 2019 in Wuhan, People's Republic of China, has developed into an unprecedented pandemic with enormous pressure on health-care providers around the world. A higher mortality rate has been described in older infected individuals. Patients with hip fracture are a particularly vulnerable population during this pandemic because older age is associated with a higher mortality rate. Our aim was to describe the early mortality rate and demographic variables in a hip fracture sample population in Spain during the coronavirus pandemic. METHODS: This is a multicenter, observational, retrospective, descriptive study. We collected data from 13 major hospitals in Spain from the beginning of the national state of alarm (declared on March 14, 2020, by the Spanish government) until the end of our study period on April 4, 2020. All patients who were ≥65 years of age, presented to the Emergency Department of the participating hospitals during this period with a diagnosis of proximal femoral fracture, and had a minimum follow-up of 10 days were included in the cohort. In addition to mortality, demographic and other potential prognostic variables were also collected. RESULTS: In this study, 136 patients with a hip fracture were included. Of these patients, 124 underwent a surgical procedure and 12 were managed nonoperatively. The total mortality rate was 9.6%. Sixty-two patients were tested for COVID-19, with 23 patients being positive. The mortality rate for these 23 patients was 30.4% (7 of 23 patients) at a mean follow-up of 14 days. The mortality rate was 10.3% (4 of 39) for patients who had been tested and had a negative result and 2.7% (2 of 74) for patients who had not been tested. Of the 12 patients who were managed nonoperatively, 8 (67%) died, whereas, of the 124 patients who were surgically treated, 5 (4%) died. Results differed among centers. CONCLUSIONS: There is a higher mortality rate in patients with a hip fracture and an associated positive test for COVID-19. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Técnica DHS mínimamente invasiva: menor tiempo quirúrgico con similares resultados en el postoperatorio inmediato respecto al DHS convencional. Estudio retrospectivo de cohortes / Minimally invasive dynamic hip screw technique: Shorter surgical time with similar post-surgical results compared to conventional DHS technique. A retrospective cohort study

Objetivos. El tratamiento de fracturas pertrocantéreas con clavo DHS (Dynamic Hip Screw) mediante técnica mínimamente invasiva (MIDHS) ha mostrado resultados superiores a la técnica convencional (CDHS) en estudios previos. El presente estudio pretende determinar si existen diferencias en requerimientos transfusionales, morbilidad, estancia hospitalaria y en el coste asociado, a partir de un análisis retrospectivo de 2 cohortes. Material y método. Estudio de cohortes en 80 pacientes con fracturas intertrocantéreas de fémur (31-A1 y 31-A2.1) tratados con implante DHS entre julio de 2005 y septiembre de 2007: 40 de ellos con la técnica convencional y 40 de ellos con técnica MIDHS. Resultados. No se observaron diferencias estadísticamente significativas ni en la pérdida sanguínea, ni en requerimientos transfusionales, ni en morbilidad. La estancia hospitalaria en el grupo MIDHS fue 1,3 días menor, con un coste directo de 306,3 Euros por caso, inferior al grupo CDHS, aunque sin significación estadística (p = 0,3). La duración de la intervención fue menor en el grupo MIDHS: 49,3 versus 78,8 min (p = 0,0001). Discusión. Contrariamente a lo publicado en estudios previos, en el presente estudio la técnica MIDHS no ha mostrado ventajas excepto por requerir un menor tiempo para realizar la técnica. Consideramos que la técnica MIDHS podría ayudar en mejorar la productividad y eficiencia en el uso de quirófanos (AU)

Aim. The treatment of intertrochanteric fractures using a minimally invasive dynamic hip screw (MIDHS) technique has been reported to provide better results than the conventional technique (CDHS). The present study aims to determine whether there are any differences in terms of transfusion needs, morbidity, length of hospital stay, and economical costs, based on a study of two retrospective cohorts. Material and method. Cohorts study of 80 patients with intertrochanteric femoral fractures (31-A1 and 31-A2.1) who underwent DHS procedure from July 2005 to September 2007; 40 of them were treated using the traditional technique (CDHS), and the other 40 using the minimally invasive technique (MIDHS). Results. No differences were found in terms of blood loss, transfusion requirements or morbidity. Mean hospital stay for MIDHS group was 1.3 days lower, reducing the costs regarding the CDHS group by Euros 306.3, but this difference was not statistically significant (P =.3). The time required to perform the surgery was shorter for the MIDHS group: 49.3 versus 78.8 minutes (p = 0.0001). Discussion. Contrary to previous studies published, the present study did not show any advantage for the MIDHS technique, except for a shorter surgical time to perform the procedure. We consider that the MIDHS could help in improving operating room productivity and efficiency (AU)

[Minimally invasive dynamic hip screw technique: Shorter surgical time with similar post-surgical results compared to conventional DHS technique. A retrospective cohort study]. / Técnica DHS mínimamente invasiva: menor tiempo quirúrgico con similares resultados en el postoperatorio inmediato respecto al DHS convencional. Estudio retrospectivo de cohortes.

AIM: The treatment of intertrochanteric fractures using a minimally invasive dynamic hip screw (MIDHS) technique has been reported to provide better results than the conventional technique (CDHS). The present study aims to determine whether there are any differences in terms of transfusion needs, morbidity, length of hospital stay, and economical costs, based on a study of two retrospective cohorts. MATERIAL AND METHOD: Cohorts study of 80 patients with intertrochanteric femoral fractures (31-A1 and 31-A2.1) who underwent DHS procedure from July 2005 to September 2007; 40 of them were treated using the traditional technique (CDHS), and the other 40 using the minimally invasive technique (MIDHS). RESULTS: No differences were found in terms of blood loss, transfusion requirements or morbidity. Mean hospital stay for MIDHS group was 1.3 days lower, reducing the costs regarding the CDHS group by €306.3, but this difference was not statistically significant (P=.3). The time required to perform the surgery was shorter for the MIDHS group: 49.3 versus 78.8minutes (p=0.0001). DISCUSSION: Contrary to previous studies published, the present study did not show any advantage for the MIDHS technique, except for a shorter surgical time to perform the procedure. We consider that the MIDHS could help in improving operating room productivity and efficiency.

[What do we know about atypical fractures in patients on biphosphonates treatment? A literature review using a case series]. / ¿Qué sabemos de las fracturas atípicas en los pacientes en tratamiento con bifosfonatos? Revisión bibliográfica a raíz de una serie de casos.

AIM: Retrospective review of long term biphosphonates treated patients who sustained a subtrochanteric or diaphyseal femoral fracture with an atypical pattern. A literature review is presented as an update of the topic. MATERIAL AND METHODS: A retrospective study was conducted on 13 subtrochanteric or diaphyseal fractures in female patients treated with biphosphonates at our institution from September 2007 to March 2011. RESULTS: Four cases of subtrochanteric fractures and 13 diaphyseal fractures were detected. Four patients had bilateral fractures. All cases but one (that affected only the lateral cortex) were complete fractures. Surgically, these kinds of fractures are demanding due to the hardness of the bones. DISCUSSION: It is difficult to know if there is any relationship between bisphosphonates treatment and atypical femoral fractures. Nevertheless, current literature supports a greater benefit of their use in preventing vertebral and non-vertebral fractures. For this reason, biphosphonates continue being considered as a first choice in the prevention of osteoporotic fractures. CONCLUSIONS: Patients on long-term treatment with bisphosphonates may present atypical femoral fractures as a complication. It is considered that the maximum period for biphosphonates treatment should not exceed 5 years.

¿Qué sabemos de las fracturas atípicas en los pacientes en tratamiento con bifosfonatos? Revisión bibliográfica a raíz de una serie de casos / What do we know about atypical fractures in patients on biphosphonates treatment? A literature review using a case series

Objetivos. Realizamos una revisión retrospectiva de los pacientes en tratamiento de forma prolongada con bifosfonatos que presentaron fracturas subtrocantéreas y diafisarias de fémur de patrón atípico. Revisión de la literatura existente con el fin de realizar una actualización del tema con consideraciones de interés para el cirujano ortopeda y traumatólogo. Material y métodos. Revisión de 13 pacientes en tratamiento con bifosfonatos con fracturas subtrocantéreas y diafisarias de fémur tratadas en nuestro centro entre septiembre de 2007 y marzo de 2011. Resultados. Se detectaron 4 casos de fracturas subtrocantéreas y 13 de fracturas diafisarias. Cuatro pacientes presentaron fracturas bilaterales. Todas las fracturas eran completas salvo un caso en el que era incompleta con afectación de la cortical lateral. La intervención quirúrgica fue más demandante técnicamente por encontrarse un hueso pétreo como consecuencia de la medicación con bifosfonatos. Discusión. Existe la dificultad de establecer la relación causal directa entre el tratamiento prolongado con bifosfonatos y las fracturas atípicas femorales. No obstante, la literatura actual refiere un beneficio superior en la prevención de fracturas vertebrales y no vertebrales y, por tanto, se continua considerando a los bifosfonatos como un fármaco de primera elección en la prevención de las fracturas osteoporóticas. Conclusiones. Los pacientes con tratamiento prolongado con bifosfonatos pueden presentar fracturas atípicas femorales como complicación. Se considera que debe evaluarse en un periodo medio menor a 5 años la sustitución parcial o definitiva por otro fármaco, teniendo en cuenta el riesgo residual de fractura estimado en ese momento (AU)

Aim. Retrospective review of long term biphosphonates treated patients who sustained a subtrochanteric or diaphyseal femoral fracture with an atypical pattern. A literature review is presented as an update of the topic. Material and methods. A retrospective study was conducted on 13 subtrochanteric or diaphyseal fractures in female patients treated with biphosphonates at our institution from September 2007 to March 2011. Results. Four cases of subtrochanteric fractures and 13 diaphyseal fractures were detected. Four patients had bilateral fractures. All cases but one (that affected only the lateral cortex) were complete fractures. Surgically, these kinds of fractures are demanding due to the hardness of the bones. Discussion. It is difficult to know if there is any relationship between bisphosphonates treatment and atypical femoral fractures. Nevertheless, current literature supports a greater benefit of their use in preventing vertebral and non-vertebral fractures. For this reason, biphosphonates continue being considered as a first choice in the prevention of osteoporotic fractures. Conclusions. Patients on long-term treatment with bisphosphonates may present atypical femoral fractures as a complication. It is considered that the maximum period for biphosphonates treatment should not exceed 5 years (AU)

Enclavado de Hackethal modificado en las fracturas transversales del tercio medio del húmero / Modified Hackethal nailing in transversal fractures of the middle third of the humerus

Se analiza retrospectivamente una serie de 84 casos de fracturas transversales del tercio medio del húmero tratados por enclavado en haz de Hackethal modificado. Cuarenta y ocho pacientes eran varones y 36 mujeres, siendo la edad media de 46,2 años. El seguimiento postoperatorio medio fue de 2,5 años. Se revisan las complicaciones inmediatas y tardías de las fracturas, entre las que destacan las migraciones proximales (6 por ciento) y distales de las agujas (10,7 por ciento), las angulaciones del material (3,6 por ciento), la rotura del material (2,45) y las seudoartrosis (3,6 por ciento). Varias complicaciones pueden ocurrir en un mismo paciente, especialmente se han observado las asociaciones: migraciones distales con infecciones superficiales, el edema con la desviación y la diástasis del foco con la seudoartrosis. La tasa de infección es baja, siendo todas superficiales (2,4 por ciento); no se ha observado ningún caso de parálisis radial postoperatoria. Por la facilidad de ejecución y por los buenos resultados obtenidos el enclavado de Hackethal modificado es un método eficaz para el tratamiento de las fracturas diafisarias del tercio medio del húmero (AU)