_applied_  
_sciences_  
_Article_  
**The Impact of the Second Wave of COVID-19 on Outcomes in Hip Fracture Patients: An Observational Study**  
**[PERSON] 1,**\({}^{\ast}\)\({}^{\copyright}\), [PERSON] 1, [PERSON] \({}^{\copyright}\), [PERSON] 1, [PERSON] \({}^{\copyright}\),**  
**[PERSON] 1**  
1 IRCCS, Istituto Ortopelico Rizzoli, 40136 Bologna, Italy; [PERSON]@iorit (C.F. ); [PERSON]@iorit (A.E. ); [PERSON]] (T.B. ); [PERSON]@iorit (A.M.O. ); [PERSON]@iorit (A.M.)  
2 Dipartimento di Diagnostic e Sanita Pubblica, Universita degli Studi di Verona, 37134 Verona, Italy; elisa.ambrosi,[EMAIL_ADDRESS]  
* Correspondence: [EMAIL_ADDRESS]; Tel. : +39-051-636-6354  
**Featured Application: Restoring the hospital's normal surgical activities, the management of femur fracture patients should be carefully monitored: the care given absence for these patients should be revised and the increased complexity of the orthopaedic patients treated should be adequately addressed. **  
**Abstract: The aim of this work was to measure the healthcare outcomes for patients undergoing surgery for femur fractures during the second wave of the COVID-19 pandemic within a context of orthopaedic surgery units and living with the pandemic and compare them with pre-pandemic outcomes. A retrospective observational study was conducted. The incidence of pressure ulcers and deambulation recovery time were the main outcome. The pre-pandemic group consisted of 108 patients and the second wave pandemic group included 194 patients. The incidence of pressure ulcers increased from 10% in the pre-pandemic period to 21% in the second wave (\(p=0.016\)) and the crude relative risk (RR) was 2.06 (\(p=0.023\)). The recovery of deambulation showed no significant difference in the recovery time in terms of days needed to walk the first time (3 days vs. 2 days; \(p=0.44\)). During the second wave of COVID-19, the risk of pressure ulcers for patients undergoing femur fracture surgery increased significantly. This variation could be explained by the absence of a caregiver for these patients and the increased average complexity of the patients managed in the orthopaedic setting. The hospital management should take into account these aspects when restoring the hospital's normal surgical activities. **  
**Keywords: COVID-19; hip fracture; pressure ulcers; ambulation**  
**1. Introduction**  
The spread of the COVID-19 epidemic has brought a sharp increase in pressure on all hospitals and their healthcare systems [1, 2, 3]. In 2020 in Europe, spread of the disease is now recognised has having occurred in two waves. The first, between March and May, reaching its peak number of cases towards the end of March, the second started in September and peaked in November [4, 5]. These two phases in the spread of the disease differed both in terms of clinical mortality and characteristics of the individuals affected and in terms of the responses implemented by different countries. During the second wave, many countries sought to keep all treatment activities up and running, avoiding the closures that had occurred during the initial phase and trying to achieve coexistence with the spread of the virus [6]. [PERSON] et al. [7] point out that worldwide--in 43 of the 53 countries surveyed--lethality of COVID-19 was reduced during the second wave, although the reasons for this are not fully understood. From the orthopaedic surgery point of view, [PERSON] et al. [8] show that,in the second wave, the UK healthcare system succeeded in improving operating theatre management over that of the first wave, returning to pre-pandemic levels. However, [PERSON] et al. [9] show a significant reduction in the application of best care practices in patients with a diagnosis of hip fracture, particularly with a reduction in multidisciplinary assessment activities. However, data on the outcomes for patients who underwent femur fracture surgery during the second wave are extremely limited; in particular, observations regarding the outcomes of clinical care are rarely reported [10,11].