A Study of Outcomes in Patients With Fractured Neck of Femur During the COVID-19 Pandemic

Study Overview
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Brief Summary
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In early 2020 the evolving COVID-19 Pandemic provided the world and medical community with a generational challenge. As a novel disease, countries were left with strategic decisions and many went into social lockdown. Initial resources and research were directed at upscaling internal medicine and intensive care services, understanding the disease pathophysiology, and testing treatments. It soon became evident that COVID-19 had multi-system effects at it's worst. In orthopaedics one of the most vulnerable groups to COVID-19 were the elderly, specifically those who suffered fractured neck of femur at this time. More literature is needed urgently if we are to understand and mitigate the negative impacts in this group of patients. This observational study assesses the early morbidity and mortality of patients with this diagnosis during the evolving COVID-19 Pandemic.

Detailed Description
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Many elderly patients admitted to hospitals during the evolving COVID-19 pandemic after falls or being generally unwell, were considered to have a possible diagnosis of COVID-19. This was extremely relevant to the subgroup of patients who suffered from fractured neck of femurs during this time, with most of them elderly, frail, and more likely to have multiple co-morbidities. COVID-19 was considered a precipitating factor for falls, but also anecdotally, an indicator of potentially poor recovery and rehabilitation. With regards to orthopaedic and trauma surgery, a limited amount of literature is available pertaining to COVID-19 and specifically it's potential effects on patient outcomes in patients requiring surgery. We performed a multi centre observational study across London, United Kingdom, looking at the demographics and details of patients admitted with fractured neck of femur during the evolving pandemic. All data collected was non identifiable. Data was also collected as to the COVID-19 status of these patients, either positive or negative. Data was analysed to assess the morbidity and mortality of this patient group and search for any prognostic factors.

Official Title
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The Effects of Coronavirus on Perioperative Morbidity and Mortality in a High-risk Population: A Multicentre Cohort Study

Conditions
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Femoral Neck Fractures, SARS-CoV 2

Intervention / Treatment
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* Other: Surgery: Dynamic Hip Screw, hemiarthroplasty, hip replacement, intramedullary nail


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Fractured neck of femur Received operative intervention for fractured neck of femur Exclusion Criteria: open fracture fracture of femoral shaft periprosthetic fracture revision surgery

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| COVID-19 positive<br>All patients admitted with fractured neck of femur during specified time period testing POSITIVE for COVID-19 | Other: Surgery: Dynamic Hip Screw, hemiarthroplasty, hip replacement, intramedullary nail<br>* If fit for anaesthesia patients may undergo relevant procedure for fractured neck of femur as per NICE guidelines within limitations of resources as defined by BOAST<br>|
| COVID-19 negative<br>All patients admitted with fractured neck of femur during specified time period testing NEGATIVE for COVID-19 | Other: Surgery: Dynamic Hip Screw, hemiarthroplasty, hip replacement, intramedullary nail<br>* If fit for anaesthesia patients may undergo relevant procedure for fractured neck of femur as per NICE guidelines within limitations of resources as defined by BOAST<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mortality | Death | 30 day | 
| Morbidity | Morbidity | 30 day | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Discharge | Discharge to home, rehabilitation or community setting | 30 day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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COVID-19, Coronavirus, Neck of femur, Morbidity, Mortality, Prognosis