“Significant” Increases in Morbidity, Mortality in Hip Fracture Patients with COVID-19

by Elizabeth Hofheinz, M.P.H., M.Ed.

A recent article from Tufts Medical Center has explored the evolving interplay between orthopedic trauma and COVID-19. The study, “Inflammatory and Coagulative Considerations for the Management of Orthopaedic Trauma Patients With COVID-19: A Review of the Current Evidence and Our Surgical Experience,” appears in the May 14, 2020 edition of the Journal of Orthopaedic Trauma.

Citing evidence that COVID-19 involves “…a hyperinflammatory response predisposing patients to thromboembolic disease and acute respiratory distress…” the authors undertook a review article to examine the pathogenesis of COVID-19 and what that might mean for the management of orthopaedic trauma patients.

Co-author Scott P. Ryan, M.D., is Chief of Orthopaedic Trauma at Tufts Medical Center. He told OSN, “Our understanding of the body’s response to COVID-19 was minimal at the time of writing this paper. There were small reports of patients developing blood clots and having an elevated inflammatory response that lead to multi system organ failure. Surgery, specifically nailing of long bones can illicit an inflammatory response as well. Our hypothesis was that a COVID + status can put patients in a hypercoagulable, hyperinflammatory state and essentially function as a ‘first hit’ of a trauma despite most people being asymptomatic.  Orthopaedic surgery, especially nailing of long bones may act as a ‘second hit’ and put patients over the edge into extremis.”

“The most important message would be to consider thinking of COVID + patients as having an elevated baseline inflammatory response even if asymptomatic. This may put them at risk for increased morbidity and mortality with standard fracture surgery. There is now data showing that COVID + patients are at increased risk for morbidity and mortality during hip fracture care compared to COVID – patients. Research is ongoing, but the manifestations of this disease are scary.”

An update from Dr. Ryan as of August 31, 2020:

“Yes, we have seen evidence (specifically in hip fracture populations) of significant increased morbidity and mortality (chance of dying) for patients undergoing surgery,” said Dr. Ryan to OSN. We are working on other studies to see the impact of telemedicine in the orthopaedic trauma population during this pandemic, and other outcomes with regard to patients who sustain fractures and are COVID +.”