The Impact of COVID-19 on Neck of Femur Fracture Care: A Major Trauma Centre Experience, United Kingdom

The aim of this study was to investigate the impact of the COVID-19 pandemic on the management andoutcome of patients with neck of femur fractures. Data was collected for 96 patients with neck of femur fractures who presented to the emergency departmentbetween March 1, 2020 and May 15, 2020. This data set included information about their COVID-19 status.Parameters including inpatient complications, hospital quality measures, mortality rates, and training opportunitieswere compared between the COVID-19 positive and COVID-19 negative groups. Furthermore, our current cohort ofpatients were compared against a historical control group of 95 patients who presented with neck of femur fracturesbefore the COVID-19 pandemic. Seven (7.3%) patients were confirmed COVID positive by RT-PCR testing. The COVID positive cohort, whencompared to the COVID negative cohort, had higher rates of postoperative complications (71.4% vs 25.9%), increasedlength of stay (30.3 days vs 12 days) and quicker time to surgery (0.7 days vs 1.3 days).The 2020 cohort compared to the 2019 cohort, had an increased 30-day mortality rate (13.5% vs 4.2%), increasednumber of delayed cases (25% vs 11.8%) as well as reduced training opportunities for Orthopaedic trainees to performthe surgery (51.6% vs 22.8%). COVID-19 has had a profound impact on the care and outcome of neck of femur fracture patients duringthe pandemic with an increase in 30-day mortality rate. There were profound adverse effects on patient managementpathways and outcomes while also affecting training opportunities.Level of evidence: VI