Related Experiment Video
Updated: Dec 15, 2025
Imaging of the Microstructural Failure Mechanism in the Human Hip
Published on: September 29, 2023
IMPACT-Scot report on COVID-19 and hip fractures
Andrew J Hall1,2,3, Nicholas D Clement1,2, Luke Farrow3,4
1Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
Insights
Patients with hip fractures who contract coronavirus disease (COVID-19) face a significantly higher risk of 30-day mortality. Low platelet count may indicate COVID-19 infection in these patients.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Epidemiology
Background:
- Hip fractures are a common and serious injury, particularly in older adults.
- The coronavirus disease (COVID-19) pandemic has presented unique challenges in healthcare, impacting patient outcomes across various medical conditions.
- Understanding the interplay between hip fractures and COVID-19 is crucial for effective patient management.
Purpose of the Study:
- To determine the independent effect of COVID-19 on 30-day mortality in hip fracture patients.
- To identify clinical predictors of COVID-19 status in this population.
- To investigate the influence of social lockdown measures on hip fracture incidence and epidemiology.
Main Methods:
- A national multicentre retrospective study involving six trauma centers.
- Inclusion of patients with hip fractures over a 46-day period, encompassing pre- and post-lockdown phases.
- Collection of data on demographics, clinical factors, COVID-19 status, and 30-day mortality.
Main Results:
- 8.5% of hip fracture patients tested positive for COVID-19, with most lacking symptoms on admission.
- COVID-19-positive patients had significantly lower 30-day survival (64.5% vs 91.7%).
- COVID-19 independently increased 30-day mortality risk (HR 2.93-3.52). Presentation platelet count (< 217 × 10^9/l) predicted COVID-19 status.
- No significant difference in hip fracture incidence or epidemiology was observed between pre- and post-lockdown periods.
Conclusions:
- COVID-19 is an independent risk factor for increased 30-day mortality in hip fracture patients.
- The majority of hip fracture patients with COVID-19 are asymptomatic upon presentation, highlighting the need for universal testing.
- Platelet count serves as a potential early indicator for COVID-19 risk in hip fracture patients, informing clinical management strategies.
Aims:
The primary aim was to assess the independent influence of coronavirus disease (COVID-19) on 30-day mortality for patients with a hip fracture. The secondary aims were to determine whether: 1) there were clinical predictors of COVID-19 status; and 2) whether social lockdown influenced the incidence and epidemiology of hip fractures.
Methods:
A national multicentre retrospective study was conducted of all patients presenting to six trauma centres or units with a hip fracture over a 46-day period (23 days pre- and 23 days post-lockdown). Patient demographics, type of residence, place of injury, presentation blood tests, Nottingham Hip Fracture Score, time to surgery, operation, American Society of Anesthesiologists (ASA) grade, anaesthetic, length of stay, COVID-19 status, and 30-day mortality were recorded.
Results:
Of 317 patients with acute hip fracture, 27 (8.5%) had a positive COVID-19 test. Only seven (26%) had suggestive symptoms on admission. COVID-19-positive patients had a significantly lower 30-day survival compared to those without COVID-19 (64.5%, 95% confidence interval (CI) 45.7 to 83.3 vs 91.7%, 95% CI 88.2 to 94.8; p < 0.001). COVID-19 was independently associated with increased 30-day mortality risk adjusting for: 1) age, sex, type of residence (hazard ratio (HR) 2.93; p = 0.008); 2) Nottingham Hip Fracture Score (HR 3.52; p = 0.001); and 3) ASA (HR 3.45; p = 0.004). Presentation platelet count predicted subsequent COVID-19 status; a value of < 217 × 109/l was associated with 68% area under the curve (95% CI 58 to 77; p = 0.002) and a sensitivity and specificity of 63%. A similar number of patients presented with hip fracture in the 23 days pre-lockdown (n = 160) and 23 days post-lockdown (n = 157) with no significant (all p ≥ 0.130) difference in patient demographics, residence, place of injury, Nottingham Hip Fracture Score, time to surgery, ASA, or management.
Conclusion:
COVID-19 was independently associated with an increased 30-day mortality rate for patients with a hip fracture. Notably, most patients with hip fracture and COVID-19 lacked suggestive symptoms at presentation. Platelet count was an indicator of risk of COVID-19 infection. These findings have implications for the management of hip fractures, in particular the need for COVID-19 testing. Cite this article: Bone Joint J 2020;102-B(9):1219-1228.
More Related Videos
Related Concept Videos
01:21Types of Reports II: Incident or Occurrence Report
Purposes:
In the healthcare industry, reports play a crucial role in documenting incidents within an agency. The primary objective of these reports is to ensure patient safety, uphold the...
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...