COVID-19, the infection caused by the SARS-CoV-2 virus, can be more severe in patients with a fracture than those without one, according to a new study, “Characteristics and Early Prognosis of COVID-19 Infection in Fracture Patients,” published in the May issue of the Journal of Bone and Joint Surgery.
COVID-19 Is More Severe in Fracture Patients
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Secondary#fracture#covid19#surgicaltreatment
While the first cases of this infection first occurred in Wuhan, China in late 2019, now it has spread to pandemic proportions with 4,518,074 cases and 307,825 deaths worldwide as of May 16, 2020.
This particular study focused on data from 10 patients with a fracture and COVID-19 from 8 different hospitals in the Hubei province in China from January 1, 2020 to February 27, 2020.
A big factor in early prognosis may be the limited activity related to the fracture. The most COVID-19 symptoms at the time of presentation were fever, cough, and fatigue. Less common were sore throat, dyspnea, chest pain, nasal congestion, headache, dizziness, abdominal pain and vomiting.
Lymphophenia (<1.0 x 109 cells/L) was identified in 6 of 10 patients, 9 of 9 patients had a high serum level of D-dimer, and 9 of 9 patients had a high level of C-reactive proteins.
Overall, only three patients had surgery to treat the fracture. The rest had theirs treated nonoperatively because of their compromised health. Four patients died, 3 on day 8 and 1 on day 14 after admission.
“The clinical characteristics and early prognosis of COVID-19 in patients with fracture tended to be more severe than those reported for adult patients with COVID-19 without fracture. This finding may be related to the duration between the development of symptoms and presentation,” the researchers wrote.
“Surgical treatment should be carried out cautiously or nonoperative care should be chosen for patients with fracture in COVID-19 affected areas, especially older individuals with intertrochanteric fractures.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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