Mi B, Chen L, Xiong Y, Xue H, Zhou W, Liu G. Characteristics and Early Prognosis of COVID-19 Infection in Fracture Patients. 

J Bone Joint Surg Am. 2020;102(9):750‐758.
doi:10.2106/JBJS.20.00390

Summary by Paul D. Minetos, MD, MBA

Patients with fractures, especially lower-limb fractures and fractures that impair ambulation, are particularly susceptible to pulmonary infection.^1,2 Given the large number of confirmed diagnoses of COVID-19 and its potentially devastating pulmonary consequences,^3-6 surgeons face new challenges in the treatment of patients with severe fractures that require hospitalization. This study sought to elucidate management strategies for these patients by analyzing the clinical data of fracture patients with concomitant COVID-19 infection.

In this retrospective review, the authors analyzed medical records of 10 patients (mean age = 68.4 years) across eight hospitals in the Hubei Province of the People’s Republic of China admitted between January 1^st and February 27^th, 2020. These patients presented with fracture caused by accidents, nine of which were low-velocity and one which was a high-velocity traffic accident. All 10 patients were diagnosed with COVID-19 pneumonia, seven of which were nosocomial infections and three of which had contracted the virus prior to admission. The most common symptoms were fever, cough, and fatigue (7/10 patients each). Lymphopenia (<1.0 x 10⁹ cells/L) occurred in 6/10 patients, elevated D-dimer in 9/9 tested patients, and elevated CRP in 9/9 tested patients. Of three patients that underwent surgery, one died (post-operative day 11), while others were managed non-operatively due to compromised status. A total of three patients died on hospital day 8 and one patient died on hospital day 14.

Clinical characteristics and early prognosis of COVID-19 infection in patients with fracture tended to be more severe than those of patients with COVID-19 infection and no fracture. Timing of surgery is an important consideration for management of severe fractures, especially with respect to hip fractures in the elderly.⁷ However, non-operative management should be the preferred treatment modality for patients with fracture in COVID-19-affected areas given severity of COVID-19 pneumonia and the possibility of nosocomial infection. Surgical treatment should be approached cautiously, especially in elderly populations. Limitations of this study include small sample size and the lack of clinical outcomes for surviving patients at the time of publication.

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