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

Document Type : RESEARCH PAPER


1 1 Department of Trauma and Orthopeadics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom 2 School of Clinical Medicine, University Of Cambridge, Cambridge, United Kingdom

2 Department of Trauma and Orthopeadics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom

3 Department of Trauma and Orthopeadics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom- Department of Orthogeriatrics, Addenbrookes Hospital, United Kingdom


Background: The aim of this study was to investigate the impact of the COVID-19 pandemic on the management and
outcome of patients with neck of femur fractures.
Methods: Data was collected for 96 patients with neck of femur fractures who presented to the emergency department
between 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 opportunities
were compared between the COVID-19 positive and COVID-19 negative groups. Furthermore, our current cohort of
patients were compared against a historical control group of 95 patients who presented with neck of femur fractures
before the COVID-19 pandemic.
Results: Seven (7.3%) patients were confirmed COVID positive by RT-PCR testing. The COVID positive cohort, when
compared to the COVID negative cohort, had higher rates of postoperative complications (71.4% vs 25.9%), increased
length 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%), increased
number of delayed cases (25% vs 11.8%) as well as reduced training opportunities for Orthopaedic trainees to perform
the surgery (51.6% vs 22.8%).
Conclusion: COVID-19 has had a profound impact on the care and outcome of neck of femur fracture patients during
the pandemic with an increase in 30-day mortality rate. There were profound adverse effects on patient management
pathways and outcomes while also affecting training opportunities.
Level of evidence: VI


1. Varacallo M, Seaman TJ, Jandu JS, Pizzutillo P.
Osteopenia. StatPearls. Treasure Island (FL): StatPearls
Publishing Copyright © 2020, StatPearls Publishing
LLC.; 2020.
2. Porter JL, Varacallo M. Osteoporosis. StatPearls.
Treasure Island (FL): StatPearls Publishing Copyright
© 2020, StatPearls Publishing LLC.; 2020.
3. Veronese N, Maggi S. Epidemiology and social costs
of hip fracture. Injury. 2018;49(8):1458-60.
4. Crist BD, Eastman J, Lee MA, Ferguson TA, Finkemeier
CG. Femoral Neck Fractures in Young Patients. Instr
Course Lect. 2018;67:37-49.
5. Mao R, Liang J, Shen J, Ghosh S, Zhu LR, Yang H, et
al. Implications of COVID-19 for patients with preexisting
digestive diseases. Lancet Gastroenterol
Hepatol. 2020;5(5):425-7.
6. WHO. Coronavirus disease (COVID-19) pandemic 2020
[Available from:
7. Ramanathan K, Antognini D, Combes A, Paden M,
Zakhary B, Ogino M, et al. Planning and provision of
ECMO services for severe ARDS during the COVID-19
pandemic and other outbreaks of emerging infectious
diseases. Lancet Respir Med. 2020;8(5):518-26.
8. Awad ME, Rumley JCL, Vazquez JA, Devine JG.
Perioperative Considerations in Urgent Surgical
Care of Suspected and Confirmed COVID-19
Orthopaedic Patients: Operating Room Protocols and
Recommendations in the Current COVID-19 Pandemic.
J Am Acad Orthop Surg. 2020;28(11):451-63.
9. DePhillipo NN, Larson CM, O’Neill OR, LaPrade RF.
Guidelines for Ambulatory Surgery Centers for
the Care of Surgically Necessary/Time-Sensitive
Orthopaedic Cases During the COVID-19 Pandemic.
J Bone Joint Surg Am. 2020;102(11):933-6.
10. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC,
Vandenbroucke JP. The Strengthening the Reporting
of Observational Studies in Epidemiology (STROBE)
statement: guidelines for reporting observational
studies. J Clin Epidemiol. 2008;61(4):344-9.
11. Baker T, Schell CO, Petersen DB, Sawe H, Khalid K,
Mndolo S, et al. Essential care of critical illness must
not be forgotten in the COVID-19 pandemic. Lancet
(London, England). 2020;395(10232):1253-4.
12. Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19
in elderly patients: A comparison with young and
middle-aged patients. J Infect. 2020;80(6):e14-e8.
13. Lei S, Jiang F, Su W, Chen C, Chen J, Mei W, et al. Clinical
characteristics and outcomes of patients undergoing
surgeries during the incubation period of COVID-19
infection. EClinicalMedicine. 2020;21:100331.
14. Aminian A, Safari S, Razeghian-Jahromi A, Ghorbani
M, Delaney CP. COVID-19 Outbreak and Surgical 
Practice: Unexpected Fatality in Perioperative
Period. Ann Surg. 2020.
15. Tay MZ, Poh CM, Rénia L, MacAry PA, Ng LFP. The
trinity of COVID-19: immunity, inflammation and
intervention. Nat Rev Immunol. 2020;20(6):363-74.
16. Zhang W, Zhao Y, Zhang F, Wang Q, Li T, Liu Z,
et al. The use of anti-inflammatory drugs in the
treatment of people with severe coronavirus
disease 2019 (COVID-19): The Perspectives of
clinical immunologists from China. Clin Immunol.
17. Kuo CL, Pilling LC, Atkins JL, Masoli JAH, Delgado J,
Kuchel GA, et al. APOE e4 genotype predicts severe
COVID-19 in the UK Biobank community cohort. J
Gerontol A Biol Sci Med Sci. 2020.
18. BOAST. Management of patients with urgent
orthopaedic conditions and trauma during the
coronavirus pandemic 2020 [Available from:
19. Delgado A, Cordero GGE, Marcos S, Cordero-Ampuero
J. Influence of cognitive impairment on mortality,
complications and functional outcome after hip
fracture: Dementia as a risk factor for sepsis and
urinary infection. Injury. 2020;51 Suppl 1:S19-s24.
20. BGS. Managing Hip Fractures during COVID19 2020
[Available from:
21. Pincus D, Ravi B, Wasserstein D, Huang A, Paterson
JM, Nathens AB, et al. Association Between Wait
Time and 30-Day Mortality in Adults Undergoing Hip
Fracture Surgery. Jama. 2017;318(20):1994-2003.
22. Muñoz Vives JM, Jornet-Gibert M, Cámara-Cabrera
J, Esteban PL, Brunet L, Delgado-Flores L, et al.
Mortality Rates of Patients with Proximal Femoral
Fracture in a Worldwide Pandemic: Preliminary
Results of the Spanish HIP-COVID Observational
Study. J Bone Joint Surg Am. 2020.
23. Egol KA, Konda SR, Bird ML, Dedhia N, Landes EK,
Ranson RA, et al. Increased Mortality and Major
Complications in Hip Fracture Care During the
COVID-19 Pandemic: A New York City Perspective.
Journal of Orthopaedic Trauma. 2020;Publish Ahead
of Print.
24. Morrissey N, Iliopoulos E, Osmani AW, Newman K.
Neck of femur fractures in the elderly: Does every
hour to surgery count? Injury. 2017;48(6):1155-8.
25. RCS. COVID-19: Good Practice for Surgeons and
Surgical Teams 2020 [Available from] https://www.