Meta-Analysis
Copyright ©The Author(s) 2021.
World J Orthop. Jan 18, 2021; 12(1): 35-50
Published online Jan 18, 2021. doi: 10.5312/wjo.v12.i1.35
Table 1 Search strategy of Medline database
Keyword
Search strategy
No. of hits
COVID, COVID-19, Pandemic, Hip fracture, Trochanter fracture, Femur neck fracture(("COVID"[All Fields] AND ("humans"[MeSH Terms] AND "medline"[Filter] AND "english"[Language]) AND ("humans"[MeSH Terms] AND "medline"[Filter] AND 1000/01/01:2020/08/01[Date - Publication] AND "english"[Language])) OR (("severe acute respiratory syndrome coronavirus 2"[Supplementary Concept] OR "severe acute respiratory syndrome coronavirus 2"[All Fields] OR "ncov"[All Fields] OR "2019 ncov"[All Fields] OR "covid 19"[All Fields] OR "sars cov 2"[All Fields] OR (("coronavirus"[All Fields] OR "cov"[All Fields]) AND 2019/11/01:3000/12/31[Date - Publication])) AND ("humans"[MeSH Terms] AND "medline"[Filter] AND "english"[Language]) AND ("humans"[MeSH Terms] AND "medline"[Filter] AND 1000/01/01:2020/08/01[Date - Publication] AND "english"[Language])) OR (("pandemic s"[All Fields] OR "pandemically"[All Fields] OR "pandemicity"[All Fields] OR "pandemics"[MeSH Terms] OR "pandemics"[All Fields] OR "pandemic"[All Fields]) AND ("humans"[MeSH Terms] AND "medline"[Filter] AND 1000/01/01:2020/08/01[Date - Publication] AND "english"[Language]))) AND ("humans"[MeSH Terms] AND "medline"[Filter] AND 1000/01/01:2020/08/01[Date - Publication] AND "english"[Language]) AND (((("hip fractures"[MeSH Terms] OR ("hip"[All Fields] AND "fractures"[All Fields]) OR "hip fractures"[All Fields] OR ("hip"[All Fields] AND "fracture"[All Fields]) OR "hip fracture"[All Fields]) AND ("humans"[MeSH Terms] AND "medline"[Filter] AND 1000/01/01:2020/08/01[Date - Publication] AND "english"[Language])) OR (("femur"[MeSH Terms] OR "femur"[All Fields] OR "trochanter"[All Fields] OR "trochanters"[All Fields]) AND ("fractur"[All Fields] OR "fractural"[All Fields] OR "fracture s"[All Fields] OR "fractures, bone"[MeSH Terms] OR ("fractures"[All Fields] AND "bone"[All Fields]) OR "bone fractures"[All Fields] OR "fracture"[All Fields] OR "fractured"[All Fields] OR "fractures"[All Fields] OR "fracturing"[All Fields]) AND ("humans"[MeSH Terms] AND "medline"[Filter] AND "english"[Language]) AND ("humans"[MeSH Terms] AND "medline"[Filter] AND 1000/01/01:2020/08/01[Date - Publication] AND "english"[Language])) OR (("femoral neck fractures"[MeSH Terms] OR ("femoral"[All Fields] AND "neck"[All Fields] AND "fractures"[All Fields]) OR "femoral neck fractures"[All Fields] OR ("femur"[All Fields] AND "neck"[All Fields] AND "fracture"[All Fields]) OR "femur neck fracture"[All Fields]) AND ("humans"[MeSH Terms] AND "medline"[Filter] AND 1000/01/01:2020/08/01[Date - Publication] AND "english"[Language]))) AND ("humans"[MeSH Terms] AND "medline"[Filter] AND 1000/01/01:2020/08/01[Date - Publication] AND "english"[Language]))24
Table 2 Demographic properties, fracture type and surgical techniques in hip fractured patients treated during coronavirus disease 2019 and pre-coronavirus disease 2019 times (2020)
Study/country
Macey et al[9]/United Kingdom
Malik-Tabassum et al[38]/United Kingdom
Segarra et al[27]/Spain
Thakrar et al[19]/United Kingdom
Egol et al[20]/United States
Williams et al[28]/United Kingdom
Slullitel et al[39]/Argentina
Karayiannis et al[29]/United Kingdom
Study designRetrospective study with prospective data collectionRetrospective observational studiesLongitudinal prospective cohort studyProspective cohort studyProspective cohort studyRetrospective observational studyRetrospective case-control studyRetrospective case-control study, multicentre
Sample size/ durationPre-COVID76 (20th March 2019-24th April 2019)174 [90 (23rd March 2018-11th May 2018); 84 (23rd March 2019-11th May 2019)]70 (1st February 2019-15th April 2019)99 [51 (15th March 2018-15th April 2018); 48 (15th March 2019-15th April 2019)]115 (1st February 2019-15th April 2019)15 (January 2020)86 (1st December 2019-19th March 2020)266 (18th March 2019-27th April 2019)
COVID76 (20th March 2020-24th April 2020)68 (23rd March 2020-11th May 2020)68 (1st February 2020-15th April 2020)43 (15th March 2020-15th April 2020)138 (1st February 2020-15th April 2020)15 (March 2020)74 (20th March 2020-31st May 2020)203 (18th March 2020-27th April 2020)
COVID +10 (13.16%)1 (1%)2 (2.94%)12 (27.9%)31 (22.5%)0021 (10.35%)
COVID −66 (86.84%)67 (99%)66 (97%)31 (72.1%)107 (77.5%)15 (100%)74 (100%)182 (89.65%)
NOS8 (moderate risk)8 (moderate risk)7 (moderate risk)8 (moderate risk)9 (low risk)7 (moderate risk)8 (moderate risk)7 (moderate risk)
Age (yr)Pre-COVIDMedian: 83 (IQR, 74-88)2018: 82.9 ± 9.9; 2019: 83.8 ± 7.784 ± 7.82018: 81.6 ± 12.3; 2019: 84.0 ± 8.781.5 ± 10.786.6Median: 86 (IQR, 78-90)78.0 ± 12.8
COVIDMedian: 83 (73-87)84.3 ± 8.982.4 ± 7.481.6 ± 11.383.0 ± 10.281.5Median: 86 (IQR, 80–91)81.3 ± 9.7
Sex, M:FPre-COVID58:1837:13718:5225:7434:812:1319:6779:187
COVID58:1825:4321:4723:2050:883:129:6565:138
BMI (kg/m2)Pre-COVIDNMNMNMNM24.6 ± 5.2NMMedian 24 (IQR, 21.7–26.6)NM
COVIDNMNMNMNM24.4 ± 5.1NMMedian 24.5 (IQR, 22.3-27.3)NM
Domicile statusPre-COVIDHome: 58 (79.45%); residential care: 10 (13.69%); hospital: 5 (6.84%)Nursing care: 14 (8.04%); own home/sheltered housing: 135 (77.58%); residential care: 25 (14.36%)NMNMNMNMNMNM
COVIDHome: 61 (80.2%); residential care: 11 (14.47%); hospital: 4 (5.26%)Nursing care: 8 (11.8%); own home/sheltered housing: 52 (76.5%); residential care: 8 (11.8%)NMNMNMNMNMNM
ASA gradePre-COVID1:2 (2.6%); 2:18 (24%); 3:42 (56%); 4:13 (17.3%); 5:0 (0%)1:4 (2.29%); 2:53 (30.4%); 3:98 (56.3%); 4:19 (10.9%)1:0; 2:22 (31.4%); 3:48 (68.6%); 4:0NMNMNM1 and 2: 22 (25.6%); 3 and 4: 64 (74.4%)1 and 2: 66 (25.3%); 3, 4 and 5: 195 (74.7%)
COVID1:2 (2.6%); 2:12 (15.7%); 3:51 (67%); 4:9 (11.8%); 5:2 (2.6%);1:0 (0.0%); 2:17 (25.0%); 3:47 (69.1%); 4:4 (5.9%);1:0; 2: 29 (42.7%); 3:37 (54.4%); 4:2 (2.9%)NMNMNM1 and 2: 12 (16.2%); 3 and 4: 62 (84%)1 and 2: 35 (17.2%); 3, 4 and 5: 168 (82.8%)
AnesthesiaPre-COVIDGA: 51 (69.8%); SA: 22 (30.1%)NMNMNMGA: 78 (70.3%); SA: 33 (29.7%)NMNMGA: 76 (29.1%); SA/nerve block: 185 (70.9%)
COVIDGA: 36 (50%); SA: 36 (50%)NMNMNMGA: 82 (61.2%); SA: 52 (38.8%)NMNMGA: 37 (18.2%); SA/ nerve block: 166 (81.8%)
Time to surgery (h)Pre-COVIDMedian: 20 (IQR, 16-25); 1mean: 20.35 + 6.802018: 26.5 ± 18.7; 2019: 28.2 ± 51.736 ± 38.4NM33.6 ± 19.221.8 (range, 8-48)Median: 16.5 (IQR, 9-30); 1mean 18.61 ± 15.83< 24 h: 56 (21.4%); 24-48 h: 85 (32.6%); > 48 h: 120 (46.0%)
COVIDMedian: 23 (IQR, 18-30); 1mean: 23.7 ± 9.0621.8 ± 12.143.2 ± 31.251.233.6 ± 3635.8 (range, 8.5-79)Median: 24 (IQR, 24-48); 1mean: 32.46 ± 18.14< 24 h: 78 (38.4%); 24-48 h: 92 (45.3%); > 48 h: 33 (16.3%)
Fracture typePre-COVIDFN: 45 (59.2%); IT: 31 (40.7%)FN: 101 (58.0%); IT: 66 (37.9%); ST: 7 (4.02%)NMNMFN: 43 (37.4%); IT: 69 (60.0%); ST: 3 (2.6%)NMIT: 45 (52.33%); FN: 41 (47.67%)FN: 266
COVIDFN: 51 (67.1%); IT: 25 (32.8%)FN: 44 (64.7%); IT: 21 (30.8%); ST: 3(4.41%)NMNMFN: 71 (51.4%); IT: 60 (43.5%); ST: 7 (5.1%)NMFN: 33 (44.59%); IT: 41 (55.41%)FN: 203
Surgical techniquesPre-COVIDNonoperative: 3 (3.9%); DHS: 26 (34.2%); IMN: 9 (11.8%); Hemi A: 31 (40.7%); THA: 7 (9.2%); CRPP: 0 (0%)THA: 12 (6.8%); Hemi A: 77 (44.2%); CCS: 4 (2.29%); DHS: 48 (27.5%); IMN: 31 (17.8%); Nonoperative: 2 (1.14%)Operative: 67 (95.7%); nonoperative: 3 (4.3%)NMIMN: 61 (54.9%); Hemi A: 22 (19.8%); THA: 10 (9.0%); DHS: 10 (9.0%); CRPP: 8 (7.2%); nonoperative: 4 (3.5%)All operative (15)CS: 11 (12.8%); Hemi A: 14 (16.3%); THA: 19 (22.1%); Girdlestone: 1 (1.1%); IMN: 41 (47.7%); nonoperative: 0Hemi A: 115 (44.1%); DHS: 68 (26%); IMN: 43 (16.5%); THA: 35 (13.4%); conservative: 5 (1.9%)
COVIDNonoperative: 3 (3.9%); CRPP: 1 (1.31%); DHS: 14 (18.4%); IMN: 13 (17.1%); Hemi A: 42 (55.2%); THA: 3 (3.9%)Nonoperative: 2 (2.94%); CCS: 3 (4.41%); DHS: 12 (17.64%); IMN: 11 (16.17%); Hemi A: 39 (57.35%); THA: 1 (1.47%)Operative: 64 (94.1%); nonoperative: 4 (5.9%)DHS: -7 (16.27%); CS: 3 (6.9%); Hemi A: 15 (34.8%); IMN: 13 (30.2%); THA: 1 (2.3%); Rev THA: 4 (9.3%)IMN: 64 (46.3%); Hemi A: 42 (31.3%); THA: 6 (4.5%); DHS: 7 (5.2%); CRPP: 15 (11.2%); nonoperative: 4 (2.9%)Operative:14; 1 patient expired before surgeryCS: 2 (2.75%); Hemi A: 20 (27%); THA: 10 (13.5%); Girdlestone: 0; IMN: 41 (55.4%); nonoperative: 1 (1.35%)Hemi A:113 (55.7); DHS: 47 (23.1%); IMN: 36 (17.7%); THA: 7 (3.4%); conservative: 0
Table 3 Mortality and complications in hip-fractured patients treated during coronavirus disease 2019 and pre-coronavirus disease 2019 times (2020)
Study/country
Macey et al[9]/United Kingdom
Malik-Tabassum et al[38]/United Kingdom
Segarra et al[27]/Spain
Thakrar et al[19]/United Kingdom
Egol et al[20]/United States
Williams et al[28]/United Kingdom
Slullitel et al[39]/Argentina
Karayiannis et al[29]/United Kingdom
30-d mortalityPre-COVID10 (13%)12 (6.89%)9 (12.9%)6 (6.06%)3 (2.7%)1 (6.6%)016 (6%)
COVID11 (14%)6 (8.8%)8 (11.8%)7 (16.3%)17 (12.3%)2 (13.3%)8 (10.8%)7 (3.4%)
COVID +2 (20%)1 (100%)NM4 (33%)9 (52.9%) + 2 (14.3%); Total-11 (35.4%)NMNM4 (57.14%)
COVID −9 (13.6%)5 (7.4%)NM3 (9.6%)6 (5.6%)NMNM3 (42.86%)
In-patient mortalityPre-COVIDNM11 (6.32%)NMNM1 (0.9%)NMNMNM
COVIDNM4 (5.9%)NMNM8 (5.8%)NMNMNM
Length of hospital stay (d)Pre-COVIDMedian: 12 (range, 7-26); 1mean: 14.25 ± 3.172018: 15.8 ± 11.4; 2019: 16.3 ± 11.4NMNM5.8 ± 3.711.7Median: 5 (IQR, 4-7); 1mean: 5.35 ± 2.26NM
COVIDMedian: 11.5 (range, 6-22); 1mean: 12.75 ± 2.678.6 ± 4.6NMNM5.8 ± 3.86.2Median: 6 (IQR, 5-8); 1mean: 6.35 ± 2.26NM
Major complicationsPre-COVID11 (14.5%)17 (9.7%)NMNM10 (8.7%)NM10 (11.6%)NM
COVID17 (22.4%)3 (4.5%)NMNM28 (20.3%)NM16 (21.6%)NM
Pulmonary complications/pneumonia/ respiratory infectionPre-COVID8 (10.95%)NMNMNMNM2 (13.3%)2 (2.32%)NM
COVID 15 (20.54%)NMNMNMNM00NM
Deep vein thrombus/pulmonary embolismPre-COVID1 (1.36%)2 (1.14%)NMNMNMNM0NM
COVID01 (1.47%)NMNMNMNM5 (6.75%)NM