Aims

The primary aim of this study was to compare surgical methods (sliding hip screw (SHS) vs intramedullary nailing (IMN)) for trochanteric hip fracture in relation to death within 120 days after surgery and return to independent living. The secondary aim was to assess whether the associations between surgical method and death or ability to return to independent living varied depending on fracture subtype or other patient characteristics.

The global COVID-19 pandemic has resulted in 71 million confirmed global cases and 1.6 million deaths. Hip fractures are a major global health burden with 70 000 admissions per annum in the UK. This multicentre UK study aimed to assess the impact of perioperative COVID-19 status on 30-day and 120-day mortality after a hip fracture. A prospective multicentre study of 10 hospitals in South England comprising eight DGHs and two MTCs treating c.8% of the annual incidence of hip fractures in England was performed. All fragility hip fractures presenting between 1. st. March to 30. th. April 2020 were eligible for inclusion. COVID-19 infection was diagnosed after a positive PCR swab. Expected 30-day mortality was calculated using the Nottingham Hip Fracture Score (NHFS), with non COVID-19 30-day mortality compared against the same study period in 2019. 746 patients were included in this study with 87 (12%) testing positive for COVID-19. Crude 30-day mortality for COVID-19 positive hip fractures was 35% compared to 6% for COVID-19 negative patients, with COVID-19 positive 30-mortality rates being significantly higher than expected based on NHFS alone (RR 3.0, 95% CI 1.57–5.75, p<0.001). There was no significant difference between expected NHFS and actual 2019 and COVID-19 negative hip fracture rates (p>0.05). Overall 120-day mortality was significantly higher for COVID-19 positive (46%) compared to COVID-19 negative (15%) hip fractures (p<0.001). However, mortality rates from 31–120 days were not significantly different despite COVID-19 status (p=0.107). COVID-19 results in significant increases in both 30 and 120-day mortality, above the expected mortality rates when confounding comorbidities are accounted for by the NHFS. However, COVID-19 positive patients who survive beyond 30-days have comparable mortality rates up to 120-days when compared to COVID-19 negative patients. Efforts should therefore be made to mitigate known risks for 30-day mortality such as time to theatre, to improve 30-day mortality rates in COVID-19 positive patients thus increasing the likelihood of long-term survival

Background. Red cell distribution width (RDW), an automated measure of variability in red blood cell size on full blood count (FBC), has recently emerged as a strong independent predictor of mortality in large population studies as well as several disease states. We wanted to determine the prognostic value of RDW in patients following a hip fracture - a condition associated with high mortality. This relationship has not been assessed to date. Methods. We examined the relationship between admission RDW and all-cause mortality on 1-year follow-up, in consecutive hip fracture cases who presented between January 2007 and November 2009. We used Cox regression analysis to adjust for baseline Haemoglobin (Hb), Mean corpuscular Volume (MCV), creatinine, age, gender, ASA grade, Charlson index, pre-morbid independence level, Mental test score (MTS), delay to surgery and post-operative cardio-respiratory complication. Results. Of 577 consecutive patients there were 377 females, 199 males; median age 81.4y. Seventeen (3%) were lost to follow-up at 1-year but were coded as survivor. One-year mortality was 23% overall. Unadjusted mortality was 12%, 15%, 29% and 35% in quartiles of increasing RDW. Along with age, gender, MTS, post-op cardiac or respiratory complication, Charlson index and ASA score, RDW remained a significant independent predictor of 120-day mortality (adjusted hazard ratio (HR): 1.211, 95% CI: 1.062–1.380, p=.004), as well as 1-year mortality (HR: 1.142, 95% CI: 1.032–1.263, p=.01). We repeated analysis excluding those lost to follow-up and this did not alter its predictive value. A third analysis in non-anaemic patients (n=464) showed that RDW remained an independent predictor of mortality on multivariate analysis (HR: 1.201, 95% CI: 1.039–1.389, p=.013). Conclusion. RDW, a widely-available parameter on full blood count, is a significant independent predictor of short and long-term mortality following hip fracture, regardless of age, co-morbidity or anaemia status