Aims

Hip fracture commonly affects the frailest patients, of whom many are care-dependent, with a disproportionate risk of contracting COVID-19. We examined the impact of COVID-19 infection on hip fracture mortality in England.

Hip fracture principally affects the frailest in society, many of whom are care dependent, and are disproportionately at risk of contracting COVID-19. We examined the impact of COVID-19 infection on hip fracture mortality in England.

We conducted a cohort study of patients with hip fracture recorded in the National Hip Fracture Database between 1st February 2019 and 31st October 2020, in England. Data were linked to Hospital Episode Statistics to quantify patient characteristics and comorbidities, Office for National Statistics mortality data, and Public Health England's SARS-CoV-2 testing results. Multivariable Cox regression examined determinants of 90-day mortality. Excess mortality attributable to COVID-19 was quantified using Quasi-Poisson models.

Analysis of 102,900 hip fractures (42,630 occurring during the pandemic) revealed that amongst those with COVID-19 infection at presentation (n=1,120) there was a doubling of 90-day mortality; hazard ratio (HR) 2.05 (95%CI 1.86–2.26), while for infections arising between 8–30 days after presentation (n=1,644) the figure was even higher at 2.52 (2.32–2.73). Malnutrition [1.44 (1.19–1.75)] and non-operative treatment [2.89 (2.16–3.86)] were the only modifiable risk factors for death in COVID-19 positive patients. Patients with previous COVID-19 initially had better survival compared to those who contracted COVID-19 around the time of their hip fracture; however, survival rapidly declined and by 365 days the combination of hip fracture and COVID-19 infection was associated with a 50% mortality rate. Between 1st January and 30th June 2020, 1,273 (99.7%CI 1,077–1,465) excess deaths occurred within 90 days of hip fracture, representing an excess mortality of 23% (20%–26%), with most deaths occurring within 30 days.

COVID-19 infection more than doubled early hip fracture mortality; the first 30-days after injury were most critical, suggesting that targeted interventions in this period may have most benefit in improving survival.

High energy chest trauma resulting in flail chest injury is associated with increased rates of patient morbidity. Operative fixation of acute rib fractures is thought to reduce morbidity by reducing pain and improving chest mechanics enabling earlier ventilator weaning.

A variety of operative techniques have been described and we report on our unit's experience of acute rib fracture fixation. Over 18 months, 10 patients have undergone acute rib fracture fixation. Outcome measures included; patient demographics, time ventilated pre-operatively, time ventilated post-operatively and time spent on ITU/HDU post operatively.

The mean time from presentation to surgery was 5 days (range 2–12 days). The mean time ventilated post operatively was 2 days (range 1–4 days) and the mean number of days spent on ITU/HDU post-operatively was 6 days (range 2–11 days).

Our results appear positive in terms of time spent ventilated post-operatively but no conclusion can be drawn as we have no comparable non-operative group. We have however shown, that rib fracture fixation can be carried out successfully and safely in a trauma centre. Further evidence on rib fracture fixation is required from a large, multi-centre randomised controlled trial.

Aims: Bone and soft tissue tumours not infrequently arise from the chest wall. Resection may require removal of ribs and reconstruction using mesh, biological materials such as lyophylised pig skin and muscle flaps. The purpose of this study was to review the experience of our multidisciplinary team in the management of chest wall resections for bone and soft tissue tumours. Patients and methods: This was a retrospective review of patient records. Between 2001 and 2005, 20 patients of mean age 50.3 years (13 to 92) underwent resections involving the chest wall. Ten were male.

Results: The diagnosis was chondrosarcoma in 8, osteosarcoma in 3, PNET/Ewings in 2, MPNST in 2, sarcoma NOS in 2, and one each of leiomyosarcoma, pleomorphic MFH, and metastatic renal carcinoma. 15 patients underwent rib resection, four sternal resections and one tumour of the clavicle was removed with the underlying rib. In 3 cases a latissimus dorsi flap was used as part of the chest wall reconstruction. The surgical margins were intralesional in 5, marginal in 11 and wide in 4 cases. Two patients died following a complication of treatment. Four patients died at a mean of 6 months (4 to 8 months) from metastatic disease. Two patients had local recurrence. At a mean follow up of 26 months (4 to 58) twelve patients were alive without evidence of disease, and two were alive with metastatic disease.

Conclusion: Chest wall resection for malignant bone or soft tissue tumours is feasible and can be achieved safely. However, there is a significant mortality rate associated with this procedure. This procedure demonstrates par excellence the value of multidisciplinary team working. Local anatomical constraints may mean that achieving a wide surgical margin is not always possible.