{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T08:28:57Z","timestamp":1782980937840,"version":"3.54.5"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,4,5]],"date-time":"2021-04-05T00:00:00Z","timestamp":1617580800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,4,5]],"date-time":"2021-04-05T00:00:00Z","timestamp":1617580800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Orthop Traumatol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Treatment of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic has posed unique challenges for the management of COVID-19-infected patients and the maintenance of standards of care. The primary endpoint of this study is to compare the mortality rate at 1\u00a0month after surgery in symptomatic COVID-positive patients with that of asymptomatic patients. A secondary endpoint of the study is to evaluate, in the two groups of patients, mortality at 1\u00a0month on the basis of type of fracture and type of surgical treatment.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials and methods<\/jats:title>\n                <jats:p>For this retrospective multicentre study, we reviewed the medical records of patients hospitalised for proximal femur fracture at 14 hospitals in Northern Italy. Two groups were formed: COVID-19-positive patients (C+\u2009group) presented symptoms, had a positive swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and received treatment for COVID-19; COVID-19-negative patients (C\u2212 group) were asymptomatic and tested negative for SARS-CoV-2. The two groups were compared for differences in time to surgery, survival rate and complications rate. The follow-up period was 1\u00a0month.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of the 1390 patients admitted for acute care for any reason, 477 had a proximal femur fracture; 53 were C+\u2009but only 12\/53 were diagnosed as such at admission. The mean age was\u2009&gt;\u200980\u00a0years, and the mean American Society of Anesthesiologists (ASA) score was 3 in both groups. There was no substantial difference in time to surgery (on average, 2.3\u00a0days for the C+\u2009group and 2.8 for the C\u2212 group). As expected, a higher mortality rate was recorded for the C+\u2009group but not associated with the type of hip fracture or treatment. No correlation was found between early treatment (&lt;\u200948\u00a0h to surgery) and better outcome in the C+\u2009group.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Hip fracture in COVID-19-positive patients accounted for 11% of the total. On average, the time to surgery was\u2009&gt;\u200948\u00a0h, which reflects the difficulty of maintaining normal workflow during a medical emergency such as the present pandemic and notwithstanding the suspension of non-urgent procedures. Hip fracture was associated with a higher 30-day mortality rate in COVID-19-positive patients than in COVID-19-negative patients. This fact should be considered when communicating with patients and\/or their family. Our data suggest no substantial difference in hip fracture management between patients with or without COVID-19 infection. In this sample, the COVID-19-positive patients were generally asymptomatic at admission; therefore, routine screening is recommended.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Level of evidence<\/jats:title>\n                <jats:p>Therapeutic study, level 4.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s10195-021-00577-9","type":"journal-article","created":{"date-parts":[[2021,4,5]],"date-time":"2021-04-05T15:02:40Z","timestamp":1617634960000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Early mortality in hip fracture patients admitted during first wave of the COVID-19 pandemic in Northern Italy: a multicentre study"],"prefix":"10.1186","volume":"22","author":[{"given":"Dante","family":"Dallari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6687-2029","authenticated-orcid":false,"given":"Luigi","family":"Zagra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Cimatti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Guindani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rocco","family":"D\u2019Apolito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Bove","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Casiraghi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Catani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"D\u2019Angelo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Franceschini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Mass\u00e8","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Momoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Mosconi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavio","family":"Ravasi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Rivera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Zatti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio Carlo","family":"Castelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,4,5]]},"reference":[{"key":"577_CR1","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1016\/j.surge.2017.11.001","volume":"16","author":"HQ Sheikh","year":"2018","unstructured":"Sheikh HQ, Aqil A, Hossain FS, Kapoor H (2018) There is no weekend effect in hip fracture surgery-a comprehensive analysis of outcomes. Surgeon 16:259\u2013264. https:\/\/doi.org\/10.1016\/j.surge.2017.11.001","journal-title":"Surgeon"},{"key":"577_CR2","doi-asserted-by":"publisher","first-page":"1994","DOI":"10.1001\/jama.2017.17606","volume":"318","author":"D Pincus","year":"2017","unstructured":"Pincus D, Ravi B, Wasserstein D et\u00a0al (2017) Association between wait time and 30-day mortality in adults undergoing hip fracture surgery. JAMA 318:1994\u20132003. https:\/\/doi.org\/10.1001\/jama.2017.17606","journal-title":"JAMA"},{"key":"577_CR3","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1186\/s12891-019-2637-6","volume":"20","author":"CT Pollmann","year":"2019","unstructured":"Pollmann CT, R\u00f8tterud JH, Gjertsen J-E et\u00a0al (2019) Fast track hip fracture care and mortality \u2212 an observational study of 2230 patients. BMC Musculoskelet Disord 20:248. https:\/\/doi.org\/10.1186\/s12891-019-2637-6","journal-title":"BMC Musculoskelet Disord"},{"key":"577_CR4","doi-asserted-by":"publisher","first-page":"483","DOI":"10.2106\/JBJS.D.01796","volume":"87","author":"CG Moran","year":"2005","unstructured":"Moran CG, Wenn RT, Sikand M, Taylor AM (2005) Early mortality after hip fracture: is delay before surgery important? JBJS 87:483\u2013489. https:\/\/doi.org\/10.2106\/JBJS.D.01796","journal-title":"JBJS"},{"key":"577_CR5","doi-asserted-by":"publisher","first-page":"124","DOI":"10.3109\/17453674.2013.775044","volume":"84","author":"M Westberg","year":"2013","unstructured":"Westberg M, Snorrason F, Frihagen F (2013) Preoperative waiting time increased the risk of periprosthetic infection in patients with femoral neck fracture. Acta Orthop 84:124\u2013129. https:\/\/doi.org\/10.3109\/17453674.2013.775044","journal-title":"Acta Orthop"},{"key":"577_CR6","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-020-04637-3","author":"F Benazzo","year":"2020","unstructured":"Benazzo F, Rossi SMP, Maniscalco P et\u00a0al (2020) The orthopaedic and traumatology scenario during Covid-19 outbreak in Italy: chronicles of a silent war. Int Orthop. https:\/\/doi.org\/10.1007\/s00264-020-04637-3","journal-title":"Int Orthop"},{"issue":"1","key":"577_CR7","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1186\/s13018-020-01816-1.PMID:32795347;PMCID:PMC7426894","volume":"15","author":"F Luceri","year":"2020","unstructured":"Luceri F, Morelli I, Accetta R, Mangiavini L, Maffulli N, Peretti GM (2020) Italy and COVID-19: the changing patient flow in an orthopedic trauma center emergency department. J Orthop Surg Res 15(1):323. https:\/\/doi.org\/10.1186\/s13018-020-01816-1.PMID:32795347;PMCID:PMC7426894","journal-title":"J Orthop Surg Res"},{"key":"577_CR8","unstructured":"World Health Organization. https:\/\/www.who.int. Accessed 20 Dec 2020."},{"key":"577_CR9","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-020-04590-1","author":"L Zagra","year":"2020","unstructured":"Zagra L, Faraldi M, Pregliasco F et\u00a0al (2020) Changes of clinical activities in an orthopaedic institute in North Italy during the spread of COVID-19 pandemic: a seven-week observational analysis. Int Orthop. https:\/\/doi.org\/10.1007\/s00264-020-04590-1","journal-title":"Int Orthop"},{"key":"577_CR10","doi-asserted-by":"publisher","first-page":"m1198","DOI":"10.1136\/bmj.m1198","volume":"368","author":"RE Jordan","year":"2020","unstructured":"Jordan RE, Adab P, Cheng KK (2020) Covid-19: risk factors for severe disease and death. BMJ 368:m1198. https:\/\/doi.org\/10.1136\/bmj.m1198","journal-title":"BMJ"},{"key":"577_CR11","doi-asserted-by":"publisher","first-page":"1533","DOI":"10.1152\/japplphysiol.00335.2020","volume":"128","author":"LH Gargaglioni","year":"2020","unstructured":"Gargaglioni LH, Marques DA (2020) Let\u2019s talk about sex in the context of COVID-19. J Appl Physiol 128:1533\u20131538. https:\/\/doi.org\/10.1152\/japplphysiol.00335.2020","journal-title":"J Appl Physiol"},{"key":"577_CR12","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1111\/joim.13091","volume":"288","author":"G Pascarella","year":"2020","unstructured":"Pascarella G, Strumia A, Piliego C et\u00a0al (2020) COVID-19 diagnosis and management: a comprehensive review. J Intern Med 288:192\u2013206. https:\/\/doi.org\/10.1111\/joim.13091","journal-title":"J Intern Med"},{"issue":"1","key":"577_CR13","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1186\/s13018-020-01702-w","volume":"15","author":"L Cipollaro","year":"2020","unstructured":"Cipollaro L, Giordano L, Padulo J, Oliva F, Maffulli N (2020) Musculoskeletal symptoms in SARS-CoV-2 (COVID-19) patients. J Orthop Surg Res 15(1):178. https:\/\/doi.org\/10.1186\/s13018-020-01702-w","journal-title":"J Orthop Surg Res"},{"key":"577_CR14","doi-asserted-by":"publisher","first-page":"922","DOI":"10.1302\/0301-620X.91B7.22446","volume":"91","author":"KA Lefaivre","year":"2009","unstructured":"Lefaivre KA, Macadam SA, Davidson DJ et\u00a0al (2009) Length of stay, mortality, morbidity and delay to surgery in hip fractures. J Bone Joint Surg Br 91:922\u2013927. https:\/\/doi.org\/10.1302\/0301-620X.91B7.22446","journal-title":"J Bone Joint Surg Br"},{"key":"577_CR15","doi-asserted-by":"publisher","first-page":"2053","DOI":"10.1001\/archinte.162.18.2053","volume":"162","author":"VA Lawrence","year":"2002","unstructured":"Lawrence VA, Hilsenbeck SG, Noveck H et\u00a0al (2002) Medical complications and outcomes after hip fracture repair. Arch Intern Med 162:2053\u20132057. https:\/\/doi.org\/10.1001\/archinte.162.18.2053","journal-title":"Arch Intern Med"},{"key":"577_CR16","doi-asserted-by":"publisher","first-page":"3001","DOI":"10.1007\/s00198-016-3624-5","volume":"27","author":"H Lv","year":"2016","unstructured":"Lv H, Yin P, Long A et\u00a0al (2016) Clinical characteristics and risk factors of postoperative pneumonia after hip fracture surgery: a prospective cohort study. Osteoporos Int 27:3001\u20133009. https:\/\/doi.org\/10.1007\/s00198-016-3624-5","journal-title":"Osteoporos Int"},{"issue":"1","key":"577_CR17","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1186\/s13018-020-01800-9","volume":"15","author":"I Morelli","year":"2020","unstructured":"Morelli I, Luceri F, Giorgino R, Accetta R, Perazzo P, Mangiavini L, Maffulli N, Peretti GM (2020) COVID-19: not a contraindication for surgery in patients with proximal femur fragility fractures. J Orthop Surg Res 15(1):285. https:\/\/doi.org\/10.1186\/s13018-020-01800-9","journal-title":"J Orthop Surg Res"},{"key":"577_CR18","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1097\/BOT.0000000000001845","volume":"34","author":"KA Egol","year":"2020","unstructured":"Egol KA, Konda SR, Bird ML et\u00a0al (2020) Increased mortality and major complications in hip fracture care during the COVID-19 pandemic: a New York City perspective. J Orthop Trauma 34:395\u2013402. https:\/\/doi.org\/10.1097\/BOT.0000000000001845","journal-title":"J Orthop Trauma"},{"key":"577_CR19","doi-asserted-by":"publisher","first-page":"89","DOI":"10.23750\/abm.v91i2.9636","volume":"91","author":"P Maniscalco","year":"2020","unstructured":"Maniscalco P, Poggiali E, Quattrini F et\u00a0al (2020) Proximal femur fractures in COVID-19 emergency: the experience of two Orthopedics and Traumatology departments in the first eight weeks of the Italian epidemic. Acta Biomed 91:89\u201396. https:\/\/doi.org\/10.23750\/abm.v91i2.9636","journal-title":"Acta Biomed"},{"key":"577_CR20","doi-asserted-by":"publisher","first-page":"1136","DOI":"10.1302\/0301-620X.102B9.BJJ-2020-1127.R1","volume":"102-B","author":"B Kayani","year":"2020","unstructured":"Kayani B, Onochie E, Patil V et\u00a0al (2020) The effects of COVID-19 on perioperative morbidity and mortality in patients with hip fractures. Bone Joint J. 102-B:1136\u20131145. https:\/\/doi.org\/10.1302\/0301-620X.102B9.BJJ-2020-1127.R1","journal-title":"Bone Joint J"},{"key":"577_CR21","doi-asserted-by":"publisher","first-page":"e194","DOI":"10.3928\/01477447-20140124-25","volume":"37","author":"JMTA Meessen","year":"2014","unstructured":"Meessen JMTA, Pisani S, Gambino ML et\u00a0al (2014) Assessment of mortality risk in elderly patients after proximal femoral fracture. Orthopedics 37:e194-200. https:\/\/doi.org\/10.3928\/01477447-20140124-25","journal-title":"Orthopedics"},{"key":"577_CR22","doi-asserted-by":"publisher","first-page":"1807","DOI":"10.2105\/ajph.84.11.1807","volume":"84","author":"RA Marottoli","year":"1994","unstructured":"Marottoli RA, Berkman LF, Leo-Summers L, Cooney LM (1994) Predictors of mortality and institutionalization after hip fracture: the New Haven EPESE cohort. Established populations for epidemiologic studies of the elderly. Am J Public Health 84:1807\u20131812. https:\/\/doi.org\/10.2105\/ajph.84.11.1807","journal-title":"Am J Public Health"},{"key":"577_CR23","doi-asserted-by":"publisher","first-page":"100331","DOI":"10.1016\/j.eclinm.2020.100331","volume":"21","author":"S Lei","year":"2020","unstructured":"Lei S, Jiang F, Su W et\u00a0al (2020) Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. E Clin Med 21:100331. https:\/\/doi.org\/10.1016\/j.eclinm.2020.100331","journal-title":"E Clin Med"},{"key":"577_CR24","first-page":"117","volume":"6","author":"M Innocenti","year":"2009","unstructured":"Innocenti M, Civinini R, Carulli C, Matassi F (2009) Proximal femural fractures: epidemiology. Clin Cases Miner Bone Metab 6:117\u2013119","journal-title":"Clin Cases Miner Bone Metab"}],"container-title":["Journal of Orthopaedics and Traumatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s10195-021-00577-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s10195-021-00577-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s10195-021-00577-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,5]],"date-time":"2021-04-05T15:02:45Z","timestamp":1617634965000},"score":1,"resource":{"primary":{"URL":"https:\/\/jorthoptraumatol.springeropen.com\/articles\/10.1186\/s10195-021-00577-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,5]]},"references-count":24,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["577"],"URL":"https:\/\/doi.org\/10.1186\/s10195-021-00577-9","relation":{},"ISSN":["1590-9921","1590-9999"],"issn-type":[{"value":"1590-9921","type":"print"},{"value":"1590-9999","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,5]]},"assertion":[{"value":"10 January 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 March 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 April 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the institutional review board of the principal study centre (Bergamo), which collected the data from the other centres in aggregated and anonymous form. All procedures were performed in accordance with the ethical standards of the institutional committee and the tenets of the 1964 Helsinki Declaration and its later amendments.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"15"}}