The epidemiology of proximal femur fractures during COVID-19 emergency in Italy: a multicentric study.

BACKGROUND AND AIM: After the first Italian case of Covid-19, the Government imposed the complete closure of all areas involved by the spread of the virus to contain transmissions. There was a massive reorganization of Hospitals, a stop of all elective activities and a convertion of many hospitals in "Covid Centers''. AITOG (Associazione Italiana Traumatologia e Ortopedia Geriatrica) conducted a retrospective study on all proximal femur fractures surgeries that occurred in this period, to find out whether the pandemic and the correlated lockdown somehow changed the incidence of these events.  Methods: 10 Italian orthopedic centers were involved in the study. Considering the geographic location, three groups were created (North, Centre and South). The considered period is the Italian "Phase 1" (February 23rd - May 3rd 2020). RESULTS: the cohort is composed of 412 patients, 116 male and 296 female (mean age 81.1 ± 9.1 years). The same period of 2019 has been used as control group, with 558 patients, 156 male and 402 female (mean age 84.2 ± 8.0 years). In 2020 we counted 323 (78.4%) fractures occurred at home, 61 (14.8%) in retirement houses and 28 (6.8%) in different locations. We mainly treated fractures with intramedullary nails (n.237 57.5%). Among all patients we had 46 (11.1%) Covid-19 positive. The mortality rate within 30 days was of 51 patients (12.4%); 23 of these died because of complications related to Covid-19 while 31 of  these were in treatment with anticoagulant/antiaggregant. CONCLUSIONS: AITOG analysis demonstrates a decrease in surgical interventions for proximal femur fractures from 2019 to 2020, a reduction in patients mean age and an increase in trauma occurred in domestic environment. We also registered a consistent difference between the North, Center and South of the Country.

Preliminary experience in the treatment of hip necrosis with BIOS screws associated with growth factors.

ntroduction: In this paper we present the preliminary results obtained in our clinic with the use of BIOS screws associated with injection of growth factors in the treatment of cephalic necrosis of the femoral head. MATERIALS AND METHODS: In the division of Orthopedics and Traumatology at Guglielmo da Saliceto" hospital in Piacenza were treated between 2012 and 2016 with the proposed technique 8 case of necrosis of the femoral head in 6 patients with a mean age of 41.8 years (between 31 and 60 years). All patients before surgery were affected by debilitating pain with VAS greater than 7 and functional limitation of the range of motion of the hip. In all patients was performed a decompression of the femoral head using cannulated screws BIOS and injection through the implants of growth factors. RESULTS: Our results have been extremely positive. All patients treated at two months have reported the resolution of the pain that affected them before surgery and the recovery of the function of the hip. At the last clinical control carried out no patient experienced recurrence of any symptoms related to necrosis. DISCUSSION: Cephalic necrosis due to various possible etiologies is a not so rare condition, often affecting young patients with high functional demands. Only few years ago the gold standard treatment for this kind of pathological condition was hip prosthesis and this fact was associated with long term complications related with the young age of patients. The treatment presented is simple, fast and very effective in allowing the penetration of growth factors through bony trabeculae of the femoral head, due to the fenestratures inside the screws. The results obtained in our experience are certainly promising, though longer follow-up is needed to evaluate the functional outcome long and to evaluate the possible re-emergence of pain. CONCLUSION: Conservative treatment using BIOS screws associated with growth factors in femoral head necrosis in our experience combine a low invasiveness to excellent functional results and should therefore be considered a valid option in treating this pathology in young patients.