BACKGROUND: Proximal femoral fractures are severe injuries in geriatric patients. Additionally, geriatric patients are at a high risk of death due to coronavirus disease 2019 (COVID-19). OBJECTIVE: To identify predictors of mortality in geriatric patients with COVID-19 and concurrent proximal femoral fractures. MATERIAL AND METHODS: Patients who underwent surgical treatment for proximal femoral fractures and also tested positive for COVID-19 were included. The age, gender, the American Society of Anesthesiology (ASA) score and the admission from a nursing home were considered as variables. The rate of reoperations, the mortality at 3 months and discharge home were evaluated as outcomes. RESULTS: In this study 46 patients with COVID-19 (female/male 31/15, median age 87.0 years with an interquartile range [IQR] of 9.8 years) met the inclusion criteria. Of these, 32 patients (69.6%) had to be cared for in the intensive care unit and 26 patients (56.5%) had a severe course of COVID-19 with pneumonia. The median length of hospital stay for survivors was 19 (IQR 17.5) days and 4 of the patients (8.7%) required surgical revision. The in-hospital and 3‑month mortality were 40.0% (n = 17) and 43.5% (n = 20), respectively. The factors which influenced the in-hospital and 3‑month mortality rates were admission from a nursing home, the presence of pneumonia (increased the risk of death) and female gender (protective). CONCLUSION: The occurrence of COVID-19 in patients with proximal femoral fractures has a high mortality. Admission from a nursing home and the presence of pneumonia increased the risk of death, whereas women were at lower risk.

ZUSAMMENFASSUNG: HINTERGRUND: Proximale Femurfrakturen (PFF) sind schwere Verletzungen bei geriatrischen Patienten. Darüber hinaus besteht für geriatrische Patienten ein hohes Risiko, an COVID-19 zu sterben. ZIEL DER ARBEIT: Ermittlung von Prädiktoren für die Mortalität bei geriatrischen Patienten mit COVID-19 und gleichzeitiger proximaler Femurfraktur. MATERIAL UND METHODEN: Patienten wurden eingeschlossen, die sich einer chirurgischen Behandlung wegen PFF unterzogen und auch positiv auf COVID-19 getestet wurden. Als Variablen wurden Alter, Geschlecht, der ASA-Score, die Aufnahme aus einem Pflegeheim berücksichtigt. Als Ergebnisse wurden die Rate der Reoperationen, die Mortalität im Krankenhaus nach 3 Monaten und die Entlassungen nach Hause ausgewertet. ERGEBNISSE: In dieser Studie erfüllten 46 Patienten mit COVID-19 (weiblich/männlich 31/15, mittleres Alter 87,0 Jahre mit einem Interquartilsbereich [IQR] von 9,8 Jahren) die Einschlusskriterien. Davon mussten 32 Patienten (69,6 %) auf der Intensivstation betreut werden. 26 Patienten (56,5 %) hatten einen schweren Verlauf von COVID-19 mit Lungenentzündung. Bei den Überlebenden betrug die mittlere Krankenhausaufenthaltsdauer 19 (IQR 17,5) Tage. Vier der Patienten (8,7 %) benötigten eine chirurgische Revision. Die 3‑Monats-Mortalität im Krankenhaus betrug 40,0 % (n = 17) bzw. 43,5 % (n = 20). Die Faktoren, die die 3‑Monats-Sterblichkeitsraten im Krankenhaus beeinflussten, waren die Aufnahme aus einem Pflegeheim, das Vorliegen einer Lungenentzündung (erhöhtes Sterberisiko) und das weibliche Geschlecht (schützend). DISKUSSION: COVID-19, das bei Patienten mit PFF auftritt, weist eine hohe Mortalität auf. Die Aufnahme aus einem Pflegeheim und das Vorliegen einer Lungenentzündung erhöhten das Sterberisiko, wohingegen das weibliche Geschlecht schützend wirkte.

3rd Department of Internal Medicine Metabolism and Gerontology University Hospital Hradec Králové Hradec Králové Czech Republic

Clinic of Orthopedics and Traumatology DIAKOMED Diakoniekrankenhaus Hartmannsdorf Germany

Clinic of Orthopedics Traumatology and Hand Surgery Hegau Bodensee Klinikum Singen Singen Germany

Clinic of Orthopedics Traumatology and Hand Surgery Klinikum Chemnitz Chemnitz Germany

Faculty of Medicine in Hradec Králové Charles University Hradec Králové Czech Republic

Geriatric Center Pardubice Hospital Pardubice Czech Republic

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