Epidemiology
The outbreak of COVID-19 disrupted usual treatment pathways but did not significantly alter the incidence of osteoporotic hip fractures [PMID:32772318].
Diagnosis
Studies suggest that real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) tests may have a high false-negative rate (32–72%) in this population [PMID:32772318].
The research [PMID:16131887] utilized computed tomography scans and anatomic dissections to accurately assess the placement and safety of transacetabular screws, suggesting these methods as essential diagnostic tools for such procedures.
Management
A naive Bayes machine-learning algorithm accurately predicted length of stay (76.5% accuracy) and cost (79.0% accuracy) of hip fracture care using preoperative patient data including age, sex, risk of mortality, and severity of illness [PMID:30730360].
In cadaver studies [PMID:16131887], a quadrant system was validated for the high hip center, identifying that only the peripheral half of the posterior quadrants are safe for screw placement to prevent injury to structures such as the external iliac vessels, obturator nerve and vessels, superior gluteal nerve and vessels, and sciatic nerve.
Complications
The Spanish HIP-COVID Observational Study reported a 10% in-hospital mortality rate among hip fracture patients who tested negative for COVID-19 [PMID:32772318].
The study [PMID:16131887] highlights that screws placed without proper guidance in the high hip center pose a significant risk of penetrating vital structures such as the sciatic nerve, emphasizing the need for precise anatomical localization.
Prognosis & Follow-up
The model demonstrated increased error in predicting length of stay and cost for patients with higher risk of mortality, highlighting the need for risk-adjusted payment models [PMID:30730360].
Key Recommendations
The study proposes a patient-specific payment model based on preoperative comorbidities and risk factors to better project reimbursements and manage costs effectively [PMID:30730360]. (Evidence: Expert opinion)
References
1 Slullitel PA, Lucero CM, Soruco ML, Barla JD, Benchimol JA, Boietti BR et al.. Prolonged social lockdown during COVID-19 pandemic and hip fracture epidemiology. International orthopaedics 2020. link 2 Karnuta JM, Navarro SM, Haeberle HS, Billow DG, Krebs VE, Ramkumar PN. Bundled Care for Hip Fractures: A Machine-Learning Approach to an Untenable Patient-Specific Payment Model. Journal of orthopaedic trauma 2019. link 3 Wasielewski RC, Galat DD, Sheridan KC, Rubash HE. Acetabular anatomy and transacetabular screw fixation at the high hip center. Clinical orthopaedics and related research 2005. link