INTRODUCTION The Coronavirus Disease 2019 (COVID-19) pandemic resulted in major disruption to hip fracture services. This frail patient group requires specialist care, and disruption to services is likely to result in increases in morbidity, mortality and long-term healthcare costs. AIMS To assess disruption to hip fracture services during the COVID-19 pandemic. METHODS A questionnaire was designed for completion by a senior clinician or service manager in each participating unit between April-September 2020. The survey was incorporated into existing national-level audits in Germany (n=71), Scotland (n=16), and Ireland (n=16). Responses from a further 81 units were obtained via online survey. RESULTS There were 185 units from 14 countries that returned the survey. 102/160 (63.7%) units reported a worsening of overall service quality, which was attributed predominantly to staff redistribution, reallocation of inpatient areas, and reduced access to surgical facilities. There was a high rate of redeployment of staff to other services, with two thirds having lost specialist orthopaedic nurses, a third orthogeriatrics services, and a quarter physiotherapists. Reallocation of inpatient areas resulted in patients being managed by non-specialised teams in generic wards, which increased the patients and staff transit between clinical areas. There was reduced operating department access, with 74/160 (46.2%) centres reporting a >50% reduction. Reduced theatre efficiency was reported by 135/160 (84.4%) and was attributed to staff and resource redistribution, longer anaesthetic and transfer times, and delays for preoperative COVID-19 testing and using personal protective equipment (PPE). CONCLUSION Hip fracture services were disrupted during the COVID-19 pandemic and this may have a sustained impact on health and social care. Protection of hip fracture services is essential to ensure satisfactory outcomes for this vulnerable patient group.

Aim To determine if number and characteristics of hip fractures changed during COVD-19 lockdown. Findings The socio-demographic characteristics and baseline status of patients suffering hip fractures during COVID-19 lockdown were similar, but the volume of hip fractures admitted dropped by nearly one quarter. Message The effect of the COVID-19 pandemic fragility hip fractures may depend on the incidence of the disease itself, as well as on the severity of lockdown measures.

Key summary points Aim What were the effects of the COVID-19 pandemic and patient cohorting on the mortality and care provided for patients with hip fractures? Findings Mortality due to COVID-19 infection was higher before patient cohorting, and no nosocomial infections were detected after cohorting. Survival of patients treated in the COVID-19 circuit was similar to non-COVID-19 controls, in spite of longer surgical delay and length of stay. Message Separate circuits for COVID-19 and non-COVID-19 patients allows adequate hip fracture care, without observing increased mortality when delaying surgery until stabilization among patients with severe respiratory illness. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00455-x.

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To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.

Background: The purpose of this meta-analysis was to evaluate the diagnostic value of D-dimer in detecting periprosthetic joint infection (PJI). Methods: A systematic search and screening of relevant studies was performed in the databases PubMed, Web of Science, and Embase using the following medical subject headings (MeSH) or keywords: "arthroplasty or joint prosthesis or joint replacement or periprosthetic joint or prosthetic joint", "infection or infectious or infected", and "D-dimer or serum D-dimer or plasma D-dimer or fibrin degradation products". Data were subsequently analysed and processed using Meta-Disc. Results: Seven studies with 1285 patients were included in this meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.75 (95% confidence interval [CI] 0.70-0.79), 0.69 (95% CI 0.66-0.72), 3.01 (95% CI 1.84-4.93), 0.32 (95% CI 0.19-0.53), and 10.20 (95% CI 3.63-28.64), respectively. Subgroup analyses showed that the use of serum D-dimer had better sensitivity and specificity than plasma D-dimer for the diagnosis of PJI. Conclusions: Serum D-dimer was shown to have a better diagnostic value than plasma D-dimer for the diagnosis of PJI. Further research is required for clarification.

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