Case Report: 100-year-old COVID-positive Hip Fracture Patient for Hemiarthroplasty Under Spinal Anesthesia

Abstract

Elderly patients undergoing hip fracture surgery represent a myriad of perioperative challenges and risks. The arrival of the global pandemic of novel coronavirus disease 2019 (COVID-19) adds an unprecedented challenge to the management of hip fracture patients. We describe the unique experience and favorable outcome of a 100-year-old COVID-positive hip fracture patient that underwent spinal anesthesia for hemiarthroplasty and subsequent hydroxychloroquine (HCQ) therapy. Multiple factors of varying known benefit may have contributed to our outcome, including preoperative medical consultation and assessment, early surgical intervention, regional anesthesia with little to no sedation, early mobilization and HCQ therapy.

Rehabilitation and COVID-19: a rapid living systematic review 2020 by Cochrane Rehabilitation Field. Update as of October 31st, 2020

“…After the removal of duplicates and the screening of titles and abstracts, 63 studies were retained, of which 22 were suitable for qualitative synthesis (Figure 1). The studies published in October 2020 were conducted in the following World Health Organization regions: 10 in Europe (Italy, 7-10 UK, 11,12 Belgium, 13,14 Germany 15 and Spain 16 ) and 10 in the Americas (USA, [17][18][19][20][21][22][23] Brazil 24,25 and Canada 26 ); one in Western Pacific (Australia 27 ) and one in the African region (Morocco). 28 A detailed overview of this update is provided as Supplementary Digital Material 1: Supplementary Table I (available on Cochrane Rehabilitation website).…”

“…Due to the heterogeneity of studies, a meta-analysis was not appropriate, and the results were described qualitatively. Based on the OCEBM 2011 Levels of Evidence table 29 the majority of studies (N.=17; 77.3%) were level 4 (six case report, 7,11,17,19,22,28 eight case series, 9,10,13,14,16,21,24,27 three historical cohort 20,23,26 ), whereas the remaining five were level 3 (four cohort studies 8,12,15,25 and one cross-sectional 18 study). No RCT or QRCTs were found in this update (Table I).…”

“…Most studies (N.=13; 59.1%) analyzed natural history/determining factors of the disease (three cohort studies, 8,12,15 one cross-sectional, 18 nine descriptive studies 11, 13, 14, 19-22, 24, 27 ). Six descriptive papers reported epidemiological data on the clinical presentation of COVID-19 infection, 7,9,10,16,17,28 and one showed disease prevalence. 26 Two historical cohort studies described data on health service organization 23 and intervention efficacy.…”

“…10,14 Seven studies reported the setting of rehabilitation service: according to the adopted classification, 5 they described four rehabilitation in acute care, 11,14,19,25 one general postacute, 26 one outpatient, 23 and one rehabilitation in the home. 27 According to the ICF-based classification of the limitations of functioning of rehabilitation interest (LFRI), most papers (N.=12; 55%) described the impact of COVID-19 infection on nervous system structure and related functions, 7, 9-12, 16, 18, 19, 21, 22, 24, 28 four studies reported on generic body structures and functions, 13,15,17,26 three on activity limitation and participation restriction, 20,23,27 two on respiratory structures and related functions, 8,14 and one on digestive function. 25 The main evidence is summarized below.…”

“…Other two descriptive papers reported the case of a 100-year-old patient with mild COVID-19 and hip fracture undergoing hemiarthroplasty without additional risk; 17 and the cases of four severe COVID-19 patients who exhibited heterotopic ossification (HO) in hips and shoulders after 30-40 days of hospital admission. 13…”