Direct Anterior versus Lateral Approach for Femoral Neck Fracture: Role in COVID-19 Disease

Abstract

Background: During the COVID-19 emergency, the incidence of fragility fractures in elderly patients remained unchanged. The management of these patients requires a multidisciplinary approach. The study aimed to assess the best surgical approach to treat COVID-19 patients with femoral neck fracture undergoing hemiarthroplasty (HA), comparing direct lateral (DL) versus direct anterior approach (DAA). Methods: A single-center, observational retrospective study including 50 patients affected by COVID-19 infection (30 males, 20 females) who underwent HA between April 2020 to April 2021 was performed. The patients were allocated into two groups according to the surgical approach used: lateral approach and anterior approach. For each patient, the data were recorded: age, sex, BMI, comorbidity, oxygen saturation (SpO2), fraction of the inspired oxygen (FiO2), type of ventilation invasive or non-invasive, HHb, P/F ratio (PaO2/FiO2), hemoglobin level the day of surgery and 1 day post operative, surgical time, Nottingham Hip Fractures Score (NHFS) and American Society of Anesthesiologists Score (ASA). The patients were observed from one hour before surgery until 48 h post-surgery of follow-up. The patients were stratified into five groups according to Alhazzani scores. A non-COVID-19 group of patients, as the control, was finally introduced. Results: A lateral position led to a better level of oxygenation (p < 0.01), compared to the supine anterior approach. We observed a better post-operative P/F ratio and a reduced need for invasive ventilation in patients lying in the lateral position. A statistically significant reduction in the surgical time emerged in patients treated with DAA (p < 0.01). Patients within the DAA group had a significantly lower blood loss compared to direct lateral approach. Conclusions: DL approach with lateral decubitus seems to preserved respiratory function in HA surgery. Thus, the lateral position may be associated with beneficial effects on gas exchange.

Indirect comparison in network meta-analysis between SuperPATH, direct anterior and conventional approach hemiarthroplasty in patients with femoral neck fracture

“…Another interesting finding was made by Maccagnano et al in COVID-19 patients with femoral neck fractures treated with HA. [ 52 ] In this retrospective study of 50 patients, preservation of respiratory function was more pronounced with direct lateral CA HA in the lateral decubitus position than with DAA HA in the supine decubitus position. These findings may be similar for SuperPATH HA as this technique is also performed in the lateral decubitus position.…”

Traumatic Proximal Femoral Fractures during COVID-19 Pandemic in the US: An ACS NSQIP® Analysis

“…This finding has not been previously reported in the literature. Our dataset lacked the details about surgical approach for hemiarthroplasty, however, a recent study emanating from Italy reported improved oxygenation in lateral decubitus position as compared to supine position [27].…”

Increased Frequency of Hand Hygiene and Other Infection Prevention Practices Correlates with Reduced Surgical Wound Infection Rates in Spinal Surgery during the COVID-19 Pandemic

“…So far (March 18), according to WHO there are 121 millions total confirmed cases and 2.68 millions deaths due to SARS-CoV-2. In Italy, on 18 March 2020, there were 3.26 millions cases of COVID-19 disease and 103,432 deaths [5][6][7].…”