]This case report details the association between hip and lower limb fractures in three elderly patients and COVID-19. It was published on 4/7/2020 out of Isfehan University of Medical Science in Iran by the Archives of Bone and Joint Surgery.

Introduction

Badrood General hospital in Iran was a hospital especially hit hard by the COVID-19 outbreak. In March of 2020, they noticed both an increase in positive COVID-19 cases and hip fractures.

Case Presentation

Patient 1 – A 73 year old male admitted with an intertrochanteric femoral fracture.  Preoperatively he complained of generalized weakness. Surgery proceeded without complications. Discharged 2 days post-op. 3 days after surgery he returns with new onset of fever, weakness, dyspnea and anorexia. Labs showed positive C-reactive protein(CRP), elevated liver tests, lymphocytopenia, and chest CT scan was diagnostic for COVID-19.

Patient 2 – A 69 year old male admitted with an intertrochanteric femoral fracture who also complained of weakness, but denied a cough or fever. A chest CT was ordered and was positive, considered as diagnostic for COVID-19. Labs showed elevations in CRP and showed lymphocytopenia.

Patient 3 – A 93 year old female admitted with a femoral neck fracture. On admission, patient showed low grade fever, cough, and fatigue. Labs showed leukocytosis, lymphopenia, and an elevated CRP. A chest CT scan was diagnostic for COVID-19.

Discussion

Weakness and fatigue were the most common complaints of the three patients. Patients with fragility lower extremity fractures are often older adults with multiple underlying conditions, their hospital stays are often lengthy, increasing their chances of obtaining and transmitting the infection. Stress associated with fracture/surgery can trigger a series of oxidative stress responses and inflammation making these patients more vulnerable to COVID-19. Authors conclude there is a possible relationship between COVID-19 infection and fragility fractures.

Shariyate MJ, Kachooei AR. Association of New Coronavirus Disease with Fragility Hip and Lower Limb Fractures in Elderly Patients. Arch Bone Jt Surg. 2020;8(suppl1):297-301. doi:10.22038/abjs.2020.47626.2333

This review was posted on behalf of Spencer Hofschulte-Beck, medical student at Marian University, and approved by Dr. Kathleen Unroe, IU School of Medicine Associate Professor, geriatrician, and IU Center for Aging Research Scientist.