Characteristics and Early Prognosis of COVID-19 Infection in Fracture Patients

Abstract

Background: Studies of the novel coronavirus-induced disease COVID-19 in Wuhan, China, have elucidated the epidemiological and clinical characteristics of this disease in the general population. The present investigation summarizes the clinical characteristics and early prognosis of COVID-19 infection in a cohort of patients with fractures.

Methods: Data on 10 patients with a fracture and COVID-19 were collected from 8 different hospitals located in the Hubei province from January 1, 2020, to February 27, 2020. Analyses of early prognosis were based on clinical outcomes and trends in laboratory results during treatment.

Results: All 10 patients presented with limited activity related to the fracture. The most common signs were fever, cough, and fatigue at the time of presentation (7 patients each). Other, less common signs included sore throat (4 patients), dyspnea (5 patients), chest pain (1 patient), nasal congestion (1 patient), headache (1 patient), dizziness (3 patients), abdominal pain (1 patient), and vomiting (1 patient). Lymphopenia (<1.0 × 10 cells/L) was identified in 6 of 10 patients, 9 of 9 patients had a high serum level of D-dimer, and 9 of 9 patients had a high level of C-reactive protein. Three patients underwent surgery, whereas the others were managed nonoperatively because of their compromised status. Four patients died on day 8 (3 patients) or day 14 (1 patient) after admission. The clinical outcomes for the surviving patients are not yet determined.

Conclusions: The clinical characteristics and early prognosis of COVID-19 in patients with fracture tended to be more severe than those reported for adult patients with COVID-19 without fracture. This finding may be related to the duration between the development of symptoms and presentation. Surgical treatment should be carried out cautiously or nonoperative care should be chosen for patients with fracture in COVID-19-affected areas, especially older individuals with intertrochanteric fractures.

Level of evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Fig. 1

Figs. 1-A through 1-J CT scans and radiographs showing the fractures in the present study. Fig. 1-A Case 1. Preoperative CT scan showing an intertrochanteric fracture and postoperative radiograph. Fig. 1-B Case 2. Preoperative radiograph showing a femoral fracture. Fig. 1-C Case 3. Preoperative CT scan showing a lumbar fracture. Fig. 1-D Case 4. Preoperative and postoperative radiographs for a patient with a femoral neck fracture. Fig. 1-E Case 5. Preoperative radiograph showing an intertrochanteric fracture. Fig. 1-F Case 6. Preoperative CT scan showing an intertrochanteric fracture. Fig. 1-G Case 7. Preoperative and postoperative radiographs for a patient with an intertrochanteric fracture. Fig. 1-H Case 8. Preoperative CT scan showing a fracture of the radius. Fig. 1-I Case 9. Preoperative radiograph showing an intertrochanteric fracture. Fig. 1-J Case 10. Preoperative CT scan showing a thoracolumbar fracture.

Fig. 2

Figs. 2-A through 2-J Chest CT scans for all 10 patients. All patients but 1 had bilateral patchy consolidation and multiple ground-glass opacities. The remaining patient (Case 2) had ground-glass opacities on the right side. Fig. 2-A Case 1. Fig. 2-B Case 2. Fig. 2-C Case 3. Fig. 2-D Case 4. Fig. 2-E Case 5. Fig. 2-F Case 6. Fig. 2-G Case 7. Fig. 2-H Case 8. Fig. 2-I Case 9. Fig. 2-J Case 10.

Fig. 3

Line graphs illustrating detailed changes in routine blood test results and coagulation function for all 10 patients, starting on the day of disease onset (Case 1) or the day of admission (Cases 2 through 9). The normal ranges of laboratory test results are as follows: white blood-cell count, 3.5 to 9.5 × 10⁹/L; neutrophil count, 1.8 to 6.3 × 10⁹/L; lymphocyte count, 1.1 to 3.2 × 10⁹/L; monocyte count, 0.1 to 0.6 × 10⁹/L; platelet count, 125 to 350 × 10⁹/L; hemoglobin, 115 to 150 g/L; APTT, 28.0 to 43.5 s; PT, 11.0 to 16.0 s; D-dimer, <0.5 mg/L FEU (fibrinogen equivalent units).

Fig. 4

Line graphs showing detailed changes of blood biochemistry and infection-related biomarkers for all 10 patients, starting from disease onset (Case 1) or the day of admission (Cases 2 through 9). The normal ranges of laboratory test results are as follows: albumin, 35 to 55 g/L; alanine aminotransferase (ALT), 5 to 35 U/L; aspartate aminotransferase (AST), 8 to 40 U/L; total bilirubin, 5.1 to 19.0 μmol/L; blood urea nitrogen, 2.9 to 8.2 mmol/L; creatinine, 44.0 to 106.0 μmol/L; procalcitonin, <0.05 ng/mL; C-reactive protein, 0 to 5 mg/L.