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

Giuseppe Maccagnano; Francesco Maruccia; Michela Rauseo; Giovanni Noia; Michele Coviello; Andrea Laneve; Alessandro Pio Quitadamo; Giacomo Trivellin; Michele Malavolta; Vito Pesce

doi:10.3390/jcm11164785

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

J Clin Med. 2022 Aug 16;11(16):4785. doi: 10.3390/jcm11164785.

Affiliations

¹ Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy.
² Department of Anesthesia and Intensive Care, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy.
³ Orthopaedic & Trauma Unit, AOU Consorziale Policlinico. Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico. Piazza Giulio Cesare 11, 70124 Bari, Italy.
⁴ Hip and Trauma Surgery Department, Piero Pederzoli Private Hospital, Peschiera del Garda, 37019 Verona, Italy.
⁵ Knee Surgery Department, Piero Pederzoli Private Hospital, Peschiera del Garda, 37019 Verona, Italy.

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.

Keywords: COVID-19; DAA; direct anterior approach; direct lateral approach; hemiarthroplasty; proximal femoral fractures.

Grants and funding

This research received no external funding.