Patient outcomes after humeral fracture surgery during the COVID-19 outbreak in Spain

Garcia-Portabella, Montserrat; Nuñez, Jorge H.; Batalla, Lledó; Plomer, Martin; Lakhani, Kushal; Massons, Josep

Abstract Background The global spread of the 2019 novel coronavirus (COVID-19) has profoundly affected the way we conduct our healthcare practices. The goal of this paper is to report the outcomes of 11 patients who underwent humeral fracture surgery in the first few weeks of the COVID-19 outbreak in Spain. Methods This was a retrospective case series of 11 patients who underwent humeral fracture surgery during the first weeks of the COVID-19 outbreak in Spain, between 10 March and 25 April 2020. The clinical outcomes of these operative patients were monitored up to 12 May 2020, the final date of follow-up, a minimum of 15 days after all patients were discharged from the hospital. COVID-19 infection, mortality, demographic, clinical, and laboratory data were analyzed. Results Thirty-six humeral fractures were recorded between 10 March and 25 April 2020. During this period, humeral fracture fixation was the third most common surgery for fracture in our institution after hip fracture and ankle fracture surgery. Eleven patients underwent surgery (30.5%), of which seven were women (63.3%). The mean age was 64.8 years (SD 13.5). Nine operated cases had a proximal humerus fracture and 2 had a humeral shaft fracture. One of the 11 patients was positive for SARS-CoV-2 on the basis of quantitative reverse transcription polymerase chain reaction (RT-PCR) of throat swab samples. The overall median surgical time was 101.2 minutes (SD 28.4). The overall median hospital length stays for the patient discharged was 2.2 days (range 1-4). No COVID-19 nosocomial intrahospital infection occurred, no patient reported COVID-19 infection during the 15 days after hospital discharge. No intrahospital mortality was recorded. Furthermore, no COVID-19 infection was reported in the shoulder surgeons that performed the surgeries. Conclusions Although humeral fractures were not the most frequent fracture during this outbreak, some required surgery. With good preoperative management that included RT-PCR for COVID-19 and chest radiographs, protective measurements for the surgical team, and rapid discharge of the patients, we were able to operate on 11 humeral fractures with no COVID-19 nosocomial intrahospital infection in the patients or in the shoulder surgeons that performed the surgeries.