Remarks on the management of proximal femoral fractures in times of COVID-19 pandemic

Proximal femoral fractures (PFFs) are among the main causes of hospitalization of elderly patients. They are often challenging to manage at the perioperative stage, which is why appropriate monitoring is recommended in order to prevent and - whenever possible - avoid foreseeable complications (infections, bedsores, bronchopneumonia, psychicological deterioration and worsening general conditions), reduce the mortality rate, facilitate functional recovery and restore the patient's ability to walk and return to everyday life activities and a normal family context. PFFs constitute a major adverse event for elderly patients, often over the age of eighty and with possible issues arising from a substantially unstable and deficient biological balance, with negative repercussions on their quality of life, longer hospitalization and higher healthcare costs. The COVID-19 pandemic has severely impacted the healthcare systems of virtually all world countries, giving rise to serious operational management difficulties (e.g. surgical staff shortages, less availability of surgical facilities, reassignment of surgical staff to other tasks, the need to convert facilities into intensive care units and dedicated COVID + operating rooms, reconfiguration of pathways and procedures with longer anesthesiological and surgical preparation times, environmental sanitation, etc.). All such factors have prolonged waiting times for surgery, causing higher complications rates especially in fragile patients. It is essential to operate through a timely multidisciplinary approach for PFF patients, who must be treated surgically as soon as possible in order to limit the risk of secondary complications due to prolonged bed rest and facilitate a rapid functional recovery.