Early clinical outcomes of surgically management unstable pelvic fractures in covid-19 patients in the North West of Iran

Background: Unstable pelvic ring fracture during these challenging times for the global communities as they battle the COVID-19 pandemic is a management dilemma for orthopedic practices. The purpose of this study was to evaluate early clinical characteristics and outcomes of covid-19 patients with unstable pelvic ring fractures who undergo open reduction and internal fixation during the covid-19 outbreak in Iran.
Methods: In this prospective cohort study, 50 covid-19 patients with unstable pelvic fractures were treated in our institution by Open Reduction and Internal Fixation (ORIF) during the covid-19 outbreak from February to March 2021 at two educational hospitals. We investigate the patient's clinical characteristics and early postoperative outcomes.
Results: All patients were positive for SARS-CoV-2 based on the quantitative Reverse Transcription-Polymerase Chain Reaction (RT-PCR) of throat swab samples. Thirty eight patients were asymptomatic at admission time. Twelve cases suffered from hypoxia (blood oxygen saturation <93%) preoperatively. All patients underwent ORIF surgery within 48 hours to 72 hours after injury. Eighteen hypoxia patients elevated oxygen demands beyond 3 days to 5 days postoperatively. None of the patients used mechanical ventilation. The mean start mobilization was 4.6 days. Respiratory failure was the most common postoperative complication. (16%) The older age of male patients died due to pulmonary embolism on postoperative days 10. The mean surgical period was 67.5 minutes. The mean period to start mobilization was 4.6 days. The mean of hospital length stays for the patient discharged was 5.4 days. The following of patients is going.
Conclusion: Covid-19 had devastating effects on orthopedic practices during the covid-19 outbreak in Iran. Still, orthopedic practice guidelines for patients with unstable pelvic fractures remained unchanged. Our results suggest that early pelvic fracture fixation in patients who suffer from asymptomatic or mild covid-19 infection could be safe undergoing multidisciplinary institutional protocol.