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Patient Pathway
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• Patients with femoral neck fractures are a highly vulnerable cohort and should be treated as such
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• In agreement with the worldwide initiative “best practice for surgeons, COVID-19 evidence based review”, all patients should have their temperature checked and a surgical mask provided on admission [35].
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• Patients admitted from the Emergency Department (ED) who are awaiting a test result should be isolated in a separate bay until the SARS-CoV-2 status is concluded and unnecessary patient transfers should be prevented.
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• High index of suspicion is warranted for patients with atypical symptoms due to the high aerosol risk and poor patient outcomes as detailed above [36].
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• SARS-CoV-2 status should be checked on a regular basis for long staying inpatients
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Theatre Pathway
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• Adaptation of the WHO checklist is recommended, to include the addition of “COVID status” and “PPE check”
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• Theatres should have negative pressure room ventilation, and aerosol generating tools e.g. oscillating saws should be used only in necessity [37, 38]
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• One dedicated emergency theatre during peak pandemic time to be expanded to a COVID and Clean theatre where possible
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• Surgeons should use familiar metalwork and trauma hardware. A COVID-19 pandemic is not the ideal period to trial new surgical components or techniques and presence of additional personnel in theatre e.g. representatives of manufacturers should be avoided.
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Staffing
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• Consultant services where possible to reduce patient waiting time or delays to decision making
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• Minimal personnel in theatre where possible
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• MDT members including physiotherapy, occupational therapy and orthogeriatric and fracture liaison services must prioritise patients with a fractured neck of femur
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• Restructuring the teams into: “Operating Team”, “On-call team” and “Clinic team” and a “Reserve Team”.
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