Background: Despite the global reduction in the transmission and mortality of Coronavirus (COVID-19), this infection remains a significant challenge for orthopedic surgeons. This study aims to evaluate the impact of COVID-19 infection on complications, prevalence, rates, mortality, and predictors of surgical outcomes in proximal femur fractures.

Methods: This prospective observational study was conducted on 611 PPF patients suspected of having COVID-19 who underwent surgery at Firouzgar Hospital affiliated with Iran University of Medical Sciences between 2011 and 2013. Fifty-nine patients were identified with a confirmed diagnosis of COVID-19. Using frequency matching, we compared the 30-day mortality rate, hip function, average length of hospitalization, and likelihood of ICU admission between patients with and without COVID-19.

Findings: The 30-day mortality rate was significantly higher in the COVID-19 positive group (28.8% vs. 10.2%, p=0.018). At the last follow-up, the mean Harris Hip Score (HHS) was lower in COVID-19 positive patients. Multivariate analysis showed that infection rates, average duration of hospitalization, and ICU admission rates were higher in COVID-19 positive patients. Older age, hypertension, and smoking significantly increased the risk of postoperative outcomes in PPF patients.

Conclusion: COVID-19 infection increases mortality rates, average duration of hospitalization, and ICU admission likelihood while decreasing the mean HHS in the target population. These findings are particularly significant in elderly patients, smokers, and those with hypertension.

Keywords: Proximal Femur Fracture, Mortality Rate, Coronavirus Disease, COVID-19, Predictors