HIP FRACTURES IN THE ELDERLY PATIENT
Abstract
Background. Hip fractures are typical of the ageing
population. They represent a severe trauma for the elderly
patient due to significant impact on life quality and morbidity.
We analyzed the characteristics of patients with hip fractures,
the methods and success of treatment. In conclusion, the
importance of continuous team approach and surgical treatment
within 24 hours are stressed.
Methods. We retrospectively evaluated patients admitted for
femoral neck and intertrochanteric fractures between 1994–
1999. The incidence of these fractures, patient age and sex, comorbidity,
methods of treatment, hospital stay and success of
treatment with regard to ambulatory status were established.
Results. 662 patients were treated in the above mentioned period,
yielding a 1‰ annual incidence for the choosen population.
The mean patient age was 76 years; there were 426 female
(64%) and 236 male patients (36%). 336 patients (51%)
had a history of accompanying disease, in 73 patients (11%)
additional fractures were diagnosed. 30 patients (4.5%) were
treated conservatively, 632 (95.5%) underwent surgery. The
mean hospital stay length was 17 days. Success of treatment
was evaluated as good in 441 patients (67%), satisfactory in
112 patients (17%) and poor in 78 patients (12%). 31 patients
(5%) died during hospital admission.
Conclusions. Patients with hip fractures represent 10% of all
in-hospital trauma patients; with hospital stays twice as long
as average trauma patients and considering the financial demands
of surgical treatment they are a challenge in trauma
wards organization and management in the Slovenian environment.
Here as well as abroad the number of these patients
is increasing, along with their mean age and co-morbidity. It
is evident that hip fractures, regardless the way of treatment,
implicate a partial or complete loss of ambulancy and hence
loss of life-quality in one-third of patients. We advise early as
possible surgery –within 24 h– where not absolutely contraindicated
because of its significant influence on decreasing morbidity.
Good team-work between trauma-surgeons and anesthesiologists
is essential. Let us bear in mind that a hip fracture
in an elderly patient with coexisting disease is as lifethreatening
as multiple trauma in the young, otherwise healthy
injured.
Downloads
References
Buchholz RW, Heckman JD eds. Rockwood and Green’s fractures in adults.
4th ed. Vol. 2. Philadelphia: Lipincott-Raven Publishers, 1996: 1695–760.
2. Lyons AR. Clinical outcomes and treatment of hip fractures. Am J Med 1997;
103 (2A): 51S–63S.
3. Reginster JY, Gillet P, Ben Sedrine W et al. Direct costs of hip fractures in
patients over 60 years of age in Belgium. Pharmacoeconomics 1999; 15:
507–14.
4. Kitamura S, Hasegawa Y, Suzuki S et al. Functional outcome after hip
fracture in Japan. Clin Orthop 1998; 348: 29–36.
5. Boereboom FT, Raymakers JA, Duursma SA. Mortality and causes of death
after hip fractures in The Netherlands. Neth J Med 1992; 41: 4–10.
6. Koval KJ, Aharonoff GB, Rosenberg AD, Schmigelski C, Bernstein RL,
Zuckerman JD. Hip fracture in the elderly: the effect of anesthetic technique.
Orthopedics 1999: 22: 31–4.
7. Hamlet WP, Lieberman JR, Freedman EL, Dorey FJ, Fletcher A, Johnson EE.
Influence of health status and the timing of surgery on mortality in hip
fracture patients. Am J Orthop 1997; 26: 621–7.
8. Larsson S, Friberg S, Hansson LI. Trochanteric fractures. Mobility, complications,
and mortality in 607 cases treated with the sliding-screw technique.
Clin Orthop 1990; 260: 232–41.
9. Koot VC, Peeters PH, de Jong JR, Clevers GJ, van der Werken C. Functional
results after treatment of hip fracture: a multicentre, prospective study in
215 patients. Eur J Surg 2000; 166: 480–5.
10. Melton LJ. Epidemiology of hip fractures: implications of the exponential
increase with age. Bone 1996; 18: 3: Suppl: 121S–5S.
11. Haentjens P, Autier P, Barette M, Boonen S. The economic cost of hip
fractures among elderly women. J Bone Joint Surg Am 2001; 83-A: 493–500.
12. Meunier PJ. Prevention of hip fractures. Am J Med 1993; 95: 75S–8S.
13. Dubey A, Koval KJ, Zuckerman JD. Hip fracture prevention: a review. Am J
Orthop 1998; 27: 407–12.
14. Brunelli MP, Einhorn TA. Medical management of osteoporosis. Fracture
prevention. Clin Orthop 1998; 348: 15–21.
15. Kanis JA, McCloskey EV. Evaluation of the risk of hip fracture. Bone 1996;18:
3: Suppl: 127S–32S.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
