Evaluation of the Surgical Treatment of Patients over 90 Years Old with Hip Fractures and Their Morbidity and Mortality

Abstract

Objective: Hip fractures in older adults have the highest impact on the patient's health. These injuries result in many complications, reducing functional capability, quality of life, and life expectancy. This study aimed to provide more epidemiological data on the outcomes of these fractures in nonagenarians from a large city treated at a tertiary hospital.

Methods: This study consisted of medical record reviews and interviews.

Results: In this study, 76 patients underwent 82 surgeries. The mean age of the patients was 92.5 years. Ninety percent of the subjects were female. The patients spent 10.4 days in hospital. Surgery occurred on average 2.3 days after hospitalization. Regarding fractures, 46 were trochanteric (56%), and 34 affected the femoral neck (41.5%). Forty-one surgeries used the short proximal femoral nail (50%), and 18 were partial hip replacements (22%). During hospitalization, 46 patients (55%) had no complications, excluding episodes of delirium, and seven patients (9%) died. Forty-two subjects completed the one-year postoperative follow-up period, with 56% alive and 44% dead.

Conclusions: Treating hip fractures in older patients is challenging. Our goal must focus on helping these subjects receive the quickest and least aggressive treatment possible and start mobilization early. We hope the data presented in this study can lead to a better understanding of the characteristics of our nonagenarian population with hip fractures and seek the best possible treatment for them.

Keywords

hip fractures - indicators of morbidity and mortality - nonagenarians

Work developed at the Orthopedics and Traumatology Department, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.

Publication History

Received: 15 May 2023

Accepted: 06 November 2023

Article published online:
21 March 2024

• Referências

• 1 Fernandes RA, Araújo DV, Takemoto MLS, Sauberman MV. Fraturas do fêmur proximal no idoso: estudo de custo da doença sob a perspectiva de um hospital público no Rio de Janeiro, Brasil. Acta Ortopédica Brasileira 2011; 21 (02) 395-416
• 2 Lustosa LP, Bastos EO. Fraturas proximais do fêmur em idosos: qual o melhor tratamento?. Acta Ortop Bras 2009; 17 (05) 309-312
• 3 Petros RSB, Ferreira PEV, Petros RSB. Influence of proximal femur fractures in the autonomy and mortality of elderly patients submitted to osteosynthesis with cephalomedullary nail. Rev Bras Ortop 2017; 52 (1, Suppl 1) 57-62
• 4 Cunha U, Veado MAC. Fratura da extremidade proximal do fêmur em idosos: independência funcional e mortalidade em um ano. Rev Bras Ortop 2006; 41 (06) 195-199
• 5 Kenzora JE, McCarthy RE, Lowell JD, Sledge CB. Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res 1984; (186) 45-56
• 6 Ions GK, Stevens J. Prediction of survival in patients with femoral neck fractures. J Bone Joint Surg Br 1987; 69 (03) 384-387
• 7 Hershkovitz A, Polatov I, Beloosesky Y, Brill S. Factors affecting mortality of frail hip-fractured elderly patients. Arch Gerontol Geriatr 2010; 51 (02) 113-116
• 8 Sexson SB, Lehner JT. Factors affecting hip fracture mortality. J Orthop Trauma 1987; 1 (04) 298-305
• 9 Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE. Survival experience of aged hip fracture patients. Am J Public Health 1989; 79 (03) 274-278
• 10 Parker MJ, Palmer CR. Prediction of rehabilitation after hip fracture. Age Ageing 1995; 24 (02) 96-98
• 11 Keene GS, Parker MJ, Pryor GA. Mortality and morbidity after hip fractures. BMJ 1993; 307 (6914): 1248-1250
• 12 Schnell S, Friedman SM, Mendelson DA, Bingham KW, Kates SL. The 1-year mortality of patients treated in a hip fracture program for elders. Geriatr Orthop Surg Rehabil 2010; 1 (01) 6-14
• 13 Morghen S, Gentile S, Ricci E, Guerini F, Bellelli G, Trabucchi M. Rehabilitation of older adults with hip fracture: cognitive function and walking abilities. J Am Geriatr Soc 2011; 59 (08) 1497-1502
• 14 Bolton D, Bush C, Wallace MT. Nonagenarian hip fractures: Morbidity and mortality at a single institution. J Clin Orthop Trauma 2020; 14: 69-73
• 15 Ooi LH, Wong TH, Toh CL, Wong HP. Hip fractures in nonagenarians–a study on operative and non-operative management. Injury 2005; 36 (01) 142-147
• 16 Lu Y, Uppal HS. Hip Fractures: Relevant Anatomy, Classification, and Biomechanics of Fracture and Fixation. Geriatr Orthop Surg Rehabil 2019;10:2151459319859139
• 17 Alegre-López J, Cordero-Guevara J, Alonso-Valdivielso JL, Fernández-Melón J. Factors associated with mortality and functional disability after hip fracture: an inception cohort study. Osteoporos Int 2005; 16 (07) 729-736
• 18 Rosso LH, Gomes GA, Maronezi LFC, Lindemann IL, Riffel RT, Stobbe JC. Delirium em idosos internados via unidades de emergência: um estudo prospectivo. J Bras Psiquiatr 2020; 69 (01) 38-43
• 19 Rozell JC, Hasenauer M, Donegan DJ, Neuman M. Recent advances in the treatment of hip fractures in the elderly. F1000Res 2016;5: F1000. Faculty Rev 1953
• 20 Características epidemiológicas e causas da fratura do terço proximal do fêmur em idosos. Rev Bras Ortop 2011; 46 (06) 660-667
• 21 Friedman SM, Menzies IB, Bukata SV, Mendelson DA, Kates SL. Dementia and hip fractures: development of a pathogenic framework for understanding and studying risk. Geriatr Orthop Surg Rehabil 2010; Nov; 1 (02) 52-62 . PMID: 23569663; PMCID: PMC3597300