Download PDF
CC BY 4.0 · Rev Bras Ortop (Sao Paulo) 2024; 59(01): e88-e92
DOI: 10.1055/s-0044-1779684
Artigo Original
Quadril

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

Article in several languages: português | English
Daniela Burguêz 
1   Serviço de Ortopedia e Traumatologia, Hospital São Lucas da PUCRS, Porto Alegre, Brasil
,
Rangel Menegatti 
1   Serviço de Ortopedia e Traumatologia, Hospital São Lucas da PUCRS, Porto Alegre, Brasil
,
Felipe Odeh Susin 
1   Serviço de Ortopedia e Traumatologia, Hospital São Lucas da PUCRS, Porto Alegre, Brasil
,
Lauro Manoel Etchepare Dornelles 
2   Serviço de Ortopedia e Traumatologia, Hospital São Lucas da PUCRS, Porto Alegre, Brasil
,
Osvaldo André Serafini 
3   Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brasil
› Author Affiliations Financial Support The authors did not receive financial support from any public, commercial, or not-for-profit sources.
› Further Information
   Permissions and Reprints

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

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • 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
    Google Scholar
  • 2 Lustosa LP, Bastos EO. Fraturas proximais do fêmur em idosos: qual o melhor tratamento?. Acta Ortop Bras 2009; 17 (05) 309-312
    CrossrefGoogle Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 6 Ions GK, Stevens J. Prediction of survival in patients with femoral neck fractures. J Bone Joint Surg Br 1987; 69 (03) 384-387
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 8 Sexson SB, Lehner JT. Factors affecting hip fracture mortality. J Orthop Trauma 1987; 1 (04) 298-305
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 10 Parker MJ, Palmer CR. Prediction of rehabilitation after hip fracture. Age Ageing 1995; 24 (02) 96-98
    CrossrefPubMedGoogle Scholar
  • 11 Keene GS, Parker MJ, Pryor GA. Mortality and morbidity after hip fractures. BMJ 1993; 307 (6914): 1248-1250
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 16 Lu Y, Uppal HS. Hip Fractures: Relevant Anatomy, Classification, and Biomechanics of Fracture and Fixation. Geriatr Orthop Surg Rehabil 2019;10:2151459319859139
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    Google Scholar
  • 20 Características epidemiológicas e causas da fratura do terço proximal do fêmur em idosos. Rev Bras Ortop 2011; 46 (06) 660-667
    CrossrefPubMedGoogle Scholar
  • 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 DOI: 10.1177/2151458510389463. . PMID: 23569663; PMCID: PMC3597300
    CrossrefPubMedGoogle Scholar