A one-year prospective study of morbidity and mortality in first year following a hip fracture among the elderly patients
Keywords:Hip fracture, Internal fixation, Arthroplasty, Geriatric age
Background: Hip fractures are one of the most commonest and devastating injuries among the geriatric population. Increasing age, cognitive impairment and higher ASA scores are significantly associated with mortality among the geriatric age group. The objective of this study to evaluate the incidence and causes of morbidity and mortality associated with fracture of the hip in first year after the injury among the elderly population.
Methods: A eighteen months prospective study at Narayana Medical College was conducted among patients aged >60 years treated for fracture of hip by arthroplasty and internal fixation. The cases were followed up for one year and mortality and morbidity were evaluated. Associated medical co morbidities were noted for all the cases in the study. Statistical analysis was carried out with IBM SPSS 24.0 and Stata 14 software.
Results: In the study, 76 cases with M:F ratio of 7:12 and mean age of 63.21±1.4 years were included. Cardio vascular disease and anaemia were common co morbidities. Total mortality percentage in the present study after one year of follow up was 31.58%. Mean age of the cases with death in arthroplasty group was 71 years and 69 years in internal fixation group. Associated medical conditions had a direct relationship with mortality on the patients following surgery for fracture of the hip.
Conclusions: Hemiarthroplasty for fracture of the neck and Internal fixation using dynamic hip screw for trochanteric fracture are still good options in the elderly. Proper post-operative management and follow up management for medical co morbidities provide better functional outcome and good results.
Wagner P, Fuentes P, Diaz A, Martinez F, Amenabar P, Schweitzer D, et al. Comparison of complications and length of hospital stay between Orthopedic and Orthogeriatric treatment in elderly patients with a hip fracture. Geriatric Orthopedic Surg Rehabilitation. 2012;3:55-8.
Dhanwal DK, Dennison EM, Harvey NC, Cooper C. Epidemiology of hip fracture: worldwide geographic variation. Indian J Orthop. 2011;45:15-22.
Aubigne MDR, Cauchoix J, Ramadier JV. Evaluation chiffree de la function de la hanche. Application a l’etude des resultants des operations mobilisatrices de la hanche. Rev Chir Orthop Reparatrice Appar Mot. 1949;35:5-12.
Ahuja K, Sen S, Dhanwal D. Risk factors and epidemiological profile of hip fractures in Indian population: A case-control study. Osteoporos Sarcopenia. 2017;3(3):138-48.
Gupta A. Osteoporosis in India: the nutritional hypothesis. Natl Med J India. 1996;9:268-74.
Parker MJ, Gurusamy K. Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. Cochrane Database Syst Rev. 2006;(4):001708.
Cornwall R, Gilbert MS, Koval KJ, Strauss E, Siu AL. Functional outcomes and mortality vary among different types of hip fractures: a function of patient characteristics. Clin Orthop Relat Res. 2004;(425):64-71.
Vestergaard P, Rejnmark L, Mosekilde L. Has mortality after a hip fracture increased. J Am Geriatr Soc. 2007;55(11):1720-6.
Richmond J, Aharonoff GB, Zuckerman JD, Koval KJ. Mortality risk after hip fracture. J Orthop Trauma. 2003;17(8):2-5.
Sircar P, Godkar D, Mahgerefteh S, Chambers K, Niranjan S, Cucco R. Morbidity and mortality among patients with hip fractures surgically repaired within and after 48 hours. Am J Ther. 2007;14(6):508-13.
Sepah JY, Umer M, Khan A, Niazi UKA. Functional outcome, mortality and in-hospital complications of operative treatment in elderly patients with hip fractures in the developing world. Int Orthop. 2010;34:431-5.