Fractures of the proximal femur in the elderly in a sub-Saharan country
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20205558Keywords:
Fractures, Proximal femur, Elderly, Sub-Saharan, EpidemiologyAbstract
Background: The aim of this study was to describe the epidemiological, radiographic and therapeutic profile of the fractures of the proximal femur in the elderly in a sub-Saharan country.
Methods: A retrospective longitudinal study was carried out at the orthopedic trauma department of Idrissa Pouye Hospital in Senegal. Sixty-six patients recruited were aged at least 90 years; and treated for proximal femur fracture between 2008 and 2017.
Results: The median age of the patients was 91 years (90-107). Females represented 54.5%. The fracture was located in the right 65.2%. Femoral neck fractures were 53% predominant with 94.3% type IV according to Garden’s classification. Concerning the 31 patients with a pertrochanteric fractures, 61.3% were stable and 38.7% unstable. The time taken for seeking hospital care was an average of 5.8±9.7 days. All patients had a preoperative anesthesic score less than 4 according to the American society of anesthesiologists (ASA). The therapeutic indication was functional in 15.1% of cases, surgical by internal fixation in 39.2% and by arthroplasty in 45.7% of cases. Pertrochanteric fractures were managed by a dynamic hip screw (DHS) in 68.2% and by gamma nail in 18.2%. Femoral neck fractures were managed by Moore's arthroplasty in 93.3% and by bipolar hip prothesis (BHP) in 6.7%.
Conclusions: Fractures of the proximal femur represent a growing problem in sub-Saharan Africa. For patients above 90 years, the management remains essentially surgical by internal fixation in pertrochanteric fractures or by arthroplasty in cervical fractures.
Metrics
References
Féron JM, Thomas T, Roux C, Puget J. Osteoporosis and the orthopaedic surgeon in 2007. Rev Chir Orthop Reparatrice Appar Mot. 2008;94(6):99-107.
Cooper C, Campion G, Melton LJ. Hip fractures in the elderly: a world-wide projection. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 1992;2(6):285-9.
Berthe A, Berthé-Sanou L, Konaté B, Hien H, Tou F, Drabo M, et al. Les personnes âgées en Afrique subsaharienne : une population vulnérable, trop souvent négligée dans les politiques publiques, The elderly in sub-Saharan Africa: a vulnerable population often ignored in public policy. Santé Publique. 2013;25(3):367-71.
Schoumaker B. Le vieillissement en Afrique subsaharienne. Espace Popul Sociétés. 2000;18(3):379-90.
Dhanwal DK, Siwach R, Dixit V, Mithal A, Jameson K, Cooper C. Incidence of hip fracture in Rohtak district, North India. Arch Osteoporos. 2013;8:135.
Wehren L, Magaziner J. Prevention of falls in management of fractures in severely osteoporotic bone. London : Springer-Verlag. 2000;333-52.
Melton LJ. Hip fractures: a worldwide problem today and tomorrow. Bone. 1993;14(1):1-8.
El Maghraoui A, Koumba BA, Jroundi I, Achemlal L, Bezza A, Tazi MA. Epidemiology of hip fractures in 2002 in Rabat, Morocco. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2005;16(6):597-602.
Karademir G, Bilgin Y, Erşen A, Polat G, Buget MI, Demirel M, et al. Hip fractures in patients older than 75 years old: Retrospective analysis for prognostic factors. Int J Surg Lond Engl. 2015;24(A):101-4.
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):57-62.
Bayray A, Enquselassie F, Gebreegziabher Z. Magnitude and pattern of osteoporotic fractures among adults in Tigiray, Ethiopia; a retrospective hospital based study. Ethiop Med J. 2012;50(4):297-305.
Meessen JMTA, Pisani S, Gambino ML, Bonarrigo D, van Schoor NM, Fozzato S, et al. Assessment of mortality risk in elderly patients after proximal femoral fracture. Orthopedics. 2014;37(2):194-200.
Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55(5):780-91.
Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing. 2006;35(2):37-41.
González-López AM, Vázquez-Cruz E, Romero-Medina JL, Gutiérrez-Gabriel I, Montiel-Jarquín AJ, Salvatori J, et al. Geriatric syndromes in patients with a non-recent hip fracture seen at a primary health care unit. Acta Ortop Mex. 2014;28(5):287-90.
Desbois A. Pathologies et complications de l’immobilisation associées à la sévérité du déclin moteur chez les patients âgés de plus de 75 ans lors d’une hospitalisation non programmée dans un service de médecine: à partir de la cohorte SAFES. 2008.
Graham SK, Martin J P, Glyn AP. Mortality and morbidity after hip fractures. BMJ. 1993;1248-50.
Mensah E, Tidjani IF, Chigblo P, Lawson E, Ndeffo K, Hans-Moevi Akué A. Aspects épidémiologiques et lésionnels des complications du traitement traditionnel des fractures de membres à Parakou (Bénin). Rev Chir Orthopédique Traumatol. 2017;103(3):330-4.
Lamah L, Abalo A, Dansokho AV, Diakite SK, Dieme CB, Kinkpe CV, et al. Complications du traitement traditionnel des fractures : à propos de 36 cas, au service d’orthopédie Aristide Le Dantec de Dakar. J Rech Sci L’Université Lomé [Internet]. 2009;11(2). Available at: https://www.ajol.info/index.php/jrsul/article/view/56933. Accessed on: 06 October 2018.
Raaymakers E, Marti R. Non-operative treatment of impacted femoral neck fractures. A prospective study of 170 cases. J Bone Joint Surg Br. 1991;73-B(6):950-4.
Cserháti P, Kazár G, Manninger J, Fekete K, Frenyó S. Non-operative or operative treatment for undisplaced femoral neck fractures: a comparative study of 122 non-operative and 125 operatively treated cases. Injury. 1996;27(8):583-8.
Physicians RC of. National Hip Fracture Database Annual Report 2014. In RCP London. 2014.
McGraw IWW, Spence SC, Baird EJ, Eckhardt SM, Ayana GE. Incidence of periprosthetic fractures after hip hemiarthroplasty: Are uncemented prostheses unsafe? Injury. 2013;44(12):1945-8.
Sharma A, Sethi A, Sharma S. Treatment of stable intertrochanteric fractures of the femur with proximal femoral nail versus dynamic hip screw: a comparative study. Rev Bras Ortop. 2017;53(4):477-81.
Steinberg EL, Blumberg N, Dekel S. The fixion proximal femur nailing system: biomechanical properties of the nail and a cadaveric study. J Biomech. 2005;38(1):63-8.
Kim WY, Han CH, Park JI, Kim JY. Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop. 2001;25(6):360-2.
Reguant F, Bosch J, Montesinos J, Arnau A, Ruiz C, Esquius P. Prognostic factors for mortality in elderly patients with hip fracture. Rev Esp Anestesiol Reanim. 2012;59(6):289-98.
Downloads
Published
How to Cite
Issue
Section
