Summary
A prospective 5-year study was carried out of 143 patients with trochanteric fractures treated by Ender nailing. A detailed proforma was used for multifactorial analysis in order to identify the prognostic indicators of social function and quality of life of the patients. Their mean age was 81 years and the female: male ratio 7∶1. The mortality rate 6 months after injury was 23%, and at the end of 5 years 45.5%. The patients surviving the first 6 months had the same life expectancy as the general population. Dementia, associated disease, medical complications, total dependency and age were the most significant predictors of mortality. These factors, with pressure sores and poor rehabilitation, were also significant in determining the prognosis of social function. Deterioration of health status was seen in 36% during the first 6 months after injury and 40% showed deterioration of their social condition within this period. Later, most survivors recovered and were restored to their previous state. Postoperative geriatric care is essential to achieve this aim.
Résumé
L'auteur présente une étude prospective, s'étendant sur 5 ans, et portant sur 143 patients atteints de fractures trochantériennes traitées par ostéosynthèse par clous de Ender. Un dossier détaillé a été utilisé en vue d'une analyse multifactorielle pour préciser le pronostic vital et fonctionnel. L'âge moyen du groupe était de 81 ans, avec des extrêmes de 60 à 100 ans, et le rapport femme/homme était de 7/1. Le taux de mortalité s'élevait à 23% six mois après la fracture et à 45.5% après 5 ans. Les patients survivant les six premiers mois ne présentaient pas un taux de mortalité excessif pendant la période d'observation et ils avaient la même espérance de vie que la population générale. La démence, les maladies associées, les complications médicales, la dépendance totale du patient et l'âge étaient les signes prédictifs les plus fiables de la mortalité. Une aggravation de l'état de santé a été observée chez 36% des patients survivants au cours des six premiers mois suivant l'accident. Les maladies associées, la démence, les escarres et un programme de rééducation insuffisant étaient les facteurs les plus significatifs du pronostic fonctionnel. Durant les six premiers mois suivant la fracture, 40% des patients survivants présentaient une détérioration de leur vie sociale. L'aggravation de l'état de santé et de l'état fonctionnel a cependant été limitée à cette période aiguë, suivant l'accident; ensuite la plupart des patients survivants ont pu recouvrer leurs conditions préalables. Ces résultats soulignent l'importance des soins gériatriques post-opératoires pour prévenir les conséquences défavorables de la fracture et ramener le patient à son état antérieur.
Similar content being viewed by others
References
Bauer GC, Hannson LI, Lidgren L et al (1985) Comprehensive care of hip fractures. Scientific Exhibit, American Academy of Orthopaedic Surgeons. Las Vegas, Nevada, Jan 24–29
Borgquist L, Ceder L, Thorngren KG (1990) Function and social status 10 years after hip fracture. Prospective follow-up of 103 patients. Acta Orthop Scand 61: 404–410
Borgquist L, Nordell E, Jarnlo GB et al (1990) Hip fractures in primary health care. Evaluation of a rehabilitation programme. Scand J Prim Health Care 8: 139–144
Bredahl C, Nyholm B, Hindsholm KB et al (1992) Mortality after hip fracture: results of operation within 12 h of admission. Injury 23: 83–86
Broos PL, Van Haaften KI, Stappaerts KH et al (1989) Hip fractures in the elderly. Mortality, functional results and social readaptation. Int Surg 74: 191–200
Ceder L, Ekelund L, Inerot S et al (1979) Rehabilitation after hip fracture in the elderly. Acta Orthop Scand 50: 681–688
Ceder L (1980) Hip fracture in the elderly. Prognosis and rehabilitation. Thesis Stundenlitteratur, Lund
Cobey JC, Cobey JH, Conant L et al (1976) Indicators of recovery from fractures of the hip. Clin Orthop Rel Res 117: 258–263
Dahl E (1980) Mortality and life expectancy after hip fractures. Acta Orthop Scand 51: 163–170
Davis TR, Sher JL, Porter BB et al (1988) The timing of surgery of intertrochanteric femoral fractures. Injury 19: 244–249
Dolk T (1990) Operation in hip fracture patients; analysis of the time factor Injury 21: 369–372
Dujardin C, Redreau B, Barsotti j (1980) Contexte médical et social actuel du pronostic des fractures du col du fémur. Chirurgie 106: 534–539
Evans JG, Prudham D, Waldless I (1979) A prospective study of fractured proximal femur: incidence and outcome. Public Health 93: 235–241
Fitts WT, Lehr HB, Schor S, et al (1959) Life expectancy after fracture of the hip. Surg Gynec Obstet 108: 7–12
Gallagher JC, Melton LJ, Riggs BL et al (1980) Epidemiology of fractures of the proximal femur in Rochester, Minnesota. Clin Orthop Rel Res 150: 163–171
Gordon PC (1971) The probability of death following fracture of a hip. Can Med Assoc J 105: 47–52
Ions GK, Stevens J (1987) Prediction of survival in patients with femoral neck fractures. J Bone Joint Surg [Br] 69: 384–387
Kenzora JE, McCarthy RE, Lowell JD et al (1984) Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery and complications. Clin Orthop Rel Res 186: 45–51
Laburthe-Tolra Y (1982) La mortalité dans les fractures de l'extrémité supérieure du fémur. Chirurgie 108: 243–247
Lehner JT, Sexson SB (1987) Factors affecting hip fracture mortality. Orthop Trans 11: 498
Lorhan PH, Shelby EA (1964) Factors influencing mortality in hip fractures. Am J Surg 108: 645–649
McGoey PF, Evans J (1966) Fractures of the hip: immediate vs. delayed treatment. Can Med Assoc J 83: 260–265
Miller CW (1978) Survival and ambulation following hip fracture. J Bone Joint Surg [Am] 60: 930–936
Mullen JO (1985) Mortality in hip fractures: relationship to mental status and hospital confusion. Orthop Trans 9: 418
Mullen JO (1987) Death in hip fractures: a prospective approach to its prediction and minimization. Orthop Trans 11: 497
Mullen JO, Mullen NL (1992) Hip fracture mortality. A prospective, multifactorial study to predict and minimize death risk. Clin Orthop Rel Res 280: 214–222
Myers AH, Robinson EG, Van Natta ML et al (1991) Hip fractures among the elderly: factors associated with inhospital mortality Am J Epidemiol 134: 1128–1137
Ochs M (1990) Surgical management of the hip in the elderly patient. Clin Geriatr Med 6: 571–587
Schenk WG, Smith RG, Stephens JG (1956) The fractured hip- a major surgical and sociologic problem. Am J Surg 91: 618–620
Steen Jensen J, Tondevold E, Hove Sorensen P (1979) Social rehabilitation following hip fractures. Acta Orthop Scand 50: 777–785
Steen Jensen J, Baggar J (1982) Long-term social prognosis after hip fractures. Acta Orthop Scand 53: 97–101
Thomas TG, Stevens RS (1974) Social effects of fractures of neck of the femur. Br Med J 3: 456–458
White BL, Fisher WD, Laurin CA (1987) Rate of mortality for elderly patients after fracture of the hip in the 1980's. J Bone Joint Surg [Am] 69: 1335–1339
Wood DJ, Ions GK, Quinsby JM et al (1992) Factors which influence mortality after subcapital hip fracture. J Bone and Joint Surg [Br] 74: 199–202
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Pitto, R.P. The mortality and social prognosis of hip fractures. International Orthopaedics 18, 109–113 (1994). https://doi.org/10.1007/BF02484420
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02484420