Functionality, comorbidity, complication & surgery of hip fracture in older adults by age distribution

SUMMARY BACKGROUND Hip fractures may be the greatest complication secondary to osteoporotic disorder. The objective of this study was to determine the influence of age distribution in the functionality, comorbidity, complications and surgical features of older adults with hip fractures. METHODS A prospective cohort study was carried out from 2013 to 2014. A sample of 557 adults over 75 years old with osteoporotic hip fractures was recruited from the Orthogeriatric Unit of the León University Hospital (Spain). Age distributions of 75-84, 85-90 and >90 years old were considered. Firstly, sociodemographic data, fracture type and hospital staying days were collected. Secondly, baseline functionality (Barthel index), ambulation, cognitive impairment and comorbidities were described. Thirdly, surgical intervention, urgency, type, American Association of Anesthesiologists (ASA) scores, non-surgical cause, and baseline pharmacologic treatments were determined. Finally, complications and features at hospital discharge were observed. RESULTS The age ranges did not show any statistically-significant differences (P<.05; R2=.000-.005) for gender, fracture type, or number of hospital staying days. Statistically-significant differences (P<.05; R2=.011-.247) between age groups were observed for Barthel index, cognitive impairment, dementia, osteoporosis, Parkinson's disease, aortic stenosis, surgery type, ASA-score, non-surgical cause, benzodiazepines, antidementia, anti-osteoporosis, insulin, pharmacologic treatments, renal function alteration, heart failure, destination and ambulation features. All other measurements did not show statistically-significant differences (P>.05; R2=.000-.010). CONCLUSION Age distributions greater than 75 years old may determine the functionality, comorbidities, surgical features, baseline pharmacologic treatments, complications and features at hospital discharge for older adults who suffer a hip fracture.

RESUMO CONTEXTO As fraturas do quadril podem ser a maior complicação secundária à doença osteoporótica. O objetivo deste estudo foi determinar a influência da distribuição etária na funcionalidade, comorbidade, complicações e características cirúrgicas de idosos com fratura de quadril. MÉTODOS Um estudo prospectivo de coorte foi realizado de 2013-2014. Uma amostra de 557 adultos mais velhos, com mais de 75 anos, com fratura de quadril osteoporótica foi recrutada na Unidade Ortogeriátrica do Hospital Universitário de León (Espanha). As distribuições de idade de 75-84, 85-90 e >90 anos foram consideradas. Em primeiro lugar, foram coletados dados sociodemográficos, tipo de fratura e dias de permanência hospitalar. Em segundo lugar, foram descritas funcionalidades de base (índice Barthel), ambulação, comprometimento cognitivo e comorbidades. Em terceiro lugar, determinaram-se a intervenção cirúrgica, a urgência, o tipo, os resultados da Associação Americana de Anestesiologistas (ASA), a causa não cirúrgica e os tratamentos farmacológicos iniciais. Finalmente, foram observadas complicações e características na alta hospitalar. RESULTADOS As faixas etárias não mostraram diferenças estatisticamente significativas (P <,05; R2 = ,000-,005) para sexo, tipo de fratura ou dias de permanência hospitalar. Foram apresentadas diferenças estatisticamente significativas (P <,05; R2 = ,011-,247) para o índice de Barthel, comprometimento cognitivo, demência, osteoporose, doença de Parkinson, estenose aórtica, tipo de cirurgia, pontuação ASA, causa não cirúrgica, benzodiazepínicos, antidementia, antiosteoporose, insulina, tratamentos farmacológicos, alteração da função renal, insuficiência cardíaca, destino e características de ambulação entre grupos etários. O restante das medidas não apresentou diferença estatisticamente significativa (P> 0,05; R2 = ,000-,010). CONCLUSÃO As distribuições de idade após 75 anos podem determinar a funcionalidade, comorbidades, características cirúrgicas, tratamentos farmacológicos de base, complicações e características na alta hospitalar de adultos mais velhos que sofrem fratura de quadril.

Calcar Preservation Arthroplasty for Unstable Intertrochanteric Femoral Fractures in Elderly

BACKGROUND: The treatment of unstable intertrochanteric fractures in elderly is still controversial. The purpose of this study is to present treatment strategies for unstable intertrochanteric fractures with hemiarthroplasty using standard uncemented collared femoral stems and at the same time preserving the fractured calcar fragment. METHODS: Fifty-four patients aged 75 years or older with unstable intertrochanteric fractures were included in this prospective cohort study. All patients were treated with calcar preserving hemiarthroplasty using cementless collored femoral stems. Fractured calcar fragment was stabilized either by compaction between the implant and femur or fixed with cable grip system. Follow-up evaluations were performed at least 24 months and later. Palmer and Parker mobility score and visual analogue scale (VAS) pain score were assessed. We also analyzed radiographs of the operated hip at each follow-up visit. RESULTS: The patients were 15 males and 39 females with a mean age of 81.3 years (range, 75 to 93 years). The average operative time was 86.6 minutes. The mean transfused blood units were 1.2 units. The average duration of hospital stay was 5.3 days. The preoperative mean mobility score was 6.20. This score was found to be 4.96 on postoperative third day and 5.90 at 24 months postoperatively. The results of the statistical analysis revealed significant increase in the mobility scores at each follow-up after three days. Radiological interpretation revealed no loosening in the cable-grip systems, and no significant subsidence (> 5 mm) of prosthesis was observed. CONCLUSIONS: Calcar preservation arthroplasty is a good option for elderly patients with severe osteoporosis, frail constitution and the patients who are at higher risk for second operation due to unstable intertrochanteric fractures.

Early interdisciplinary hospital intervention for elderly patients with hip fractures : functional outcome and mortality

OBJECTIVES: Hip fractures are associated with high levels of co-morbidity and mortality. Orthogeriatric units have been shown to be effective with respect to functional recovery and mortality reduction. The aim of this study is to document the natural history of early multidisciplinary intervention in elderly patients with hip fractures and to establish the prognostic factors of mortality and walking ability after discharge. METHODS: This observational, retrospective study was performed in an orthogeriatric care unit on patients aged >70 years with a diagnosis of hip fracture between 2004 and 2008. This study included 1363 patients with a mean age of 82.7 + 6.4 years. RESULTS: On admission to the unit, the average Barthel score of these patients was 77.2 + 27.8 points, and the average Charlson index score was 2.14 + 2.05. The mean length of stay was 8.9 + 4.26 days, and the readmission rate was 2.3%. The in-hospital mortality rate was 4.7%, and the mortality rates at one, six, and 12 months after discharge were 8.7%, 16.9%, and 25.9%, respectively. The Cox proportional hazards model estimated that male sex, Barthel scale, heart failure, and cognitive impairment were associated with an increased risk of death. With regard to functionality, 63.7% of the patients were able to walk at the time of discharge, whereas 77.4% and 80.1% were able to walk at one month and six months post-discharge, respectively. The factors associated with a worse functional recovery included cognitive impairment, performance status, age, stroke, Charlson score, and delirium during the hospital stay. CONCLUSIONS: Early multidisciplinary intervention appears to be effective for the management of hip fracture. Age, male sex, baseline function, cognitive impairment and previous comorbidities are associated with a higher mortality rate and worse functional recovery.

Morbilidad y mortalidad por fractura de cadera / Morbility and mortality due to hip fracture

Objetivo: demostrar las causas fundamentales que atentan contra la morbilidad y mortalidad de los pacientes operados de fractura de cadera. Métodos: se realizó un trabajo descriptivo, transversal y prospectivo de los pacientes operados de fractura de cadera en el Hospital General Dr. Ernesto Guevara de la Serna, en el período comprendido entre enero de 2007 y septiembre de 2009. Resultados: se demostró un predominio de esta lesión en el sexo femenino (60,7 por ciento) y en los pacientes entre los 71 y 80 años de edad (26,6 por ciento), igualmente la cirugía de urgencia fue la opción terapéutica más usada en 69,3 por ciento de los casos; las fracturas trocantéricas resultaron las más frecuentes. La descompensación de enfermedades de base y la decisión familiar, con 25,3 por ciento, 18,7 por ciento y 16 por ciento fueron las principales causas que obstaculizaron la cirugía de urgencia. En los pacientes con una estadía preoperatoria menor de 72 h, el porcentaje de complicaciones fue bajo. Conclusiones: la desorientación, la bronconeumonía y las escaras de decúbito, resultaron las complicaciones más frecuentes. El porcentaje de fallecidos fue mucho mayor en los pacientes con familias disfuncionales que en las familias funcionales, demostrándose el papel determinante del entorno familiar en la evolución y el pronóstico de estos pacientes

Objective: to demonstrate the main causes to attempt the morbility and mortality of patients operated on hip fracture. Methods: a prospective, cross-sectional and descriptive study was conducted in the patients operated on hip fracture in the Dr. Ernesto Guevara de la Serna General Teaching Hospital from January, 2007 to September, 2009. Results: there was predominance of this type of lesion in female sex (60.7 percent) and in patients aged between 71 and 80 (26.6 percent); the emergency surgery was the therapeutical option more used in the 69.3 percent of cases; the trochanteric fractures were the more frequent ones. The decompensation of base disease and the family decision with a 25.3 percent, 18.7 percent and 16 percent were the leading causes hampered the emergency surgery. In patients with a preoperative stage less than 72 h, the percentage of complications was low. Conclusions: the disorientation, bronchopneumonia and decubitus sores were the more frequent complications. The percentage of deceased was greater in patients with dysfunctional families than in the functional ones, demonstrating the determinant role of family environment in the natural history and prognosis of these patients

Quality of life and functional status of patients with hip fractures in Thailand.

Measurement of quality of life and functional status provides important additional information for priority setting in health policy formulation and resource allocation. Hip fracture has been a concern in health planning in developing countries due to an increasing trend, as reported in several studies. Ironically, in developing countries, studies of the impacts of hip fracture on quality of life and functional status are rare. This prompted our team to seek evidence of the impacts using a longitudinal follow-up approach in a Thai setting. In this study, health-related quality of life (HRQOL) before and after hip fractures was evaluated in 250 Thai patients. Measurement of HRQOL was based on a modified SF-12 questionnaire, which was developed with a realization of the following demands: 1) cultural sensitivity of measurement tools; 2) disease-specific HRQOL measurement and 3) feasibility of conducting field work. Functional status was measured using an adapted version of the Index of Activity of Daily Living (ADL), which was previously developed in another setting in Thailand. Mild, moderate and severe deficits in quality of life were found in 36%, 60%, and 4% respectively, of surviving patients. The number of patients with physical functioning dependency, as measured by the ADL, also increased significantly in all 10 activities assessed. Comorbidities were associated with deficits in health-related quality of life but age, sex, income, education level, and surgery were not. Our findings indicate that hip fracture could lead to crippling consequences, with a pronounced effect on the quality of life of Thai patients. Further studies using control groups and longitudinal design are needed to validate the results of this study.

Evaluación de masa ósea en fractura de cadera cuantificando columna lumbar y cadera contralateral con densitometría ósea / Evaluation of bone mass in hip fracture, quantifying lumbar bone marrow and contralateral hip with bone densitometry

Hip fracture is frecuent in postmenopausal women with osteoporosis. The aim of this work was to assess bone mass in women with hip fracture and compare it with that of normal women. Bone densities of lumbar spine (considering areas with and without spondylosis), female neck, greater trochanter and unfractures hip Ward's triangle were measured with a double beam isotopic densitometer. Thirty one women aged 58-95 years old were studied and compared with normal women studied at the same laboratory. Bone densities in fractures and normal women were 0.82ñ0.16 and 0.85ñ0.05 g/cm2 in lumbar spine respectively (NS), 0.74ñ0.15 and 0.85ñ0.05 g/cm2 in lumbar spine without spondylosis respectively (p<0.001), 0.60ñ0.11 and 0.65ñ0.08 g/cm2 in femoral neck respectively (NS), 0.49ñ0.09 and 0.52ñ0.09 g/cm2 in greater trochanter respectively (p<0.001) and 0.48ñ0.12 and 0.52ñ0.09 g/cm2 in Ward's triangle respectively (NS). It is concluded that the larger differences in bone density between women with and without hip fracture are observed in the greater trochanter