A systematic review of hip fractures in elderly people / 中华骨科杂志

ABSTRACT

Objective To study the age peak of incidence,pathologic sites,therapeutic effect and complications of different treatment for hip fractures in the elderly.Methods Hip fractures,therapy,elderly were used as key words to search articles both in English and Chinese from 1979 to 2017.The articles were filtrated by title,abstract and full text and 32 of them were left.All the patients were objects of this study,but the repeated cases were excluded.The patients' data such as age of onset,gender,fracture type,operation method,follow-up time,and complications were collected and analyzed by systematic analysis.Results Data of 2 758 patients in 32 papers had been collected for analysis.There were 1791 femoral neck fractures and 967 intertrochanteric fractures,with a ratio of 1.85:1.The patients' age of onset was ranging from 54 to 92 years old,with an average of 76.7 years old,and the age peak of incidence was from 70 to 79 years old.The sex ratio was 1:1.66 (1 037 males:1721 females).All the patients had been followed up for 0.5 to 18 years,(average,7.8 years).Among 927 femoral neck fractures who were treated by 3 lag screws,there were 278 cases of non-union (29.9％),139 femoral head necrosis(15.1％) and 19 internal fixation loosening (2.0％);but for 183 femoral neck fractures who were treated by dynamic hip screws (DHS),there were 51 cases of non-union (28.1％),31 femoral head necrosis(17.0％),3 internal fixation losening(1.8％),and 27 cutting effect (15％).Then for 400 femoral neck fractures who were treated by hemiarthroplasty,there were 6 cases of dislocation(1.5％),14 shaft fracture (3.5％),8 deep infection (2.0％);while for 281 femoral neck fractures who were treated by total hip arthroplasty,there were 14 cases of dislocation (5.0％),11 shaft fracture (4.0％),and 10 deep infection (3.5％).On the other hand,for 354 intertrochanteric fractures who were treated by proximal femoral nail or proximal femoral nail antirotation internal fixation (PFN or PFNA),there were 18 cases of trochanter fracture (5.0％),28 hip varus (8.1％),32 displacement (9.0％);and for 210 intertrochanteric fractures who were treated by Gamma nail,there were 17 cases of trochanter fracture (7.9％),11 cutting effect (5.0％),6 displacement (3.0％);and for 135 intertrochanteric fractures who were treated by DHS,there were 8 cases of cutting effect (6.1％),7 displacement (5.2％);and for 101 intertrochanteric who were treated by proximal femoral locking plate,there were 5 cases of displacement (5.0％);Also for 89 intertrochanteric fractures who were treated by hemiarthroplasty,there were 2 cases of dislocation(1.8％),3 shaft fracture (3.0％),1 deep infection(1.5％);and for 78 intertrochanteric fractures who were treated by total hip arthroplasty,there were 4 cases of dislocation (4.8％),3 shaft fracture (4.0％),2 deep infection (2.5％).Conclusion The elderly hip fractures' age peak of incidence is from 70 to 79 years old,and femoral neck fracture takes up a majority of it.Female patients are more than male patients.The femoral neck fractures are mainly treated by 3 lag screws internal fixation;non-union and femoral head necrosis are the common complications postoperation.While the intertrochanteric fractures are mainly treated by proximal femoral nails;displacement,hip varus and trochanter fractures are the common complications postoperation.The artificial hip replacement is the effective remedy measure for secondary femoral head necrosis after hip fractures.