Hip fractures in nonagenarians—a study on operative and non-operative management

• Published in: Injury Vol. 36; no. 1; pp. 142 - 147
• Main Authors: Ooi, L.H., Wong, T.H., Toh, C.L., Wong, H.P.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 2005; Elsevier
• Subjects: Aged; Aged, 80 and over - statistics & numerical data; Biological and medical sciences; Female; Femoral Neck Fractures - mortality; Femoral Neck Fractures - surgery; Femoral Neck Fractures - therapy; Hip fractures; Hip Fractures - mortality; Hip Fractures - surgery; Hip Fractures - therapy; Humans; Injuries of the limb. Injuries of the spine; Locomotion - physiology; Male; Medical sciences; Morbidity; Mortality; Nonagenarians; Orthopedic Procedures - methods; Postoperative Complications - etiology; Psychological Tests; Retrospective Studies; Traction - methods; Traumas. Diseases due to physical agents; Treatment Outcome; Hip fractures; Mortality; Morbidity; Nonagenarians; Human; Femur; Score test; Residence time; Diseases of the osteoarticular system; Male; Epidemiology; Intertrochanteric fracture; Hip; Score; Clinical management; Treatment; Surgery; Female; Carbon monoxide; Neck; Age
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2004.05.030

Hip fractures in nonagenarians represent a special group because of their advanced age and co-morbidities. Surgery is advocated for their younger counterparts but may not appear desirable in nonagenarians. Eighty-four patients were studied over a 2-year period. There were 73 female and 11 male patients. Forty-seven patients sustained an intertrochanteric fracture of the femur. 37 suffered a neck of femur fracture. ASA score of II was the largest group with 51. At least 62 had one co-morbidity or more; 46 were considered demented with a mental test score of less than 7. The mean length of stay was 31 days. Treatment consisted of either traction or surgery. Forty-six patients were managed surgically and 38 non-surgically. Patient review was done 2 years after the fracture. The overall rate of complications was 52% for the operative and non-operative groups. Death outcome at 24 months was not significantly affected by ASA status, number of co-morbidities at admission, or between surgical and non-surgical treatment. However, there was statistical significance between death and the mini-mental test score of less than 7 ( P < 0.05). Forty-three patients were still alive after 2 years; of which 27 had been treated surgically and 16 non-surgically. The overall mortality in both operative and non-operative groups is 49%. Surgery significantly increases the ability for independent ambulation ( P < 0.01). Therefore the outcome of non-operative and non-operative treatment in nonagenarians with hip fractures is poor due to the high rates of mortality and morbidity.