Morbidity and Mortality of the Elderly after Early Operation for Trochanteric Fractures

Se-Ang Jang; Young-Ho Cho; Young-Soo Byun; Ki-Hong Park; Hyun-Seong Yoo; Chul Jung

doi:10.12671/jkfs.2013.26.3.199

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Jang, Cho, Byun, Park, Yoo, and Jung: Morbidity and Mortality of the Elderly after Early Operation for Trochanteric Fractures

Original Article

Journal of the Korean Fracture Society 2013; 26(3): 199-204.

Published online: 15 July 2013

DOI: https://doi.org/10.12671/jkfs.2013.26.3.199

Morbidity and Mortality of the Elderly after Early Operation for Trochanteric Fractures

Se-Ang Jang, M.D., Young-Ho Cho, M.D., Young-Soo Byun, M.D., Ph.D., Ki-Hong Park, M.D., Hyun-Seong Yoo, M.D., Chul Jung, M.D.

Department of Orthopedic Surgery, Daegu Fatima Hospital, Daegu, Korea.

Address reprint requests to: Young-Ho Cho, M.D. Department of Orthopedic Surgery, Daegu Fatima Hospital, 99 Ayang-ro, Dong-gu, Daegu 701-724, Korea. Tel: 82-53-940-7320, Fax: 82-53-940-7417, femur1973@hanmail.net

Received 31 December 2012 Revised 29 March 2013 Accepted 28 May 2013

(open-access):

This is anOpen Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To find out the effect of early closed reduction and internal fixation (within 24 hours after admission to hospital) on the morbidity and mortality in the elderly with intertrochanteric fractures of the femur.

Materials and Methods

Retrospectively, we analyzed 99 patients with intertrochanteric fracture of the femur who underwent surgery from January, 2009 to December, 2010. We reviewed 89 of the 99 patients and checked for early complications and reviewed the mortality rates 3 months, 6 months and 1 year after surgery. There were 24 males and 65 females. The average age was 79.8 years (61-99 years). According to the American Society of Anesthesiologists classification, 25 patients were class 1, 37 patients were class 2, 26 patients were class 3, and 1 patient was class 4. All patients were operated on by one surgeon, who was skilled in inserting intramedullary nail.

Results

The average surgical time was 43 minutes and the average intraoperative blood loss was 165 ml. Sixteen patients experienced delirium but all of them recovered. One patient had pneumonia at one month after surgery. Pressure sores developed in one patient but improved with conservative treatment. Pulmonary thromboembolism developed in some patients one month after surgery. Three patients (3.4%) died within three months and one patient (1.1%) died between three and six months after surgery, but no patient died between six months and one year after surgery.

Conclusion

If patients are optimized for the operation, early internal fixation of trochanteric fracture in elderly patients after arrival at the hospital should be considered to reduce early complications and mortality.

Keywords: Femur, Trochanteric fractures, Early operation, Morbidity, Mortality

Figures and Tables

Table 1

Comorbidities of Patients at the Time of the Fracture

Table 2

Number of Dead Patients after Operation

References

1. Al-Ani AN, Samuelsson B, Tidermark J, et al. Early operation on patients with a hip fracture improved the ability to return to independent living A prospective study of 850 patients. J Bone Joint Surg Am. 2008; 90:1436–1442.

2. American Society of Anesthesiologists. New classification of physical status. Anesthesiology. 1963; 24:111.

3. Bakker EJ, Ravensbergen NJ, Poldermans D. Perioperative cardiac evaluation, monitoring, and risk reduction strategies in noncardiac surgery patients. Curr Opin Crit Care. 2011; 17:409–415.

4. Bottle A, Aylin P. Mortality associated with delay in operation after hip fracture: observational study. BMJ. 2006; 332:947–951.

5. Dorotka R, Schoechtner H, Buchinger W. The influence of immediate surgical treatment of proximal femoral fractures on mortality and quality of life. Operation within six hours of the fracture versus later than six hours. J Bone Joint Surg Br. 2003; 85:1107–1113.

6. Grimes JP, Gregory PM, Noveck H, Butler MS, Carson JL. The effects of time-to-surgery on mortality and morbidity in patients following hip fracture. Am J Med. 2002; 112:702–709.

7. Hoerer D, Volpin G, Stein H. Results of early and delayed surgical fixation of hip fractures in the elderly: a comparative retrospective study. Bull Hosp Jt Dis. 1993; 53:29–33.

8. Holt G, Smith R, Duncan K, Finlayson DF, Gregori A. Early mortality after surgical fixation of hip fractures in the elderly: an analysis of data from the scottish hip fracture audit. J Bone Joint Surg Br. 2008; 90:1357–1363.

9. Jang SA, Cho YH, Byun YS, Kim TG, Cho HS, Choi S. Bleeding volume after surgery for trochanteric fractures of the femur in patients treated with antiplatelet agents: comparison according to surgical timing. J Korean Fract Soc. 2012; 25:105–109.

10. Jung GH. Treatment of the intertrochanteric femoral fracture with proximal femoral nail: nailing using the provisional K-wire fixation. J Korean Fract Soc. 2011; 24:223–229.

11. Kenzora JE, McCarthy RE, Lowell JD, Sledge CB. Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res. 1984; (186):45–56.

12. Kim YH, Kim JS. The 2007 John Charnley Award. Factors leading to low prevalence of DVT and pulmonary embolism after THA: analysis of genetic and prothrombotic factors. Clin Orthop Relat Res. 2007; 465:33–39.

13. Lefaivre KA, Macadam SA, Davidson DJ, Gandhi R, Chan H, Broekhuyse HM. Length of stay, mortality, morbidity and delay to surgery in hip fractures. J Bone Joint Surg Br. 2009; 91:922–927.

14. Lieurance R, Benjamin JB, Rappaport WD. Blood loss and transfusion in patients with isolated femur fractures. J Orthop Trauma. 1992; 6:175–179.

15. Marsland D, Colvin PL, Mears SC, Kates SL. How to optimize patients for geriatric fracture surgery. Osteoporos Int. 2010; 21:S535–S546.

16. McGuire KJ, Bernstein J, Polsky D, Silber JH. The 2004 Marshall Urist award: delays until surgery after hip fracture increases mortality. Clin Orthop Relat Res. 2004; (428):294–301.

17. Melton LJ 3rd. Hip fractures: a worldwide problem today and tomorrow. Bone. 1993; 14:Suppl 1. S1–S8.

18. Mullen JO, Mullen NL. Hip fracture mortality. A prospective, multifactorial study to predict and minimize death risk. Clin Orthop Relat Res. 1992; (280):214–222.

19. Orosz GM, Magaziner J, Hannan EL, et al. Association of timing of surgery for hip fracture and patient outcomes. JAMA. 2004; 291:1738–1743.

20. Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br. 1993; 75:797–798.

21. Parker MJ, Pryor GA. The timing of surgery for proximal femoral fractures. J Bone Joint Surg Br. 1992; 74:203–205.

22. Perez JV, Warwick DJ, Case CP, Bannister GC. Death after proximal femoral fracture--an autopsy study. Injury. 1995; 26:237–240.

23. Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ. 2005; 331:1374.

24. Rogers FB, Shackford SR, Keller MS. Early fixation reduces morbidity and mortality in elderly patients with hip fractures from low-impact falls. J Trauma. 1995; 39:261–265.

25. Sernbo I, Johnell O. Consequences of a hip fracture: a prospective study over 1 year. Osteoporos Int. 1993; 3:148–153.

26. Siegmeth AW, Gurusamy K, Parker MJ. Delay to surgery prolongs hospital stay in patients with fractures of the proximal femur. J Bone Joint Surg Br. 2005; 87:1123–1126.

27. Weller I, Wai EK, Jaglal S, Kreder H. The effect of hospital type and surgical delay on mortality after surgery for hip fracture. J Bone Joint Surg Br. 2005; 87:361–366.

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