Abstract
Objective
Hip fractures in the elderly are usually associated with a high rate of morbidity and mortality and affect quality of life. On review of published data, the current guidelines in the literature indicate that early surgery should be performed within 24 h of injury because it is associated with better functional outcomes and lower rates of perioperative complications and mortality. The aim of this study was to evaluate whether any correlation exists between early surgical intervention and functional outcomes.
Methods
In a retrospective study, we analyzed the records between January 2010 and December 2016 and 550 elderly patients between the age group of 65–95 were included.
Results
The results of early surgery were promising, 451 (82%) patients did not have any complication, 42 (7.6%) has developed bed sore, 23 (4%) developed a hospital-acquired infection, 13 (2.3%) developed wound infection, 08 (1.4%) developed DVT, 04 (0.7%) developed implant failure, and 09 (01%) died of some or other complications.
Conclusion
Still, there is conflicting evidence in the published data that early surgery would improve mortality and function. However, early surgery definitively improves outcome and reduces morbidity, bed sores, infection, and the length of hospital stay could be improved by reducing the waiting time of hip surgery following fracture. We concluded that it is beneficial to the elderly patients to receive surgical treatment as early as possible.
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References
Weller I, Wai EK, Jaglal S, Kreder HJ (2005) The effect of hospital type and surgical delay on mortality after surgery for hip fracture. J Bone Joint Surg Br 87:361–366
Bottle A, Aylin P (2006) Mortality associated with delay in operation after hip fracture: observational study. BMJ 332:947–951
Johnell O, Kanis JA (2004) An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int 15:897–902
Parker M, Johansen A (2006) Hip fracture. BMJ 333:27–30
Wiktorowicz ME, Goeree R, Papaioannou A, Adachi JD, Papadimitropoulos E (2001) Economic implications of hip fracture: health service use, institutional care and cost in Canada. Osteoporos Int 12:271–278
Ray NF, Chan JK, Thamer M, Melton LJ (1997) III Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 12:24–35
Hornby R, Evans JG, Vardon V (1989) Operative or conservative treatment for trochanteric fractures of the femur. A randomized epidemiological trial in elderly patients. J Bone Joint Surg Br 71:619–623
Magaziner J, Hawkes W, Hebel JR et al (2000) Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 55:M498–M507
Magaziner J, Simonsick E, Kashner M, Hebel J, Kenzora J (1990) Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol 45:M101–M107
Orosz GM, Hannan EL, Magaziner J et al (2002) Hip fracture in the older patient: reasons for delay in hospitalization and timing of surgical repair. J Am Geriatr Soc 50:1336–1340
Kates SL, Mendelson DA, Friedman SM (2010) Co-managed care for fragility hip fractures (Rochester model). Osteoporos Int 21(suppl 4):S621–S625
Bukata SV, DiGiovanni BF, Friedman SM et al (2011) A guide to improving the care of patients with fragility fractures. Geriatr Orthop Surg Rehabil 2(1):5–37
Friedman SM, Mendelson DA, Kates SL, McCann RM (2008) Geriatric co-management of proximal femur fractures: total quality management and protocol-driven care result in better outcomes for a frail patient population. J Am Geriatr Soc 56(7):1349–1356
Choong PF, Langford AK, Dowsey MM, Santamaria NM (2000) Clinical pathway for fractured neck of femur: a prospective, controlled study. Med J Aust 172(9):423–427
Roberts HC, Pickering RM, Onslow E et al (2004) The effectiveness of implementing a care pathway for femoral neck fracture in older people: a prospective controlled before and after study. Age Ageing 33(2):178–184
Ethans K, MacKnight C (1998) Hip fracture in the elderly: an interdisciplinary team approach to rehabilitation. Postgrad Med 103:157–158
Riemen AHK, Hutchison JD (2016) The multidisciplinary management of hip fractures in older patients. Orthopaedics Trauma 30(2):117–122
Choong PF, Langford AK, Dowsey MM, Santamaria NM (2000) Clinical pathway for fractured neck of femur: a prospective, controlled study. Med J Aust 172(9):423–427
Phy MP, Vanness DJ, Melton LJ 3rd et al (2005) Effects of a hospitalist model on elderly patients with hip fracture. Arch Intern Med 165(7):796–801
Roberts HC, Pickering RM, Onslow E et al (2004) The effectiveness of implementing a care pathway for femoral neck fracture in older people: a prospective controlled before and after study. Age Ageing 33(2):178–184
Koval KJ, Chen AL, Aharonoff GB, Egol KA, Zuckerman JD (2004) Clinical pathway for hip fractures in the elderly—the Hospital for Joint Diseases experience. Clin Orthop Relat Res 425:72–81
Kammerlander C, Roth T, Friedman SM, Suhm N, Luger TJ, Kammerlander-Knauer U, Krappinger D, Blauth M (2010) Ortho-geriatric service–a literature review comparing different models. Osteoporos Int 21(4):S637–S646. doi:10.1007/s00198-010-1396-x
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Rai, S.K., Varma, R. & Wani, S.S. Does time of surgery and complication have any correlation in the management of hip fracture in elderly and can early surgery affect the outcome?. Eur J Orthop Surg Traumatol 28, 277–282 (2018). https://doi.org/10.1007/s00590-017-2047-0
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DOI: https://doi.org/10.1007/s00590-017-2047-0