Time trends of mortality after first hip fractures

Summary A register-based study including 2,674 first hip fracture patients from 1987–1996 investigated if the mortality after hip fracture was associated with time trend and fracture type. Despite significantly increasing age at admission no changing time trend of mortality was observed, nor was the mortality linked to the kind of fracture suffered. Introduction and hypothesis A retrospective cohort study was performed to investigate if the mortality of first hip fracture patients was associated with time trend and fracture type. The hypotheses were that cumulative mortality would remain unchanged and there would be no difference in mortality between cervical and pertrochanteric patients. Methods Study material was obtained by record linkage of excerpts from two computerized national health registers. First hip fractures were identified indirectly by searching the files ten years before the date of admission. The period 1987–1996 saw inclusion of 2,674 patients aged 50 years and older (average follow-up 2.6 years). Statistics: Weighted regression analysis, χ ² test, and t test. Results Cumulative mortality did not change significantly (P > 0.05). Weighted average cumulative mortality was 9% (95% CI, 7.9–10.1) at 1 month, 15.5% (95% CI, 14.1–16.8) at 3 months, 26.5% (95% CI, 24.7–28.3) at 1 year, and 36.2% (95% CI, 34.1–38.3) at 2 years. Cervical and pertrochanteric first hip fracture patients did not have significantly different mortality rates (P > 0.05). Conclusion No changing time trend of mortality after first hip fracture was observed despite significantly increasing age at admission, nor was the mortality linked to the kind of fracture suffered.     

老年患者髋部骨折术后1年病死率及危险因素分析:一项回顾性队列研究

目的 调查老年髋部骨折患者术后1年病死率,并分析其危险因素. 方法 研究为回顾性队列研究,收集2011年～2014年因髋部骨折行手术治疗的老年(年龄≥65岁)患者信息,随访术后1年存活情况,采用Logistic回归分析筛选术后死亡的危险因素. 结果 共295名老年髋部骨折患者纳入本研究,平均年龄(78.4±6.7)岁,女性占71.5％,术前有3种以上合并症的占38％,平均随访(31.2±0.7)个月.住院期间、术后30 d、术后1年以及随访结束时病死率分别为0.7％、1.7％、3.7％和5.8％. 结论 高龄、术前合并呼吸系统疾病、既往有脑卒中病史及采用内固定手术是老年髋部骨折患者术后1年死亡的危险因素.     

老年髋部骨折术后1年急性脑血管事件发生危险因素及预后分析

目的:探讨老年髋部骨折术后1年内发生急性脑血管事件的危险因素及预后影响。方法:回顾性分析2017年7月至2020年12月收治老年髋部骨折320例,男111例,女209例;年龄60～101(79.05±8.48)岁。根据术后1年内是否发生急性脑血管事件,将患者分为脑血管事件和无脑血管事件组。收集患者的临床资料,包括年龄、性别、合并症、骨折类型、白细胞计数、血红蛋白、白蛋白、独立生活能力(activities of daily living,ADL)评分、行走能力、麻醉方式、手术方式和住院时间,通过单因素分析和多因素Logistic回归分析老年髋部骨折术后1年内急性脑血管事件的独立危险因素,比较两组术后1年ADL、行走能力和死亡率等。结果:术后1年内38例(11.9%)发生急性脑血管事件,脑血管事件组男20例,女18例,年龄(82.53±7.91)岁;非脑血管事件组男91例,女191例,年龄(78.59±8.46)岁。单因素分析结果显示急性脑血管事件与年龄(t=2.712,P=0.007)、男性(χ²=6.129,P=0.013)、高血压病(χ²...     

Factors influencing survival following hip fracture among octogenarians and nonagenarians in the United States

IntroductionHip fractures account for a significant disease burden in the Unites States. With an aging population, this disease burden is expected to increase in the upcoming decades.Materials and methodsThis represents a retrospective cohort study to assess mortality following hip fracture in the octogenarian and nonagenarian populations. Odds ratios for postoperative mortality were constructed using normalized patients from United States Social Security death tables. Kaplan Meier analysis and binary logistic regression were used to assess the impact of surgical delay and medical comorbidity (measured by the Carlson Comorbidity Index (CCI)) on postoperative mortality.Results189 octogenarians and 95 nonagenarians were included. One-year mortality was nearly three times higher for both the octogenarians (OR: 3.1) and nonagenarians (OR: 3.14), and returned to that of the normal population 4 years post-op for octogenarians and 5 years post-op for nonagenarians. Higher preoperative medical comorbidity (CCI) was associated with higher post-op mortality for both octogenarians (log rank = 0.026) and nonagenarians (log rank = 0.034). A 48-h surgical delay resulted in significantly increased postoperative mortality among healthy patients (CCI of 0 or 1, OR: 18.1), but was protective for patients with significant medical comorbidity (CCI ≥ 3). Age, preoperative CCI, and 48-h surgical delay were all independent predictors of 1-year post-op mortality.ConclusionsFollowing hip fracture, there is a 3-fold increase in mortality for octogenarians and nonagenarians at 1 year post-op. A 48-h surgical delay significantly increased mortality for healthier patients but was protective against mortality for sicker patients.     

Mortality profile after 2 years of hip fractures in elderly patients treated with early surgery

BackgroundIn geriatric age group, hip fractures tend to become a major public health hazard. Due to this high occurrence, there is a need to develop standardized, effective, and multidisciplinary management for treatment. These elderly patients have excessive mortality that can extend ahead of the time of recovery. Early surgery after hip fractures has lead to a notable reduction in mortality rates. Still, it is considerably high as compared to other fractures.Methods266 patients of >65 years who were operated within 72 h hours in a tertiary level health care centre for hip fractures were included. They were evaluated with X-rays and grade of Singh’s index was noted. Mortality rates and the factors associated with it such as age, sex, co morbidities (using Charlson’s co morbidity Index/CCI) were evaluated after 2 year follow up.ResultsThe overall 2-year mortality reported in our study population was 11.2%. It was broadly lower as compared to most of the other studies. It was 6.3% in females as compared to 18.1% in males. While it was reported to be only 6% in 65–74 years of age, it was 25% in patients who were 85 years and above. 76.6% of the patients had Singh’s index of ≤ grade 3 showing osteoporosis. The patients with Low Charlson’s score showed only 4.2% mortality while those with high Charlson’s score showed 25.5% mortality.ConclusionIt was concluded that Mortality among elderly patients after early surgery after osteoporotic hip fractures is quite significant. The factors for improvement in long term survival post-hip fracture may include changing treatment patterns, increasing life expectancy and early surgery. Increase in age, female sex, and high CCI Scores were major risk factors of mortality after hip fractures in a 2-year follow-up period.     

Complications of hip fractures: A review

Nowadays, fracture surgery represents a big part of the orthopedic surgeon workload, and usually has associated major clinical and social cost implications. These fractures have several complications. Some of these are medical, and other related to the surgical treatment itself. Medical complications may affect around 20% of patients with hip fracture. Cognitive and neurological alterations, cardiopulmonary affections (alone or combined), venous thromboembolism, gastrointestinal tract bleeding, urinary tract complications, perioperative anemia, electrolytic and metabolic disorders, and pressure scars are the most important medical complications after hip surgery in terms of frequency, increase of length of stay and perioperative mortality. Complications arising from hip fracture surgery are fairly common, and vary depending on whether the fracture is intracapsular or extracapsular. The main problems in intracapsular fractures are biological: vascularization of the femoral head, and lack of periosteum -a major contributor to fracture healing- in the femoral neck. In extracapsular fractures, by contrast, the problem is mechanical, and relates to load-bearing. Early surgical fixation, the role of anti-thromboembolic and anti-infective prophylaxis, good pain control at the perioperative, detection and management of delirium, correct urinary tract management, avoidance of malnutrition, vitamin D supplementation, osteoporosis treatment and advancement of early mobilization to improve functional recovery and falls prevention are basic recommendations for an optimal maintenance of hip fractured patients.     

Perioperative mortality and morbidity of hip fractures among COVID-19 infected and non-infected patients: A systematic review and meta-analysis

PurposeHip fractures among elderly patients are surgical emergencies. During COVID-19 pandemic time, many such patients could not be operated at early time because of the limitation of the medical resources, the risk of infection and redirection of medical attention to a severe infective health problem.MethodsA search of electronic databases (PubMed, Medline, CINAHL, EMBASE and the Cochrane Central Register of Controlled Trials) with the keywords “COVID”, “COVID-19″, “SARS-COV-2”, “Corona”, “pandemic”, “hip fracture”, “trochanteric fracture” and “neck femur fracture” revealed 64 studies evaluating treatment of hip fracture in elderly patients during COVID-19 pandemic time. The 30-day mortality rate, inpatient mortality rate, critical care/special care need, readmission rate and complications rate in both groups were evaluated. Data were analyzed using Review Manager (RevMan) V.5.3.ResultsAfter screening, 7 studies were identified that described the mortality and morbidity in hip fractures in both COVID-19 infected (COVID-19 +) and non-infected (COVID-19 −) patients. There were significantly increased risks of 30-day mortality (32.23% COVID-19 + death vs. 8.85% COVID-19 − death) and inpatient mortality (29.33% vs. 2.62%) among COVID-19 + patients with odds ratio (OR) of 4.84 (95% CI: 3.13 – 7.47, p < 0.001) and 15.12 (95% CI: 6.12 – 37.37, p < 0.001), respectively. The COVID-19 + patients needed more critical care admission (OR = 5.08, 95% CI: 1.49 – 17.30, p < 0.009) and they remain admitted for a longer time in hospital (mean difference = 3.6, 95% CI: 1.74 – 5.45, p < 0.001); but there was no difference in readmission rate between these 2 groups. The risks of overall complications (OR = 17.22), development of pneumonia (OR = 22.25), and acute respiratory distress syndrome/acute respiratory failure (OR = 32.96) were significantly high among COVID-19 + patients compared to COVID-19 − patients.ConclusionsThere are increased risks of the 30-day mortality, inpatient mortality and critical care admission among hip fracture patients who are COVID-19 +. The chances of developing pneumonia and acute respiratory failure are more in COVID-19 + patients than in COVID-19 ‒ patients.     

Morbidity and mortality after hip fracture: the impact of operative delay

Introduction The relationship between the timing of surgery after hip fracture and the subsequent survival of the patient has been studied extensively, yet still remains a controversy. This study aims to assess the impact of operative delay on the 1-year survival of patients and on the rate of complications during the postoperative hospital stay.Materials and methods Medical and demographic data were extracted from the hospital records of 651 consecutive hip fracture patients over 60 years old. Information on mortality was obtained by cross-linkage with the Department of Interior population files. The multivariate survival analysis model was utilized to assess the association between the time from fracture incident to surgery and the outcome (1-year survival and postoperative complications).Results The hazard ratio (HR) of 1-year mortality for postponing surgery beyond 48 h was 1.63 (95%CI 1.11–2.40), as derived by the Cox proportional hazards model. Other variables found to be independently associated with decreased survival are: male gender (HR=1.54), mental deterioration (HR=2.94), postoperative mobility (HR=2.45), and severity of pre-existing diseases (HR=1.96). Occurrence of general complications during the postoperative hospital stay was a significant predictor of decreased 1-year survival (HR=1.83).Conclusion These findings suggest that early (within 48 h) surgical treatment of hip fractures is associated with improved 1-year survival.     

Changing trends in the mortality rate at 1-year post hip fracture-a systematic review

BACKGROUND Traditionally, the mortality rate at 1-year post hip fracture was quoted as approximately 30% of all hip fractures. There have been recent improvements in hip fracture care in the main driven by national hip fracture registries with reductions in 30-d mortality rates reported.AIM To address recent 1-year post hip fracture mortality rates in the literature.METHODS Systematic literature review, national hip fracture registries/databases, local studies on hip fracture mortality, 5 years limitation(2013-2017), cohorts 100,studies in English. Outcome measure: Mortality rate at 1-year post hip fracture.RESULTS Recent 1-year mortality rates were reviewed using the literature from 8 National Registries and 36 different countries. Recently published 1-year mortality rates appear lower than traditional figures and may represent a downward trend.CONCLUSION There appears to be a consistent worldwide reduction in mortality at 1-year post hip fracture compared to previously published research. Globally, those which suffer hip fractures may currently be benefiting from the results of approximately 30 years of national registries, rigorous audit processes and international collaboration. The previously quoted mortality rates of 10% at 1-mo and 30% at 1-year may be outdated.     

Pre-operative factors associated with increased mortality in elderly patients with a hip fracture: A cohort study in a developing country

BackgroundHip fractures are a public health problem worldwide, and several factors are involved with post-operative mortality. The aim of this study was to identify the pre-operative factors associated with increased mortality in elderly patients with hip fractures in a developing country during the first post-operative year.MethodsAn ambidirectional cohort study was conducted with patients ≥ 65 years of age who underwent hip surgery due to a hip fracture caused by a fall from a standing position. Socio-demographic data, time to surgery, and comorbidities measured by the Charlson Comorbidity Index (CCI) were recorded. One-year mortality from all causes was the primary outcome, and 30-day and 6-month mortality were the secondary outcomes. Log-rank test was used to evaluate survival, and Cox’s proportional hazard regression was used to detect the factors associated with increased mortality.Results478 patients who underwent hip surgery were included in this study. The mean age was 80.2 ± 9.9, and 297 (62%) were females. There were 150 (31.4%) deaths at the end of the first follow-up year, and the mean of surgical delay was 8.8 days ± 6.4. Patients who underwent surgery during the first 4 days (Log-rank test < 0.001) after hip fracture occurred and patients with a CCI ≤ 2 (Log-rank test < 0.001) showed better survival (90%), comparing to mortality (52%) of patients with a CCI ≥ 3 and surgical delay > 4 days. The age ≥ 80 years (Hazard ratio 2.55 (HR), 95% confidence interval (CI) 1.70 to 3.84, p < 0.001), CCI ≥ 3 (HR 1.61, 95% CI 1.14–2.26, p 0.006), surgical delay > 4 days (HR 2.41, 95% CI 1.38–4.21, p 0.006), and haemoglobin < 10 g/dl (HR 1.51, 95% CI 1.06–2.15, p 0.02) were associated with increased 1-year mortality. In addition, 30-day mortality was associated with age ≥ 80 years (HR 4.15, 95% CI 1.98–8.70, p < 0.001), CCI ≥ 3 (HR 1.80, 95% CI 1.08–2.99, p 0.023), pre-surgical time >48 h (HR 3.0, 95% CI 1.58–5.92, p 0.001), and surgical delay > 4 days (HR 3.0, 95% CI 1.33–6.81, p 0.008); and 6-month mortality was associated with surgical delay > 4 days (HR 2.72, 95% CI 1.42–5.23, p 0.003), and haemoglobin < 10 g/dl (HR 1.56, 95% CI 1.04–2.33, p < 0.028).ConclusionsSurgical delay greater than 4 days and Charlson Comorbidity Index ≥ 3 were found as factors associated with increased mortality, along with anaemia < 10 g/dl and age ≥ 80 years. A similar mortality rate was found in this study compared to the rates reported by the literature, despite a surgical delay of 8.8 days.     

Geriatric distal femoral fractures: A retrospective study of 30 day mortality

Introduction

Distal femoral fractures have many of the same challenges as hip fractures, but there has been limited research into outcomes following these. The aim of this study was to assess 30 day mortality following distal femoral fractures in comparison to hip fractures presenting to a single institution Secondary outcomes included risk factors for mortality, post-operative complications and union.

Plasma concentrations of pro- and anti-inflammatory cytokines and outcome prediction in elderly hip fracture patients

Background

Hip fractures, particularly intertrochanteric fractures, frequently occur in the elderly, and they are associated with a high incidence of complications and mortality. The development of markers is essential to allow for adjustments to treatment strategies in patients, as it remains unclear why some patients endure organ failure and others do not under seemingly similar clinical conditions.

Objective

Our objective was to determine the kinetics of tumour necrosis factor (TNF)-a, interleukin (IL)-6 and IL-10 during the hospitalisation of patients and to examine the relationship of these parameters to outcome (mortality and complications) 6 months and 12 months postoperatively.

Methods and subjects

A total of 127 elderly patients, who underwent hip fracture surgery, were prospectively followed up for 12 months, and 60 healthy elderly volunteers were enrolled in the control group to examine the effects of trauma and surgery on the inflammatory response. The epidemiological characteristics, chronic medical conditions and type of operation and anaesthetic were recorded. Cognition was evaluated using the Mini-Mental State Examination, and TNF-a, IL-6 and IL-10 levels were assessed during admission and preoperatively (post-anaesthesia) as well as 1 h, 1 day, 3 days and 5 days postoperatively. During the follow-up period, serious complications and mortality within 1 year were evaluated.

Results

Overall, 96 patients survived, and 31 died within the 6-month postoperative period; 43 patients died, and 84 survived when examining the 12-month postoperative period. There were significant within-subject effects of time on TNF-a, IL-6 and IL-10 (P < 0.001, P < 0.001 and P < 0.001). The above three cytokines were all significantly increased in the hip fracture patients compared with the control group. There were also differences in the kinetic patterns of all three parameters when the patients who died were compared with those who survived during the 6-month and 12-month postoperative periods. Multiple logistic regression analysis showed that TNF-a at 1 day (odds ratio (OR) = 1.020, P = 0.045) and 3 days (OR = 1.034, P = 0.037) postoperatively and IL-6 at 1 day (OR = 1.048, P = 0.000) postoperatively were independent predictors of mortality at 6 months; IL-6 (OR = 1.019, P = 0.025) and IL-10 (OR = 1.018, P = 0.042) at 1 day postoperatively were independent predictors of mortality at 1 year. The analysis of the receiver operating characteristics curve (ROC) showed that only IL-6 or IL-10 had the highest values for the area under the curve for mortality at 6 months and 12 months. Of the 84 patients who survived, 23 patients had 32 complications. The most common complication was pneumonia infection (11/84, 13%). TNF-a, IL-6 and IL-10 kinetics were found to differ in patients with complications compared to those without complications and in patients with infections compared with patients without complications. Multiple logistic regression analysis showed that IL-6 (OR = 1.081, P = 0.000) at 1 day postoperatively was an independent outcome predictor.

Conclusion

In elderly hip fracture patients, cytokine concentrations (TNF-a, IL-6 and IL-10) represented independent outcome predictors for adverse postoperative outcomes (mortality and complications). The inflammatory response played an important role in postoperative organ dysfunction in elderly hip fracture patients, and further study is needed to define whether decreasing the inflammatory response through cytokine antibodies or damage control strategies would decrease mortality and complication following hip fracture.     

Do-Not-Resuscitate status is an independent risk factor for medical complications and mortality among geriatric patients sustaining hip fractures

BackgroundThe purpose of this study was to compare outcomes after hip fracture surgery between DNR/DNI and full code cohorts to determine whether DNR/DNI status is an independent predictor of complications and mortality within one year. A significant number of geriatric hip fracture patients carry a code status designation of DNR/DNI (Do-Not-Resuscitate/Do-Not-Intubate). There is limited data addressing how this designation may influence prognosis.MethodsA retrospective chart review of all geriatric hip fractures treated between 2002 and 2017 at a single level-I academic trauma center was performed. 434 patients were eligible for this study with 209 in the DNR/DNI cohort and 225 in the full code cohort. The independent variable was code-status and dependent variables included patient demographics, surgery performed, American Society of Anesthesiologists, score, Charlson Comorbidity Index, significant medical and surgical complications within one year of surgery, duration of follow-up by an orthopaedic surgeon, duration of follow-up by any physician, and mortality within 1 year of surgery. One-year complication rates were compared, and multiple logistic regression analyses were performed to analyze the relationship between independent and dependent variables.ResultsThe DNR/DNI cohort experienced significantly more surgical complications compared to the full code cohort (14.8% vs 7.6%, p = 0.024). There was a significantly higher rate of medical complications and mortality in the DNR/DNI cohort (57.9% vs 36%, p < 0.001 and 19.1% vs 3.1%, p = 0.037, respectively). In the regression analysis, DNR/DNI status was an independent predictor of a medical complication (odds ratio 2.33, p = 0.004) and one-year mortality (odds ratio 9.69, p < 0.001), but was not for a surgical complication (OR 1.95, p = 0.892).ConclusionsIn our analysis, DNR/DNI code status was an independent risk factor for postoperative medical complications and mortality within one year following hip fracture surgery. The results of our study highlight the need to recognize the relationship between DNR/DNI designation and medical frailty when treating hip fractures in the elderly population.     

Excess mortality following hip fracture: the role of underlying health status

Summary We evaluated the long-term excess mortality associated with hip fracture, using prospectively collected data on pre-fracture health and function from a nationally representative sample of U.S. elders. Although mortality was elevated for the first six months following hip fracture, we found no evidence of long-term excess mortality. Introduction The long-term excess mortality associated with hip fracture remains controversial. Methods To assess the association between hip fracture and mortality, we used prospectively collected data on pre-fracture health and function from a representative sample of U.S. elders in the Medicare Current Beneficiary Survey (MCBS) to perform survival analyses with time-varying covariates. Results Among 25,178 MCBS participants followed for a median duration of 3.8 years, 730 sustained a hip fracture during follow-up. Both early (within 6 months) and subsequent mortality showed significant elevations in models adjusted only for age, sex and race. With additional adjustment for pre-fracture health status, functional impairments, comorbid conditions and socioeconomic status, however, increased mortality was limited to the first six months after fracture (hazard ratio [HR]: 6.28, 95% CI: 4.82, 8.19). No increased mortality was evident during subsequent follow-up (HR: 1.04, 95% CI: 0.88, 1.23). Hip-fracture-attributable population mortality ranged from 0.5% at age 65 among men to 6% at age 85 among women. Conclusions Hip fracture was associated with substantially increased mortality, but much of the short-term risk and all of the long-term risk was explained by the greater frailty of those experiencing hip fracture.     

老年髋部骨折术后早期并发症对疗效的影响

[目的]分析老年髋部骨折患者术后心肺及血液系统早期并发症对手术疗效的影响。[方法]研究2001年1月-2005年7月本科收治的59例髋部骨折，其中39例合并有内科疾病，多为高血压、慢性支气管炎、糖尿病、心律失常。共有56例行手术治疗。[结果]52例均手术成功，1例死亡。死亡原因为肺间质纤维化。术后呼吸道、泌尿系、伤口感染、褥疮、应激性溃疡和下肢深静脉血栓的发生率分别为19％、10％、8％、5％、2％和4％。[结论]老年髋部骨折病人术后肺部感染的发病率最高，术前应评价心肺功能。下肢深静脉血栓是最严重的并发症，术后应早期开始股四头肌功能锻炼，并适时应用抗凝剂，同时辅助行CPM机锻练。手术方式的选择也是影响疗效的一个重要因素。     

Increased mortality in patients with a hip fracture-effect of pre-morbid conditions and post-fracture complications

Summary In a cohort of 169,145 patients with a hip fracture and 524,010 controls we observed an excess mortality among patients compared to controls for as long as 20 years after the hip fracture. The main reason for the excess mortality was linked to the trauma that caused the hip fracture. Introduction Patients with a hip fracture have a significant excess mortality. However, it remains unclear if the mortality is linked to the pre-morbid conditions or to complications to the fracture. Methods All subjects with a hip fracture in Denmark between 1977 and 2001 were compared with three age- and gender-matched subjects from the general population. Results A total of 169,145 fracture cases were compared to 524,010 controls. The cases had a much higher prevalence of co-morbidity than the controls. The mortality rate was twice as high in fracture cases compared with controls (HR = 2.26, 95% CI: 2.24–2.27). Adjustments for confounders only changed the excess mortality risk little. The mortality after the hip fracture was divided into two categories: an excess mortality of 19% within the first year following the fracture (relative survival = 0.81 compared to controls), and an excess mortality of 1.8% per year (relative survival 0.982) for every additional year following the fracture. The major causes of the excess mortality were due to complications to the fracture event (70.8% within the first 30 days). Conclusions Patients with a hip fracture have a pronounced excess mortality risk. The major cause was linked to the fracture event and not to pre-existing co-morbidity.     

Perioperative mortality for patients with a hip fracture

IntroductionStudies on mortality following hip fracture surgery have hitherto focused on the 30 day to 1 year period and beyond. This study focuses on the immediate perioperative period. It examines mortality rates, patient characteristics, operative details and post-operative complications.Patients and methodsA retrospective study of a hip fracture database in a large District General Hospital in the United Kingdom, from 1986 to 2015. A dataset of 9393 patients was identified, including patients undergoing surgery for curative and palliative purposes, over fifteen years of age and with no upper age limit imposed. It compared patients who survived the first 48 h from start of surgery with those who died within this perioperative period.Results9393 patients were treated surgically and included within this study, with a mean age of 80.13 and consisting of 7130 female and 2263 male patients. The all cause mortality within 48 h from start of surgery was 0.8% (72 patients). Increased risk of perioperative mortality was associated with increasing age, ASA grade 3 and above, in-hospital falls, impaired mobility prior to the fall and a reduced mental test score on admission. For the patient with a perioperative death, the most common circumstances identified in this study involved being found dead in bed by attending staff within 48 h of surgery.DiscussionThere has been significant attention paid to the optimization of patient management leading up to hip fracture surgery and its attendant impact on medium and longer term survival. The information from this study may be used to identify patients most at risk of death in the 48 h after surgery. The importance of this dataset is that it provides large numbers, which are needed in order to look for associations, given the low 48 h mortality rate found.ConclusionWe are unable to highlight any correctable or alterable factors associated with mortality. Further studies with detailed collection of data on a national scale may be needed to assess the impact of levels of postoperative care for hip fracture patients and perioperative mortality.     

人工股骨头置换治疗90岁以上患者髋部骨折

[目的]报告人工股骨头置换治疗90岁以上患者髋部骨折的疗效。[方法]本组23例（24髋），男7例，女16例：年龄90～100岁，平均94岁。骨折分类：股骨颈骨折10例，按Garden分型，Ⅲ型6例，Ⅳ型4例；股骨粗隆问骨折13例（1例为双侧），按Evans分型，ⅢA型6例，ⅢB型6例，Ⅳ型1例。除2例在室外被碰伤外，其余骨折均发生在室内。患者入院后暂用皮牵引制动患肢，然后抓紧时间进行各项必要的术前检查，了解患者的健康情况。争取在短时间内请有关科室联合会诊，对患者的全身情况评估，论证能否耐受手术。本组患者在骨折前均并存各种不同程度的内科疾病，但经过对症处理相对稳定，大部分都能生活自理，经过评估后认为无绝对手术禁忌证。手术均用气管插管全麻，术中心电监护仪监护。取侧卧位，髋后外侧切口，股骨颈骨折的手术操作与其他年龄段患者操作相同。股骨粗隆间骨折，需要将骨折分离的股骨大、小粗隆重新复位，用钢丝捆绑固定，股骨距部位的骨缺损用骨水泥充填、重塑。股骨粗隆问骨折患者术中适当输血，本组8例术中输血200～800ml，平均400ml：关节腔内置负压引流管，48～72h后拔除。[结果]23例均顺利通过手术，术后下床时间2～7d，平均4d，住院时间15～28d，平均21d。并发症：6例术后出现一过性精神障碍，经过治疗逐渐恢复；1例出现患肢轻度深静脉炎，对症处理后未影响治疗效果；1例95岁女性患者ⅢB型股骨粗隆问骨折，术后3周死于多脏器功能衰竭。16例（9例股骨粗隆间骨折，7例股骨颈骨折）有随诊结果，随访5～36个月，平均8个月。10例（6例股骨粗隆问骨折，4例股骨颈骨折）基本达到骨折前的状况，5例（2例粗隆间骨折，3例股骨颈骨折）生活部分自理，1例股骨粗隆间骨折患者术后6个月死于其他疾病。[结论]人工股骨头置换治疗90岁以上患者髋部骨折，疗效满意，可早下床活动，减少并发症，降低死亡率，改善生活质量，减轻家庭生活护理负担。     

An estimate of the worldwide prevalence,mortality and disability associated with hip fracture

The aim of this study was to quantify the global burden of osteoporosis as judged by hip fracture and the burden in different socio-economic regions of the world. The population mortality in 1990 and the incidence of hip fracture in different regions were identified, where possible in 1990. Excess mortality from hip fracture used data for Sweden, and disability weights were assigned to survivors from hip fracture. In 1990 there were an estimated 1.31 million new hip fractures, and the prevalence of hip fractures with disability was 4.48 million. There were 740,000 deaths estimated to be associated with hip fracture. There were 1.75 million disability adjusted life-years lost, representing 0.1% of the global burden of disease world-wide and 1.4% of the burden amongst women from the established market economies. We conclude that hip fracture is a significant cause of morbidity and mortality worldwide.     

First-year mortality and long-term results of hemiarthroplasty for hip fractures in the elderly

Hip fractures are injuries that affect not only the joint in an elderly person, but also the patient's survival. The aim of this study was to asses hemiathroplasty as a treatment for these lesions and their complications; mortality within the first year after fracture was assessed and functional results were compared with the previous conditions. Between 1 January 1995 and 31 May 2001, we treated 29 patients who suffered hip fracture (2 bilateral). The average age was 80.7 years. The mean follow-up was 23 months. We obtained information by a telephone interview. We compared independence in daily activities before and after fracture. Moreover we examined the social surroundings in which the patients lived, before and after the fracture. Of the 24 patients available for follow-up, 4 (16.7%) had clinical and surgical complications. Mortality within the first year after fracture was 24.1% (7 patients). With respect to functional results, 47.4% of patients reached a score between 26 and 54 points (fair) in postoperative time. Furthermore, the percentage of patients who needed to live in geriatric institutions after the fracture increased from 15.8% to 42.1%. We consider hemiarthroplasty to be a treatment which has a lot of advantages, since it allows the immediate return to daily activities and avoids bedrest complications. However we believe that medical society has to advance more in prevention and care of this group of patients due to the high mortality within the first year after fracture, which causes them to lose independence in daily life and to become dependant on third-party assistance. Received: 15 February 2002, Accepted: 10 May 2002 Correspondence to: J. Boretto