A Comparative Study of Hip Arthroplasty and Closed Reduction Proximal Femur Nail in the Treatment of Elderly Patients with Hip Fractures

Enhancing Elderly Hip Fracture Care: Reducing the Length of Stay Through Guidelines Implementation

BACKGROUND

Hip fractures are a significant concern for the elderly population due to their impact on health and well-being. Surgical interventions, including hip arthroplasty and osteosynthesis, play a crucial role in the management of these fractures. In 2015, a hospital-based protocol was introduced to expedite surgical interventions within 48 hours of admission for elderly patients with hip fractures, aiming to enhance preoperative care and minimize delays.

OBJECTIVES

This retrospective observational study aimed to evaluate the effects of protocol implementation on elderly patients (aged >60 years) undergoing osteosynthesis for hip fractures. Primary objectives included assessing postoperative complications, 30-day and one-year mortality rates, functional recovery, and length of hospital stay. The secondary objective was to explore the impact of early surgical intervention (within 48 hours of admission) on these outcomes.

METHODS

Electronic medical records of hip fracture patients treated at Braga Public Hospital from 2013 to 2016 were retrospectively reviewed.

RESULTS

We included a total of 744 patients, with 391 in the pre-protocol group and 353 in the post-protocol group. Protocol implementation led to a significant increase in surgeries performed within 48 hours of admission (36% versus 53%). While post-protocol patients were older and had higher comorbidity scores, they experienced more postoperative complications. However, their hospital stay was shorter, with no significant changes in mortality rates or time to assisted ambulation.

DISCUSSION

This study highlights the benefits of protocol implementation in expediting surgical interventions for elderly hip fracture patients. Despite increased complications, the protocol reduced hospital stay without affecting mortality rates. Early surgical intervention was associated with faster postoperative mobilization.

Cemented bipolar hemiarthroplasty for unstable intertrochanteric fracture in elderly patients over 70 years: Boon or bane?

INTRODUCTION

The surgical management of intertrochanter femur fracture in elderly patient is still under debate. Various implants can be utilised but prosthetic replacement is gaining popularity. This study was performed to evaluate the functional and clinical outcomes of cemented bipolar arthroplasty as a primary treatment for unstable intertrochanteric fracture in elderly patients (> 70 years).

MATERIALS AND METHODS

Thirty-seven patients with unstable intertrochanteric fracture in elderly patient (> 70 years) who underwent cemented bipolar hemiarthroplasty. Intra-operative and post-operative complications were noted; functional outcomes were assessed using Harris hip score (HHS). All patients were followed up for a minimum of 12 months.

RESULTS

Overall 90% of patients has some minor or major intra or post-operative complication. One year mortality rate was 16% (6/37). Cardiopulmonary events were the most common life threatening incident. Mean fall in Haemoglobin was 1.6 gm/dL. The average time for full weight bearing mobilisation with the help of walker was 2.8 ± 1.2 days (1-8 days). The average duration of surgery was 58 ± 6 min (44-96 min) with an average blood loss of 126 ± 24 mL (90-380 mL). HHS at the end of 12 months was 77.

CONCLUSIONS

The use of bipolar hemiarthroplasty in senile patient with unstable hemiarthroplasty gives an advantage of early weight bearing. However, it is associated with risk of significant intra or post-operative morbidity due to intra-operative trauma, surgical time and blood loss during the surgery. Although hemiarthroplasty can be a single-time solution to the complexities of intertrochanter fracture in elderly patients but should be performed in selected patients only.