title: Hip fractures in nonagenarians--a study on operative and non-operative management.
abstract: 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.
authors.affiliation: Dept of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. ooi818@yahoo.com.sg
authors.forename: L H
authors.initials: LH
authors.lastname: Ooi
authors.forename: T H
authors.initials: TH
authors.lastname: Wong
authors.forename: C L
authors.initials: CL
authors.lastname: Toh
authors.forename: H P
authors.initials: HP
authors.lastname: Wong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over / Q000706:statistics & numerical data; D005260:Female; D005265:Femoral Neck Fractures / Q000401:mortality / Q000601:surgery / Q000628:therapy; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008124:Locomotion / Q000502:physiology; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D011581:Psychological Tests; D012189:Retrospective Studies; D014143:Traction / Q000379:methods; D016896:Treatment Outcome