Factors affecting ambulatory status and survival of patients 90 years and older with hip fractures.
This study was done to assess the long-term functional outcome of very elderly patients with hip fractures, to determine whether bone mineral density and prevalent vertebral fractures could affect mortality and ambulatory status, and to examine which patient characteristics reported in the literature are predictive of patient mortality and ambulatory status. Seventy-four patients 90 years and older with hip fractures were analyzed and followed up for at least 4 years or until death. The mean age of the patients was 92.8 years and all were treated surgically. Walking ability before injury was better than at discharge; walking ability decreased during the first year after discharge, but thereafter reached a plateau. The predictors of survival were the preoperative American Society of Anesthesiologists score, walking ability, fracture type, type of surgery, and the number of prevalent vertebral fractures on admission. Dementia and the number of prevalent vertebral fractures were predictors of the recovery of walking ability. Type of surgery and fracture type are collinear variables, and because it is difficult to separate the effects of one versus the other, additional well-designed, randomized studies on the effect of the type of surgery and fracture type on outcome are needed.


METHODS
Prognostic study, Level II-1 (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.
Department of Orthopaedic Surgery, Yamaguchi University School of Medicine; Yamaguchi, Japan. myishida@yamaguchi-u.ac.jp
Yoichiro
Y
Ishida
Shinya
S
Kawai
Toshihiko
T
Taguchi
D015502:Absorptiometry, Photon; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000378:metabolism; D015897:Comorbidity; D005260:Female; D016330:Frail Elderly; D006305:Health Status Indicators; D006620:Hip Fractures / Q000378:metabolism / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D010024:Osteoporosis / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D016103:Spinal Fractures / Q000378:metabolism / Q000401:mortality; D015996:Survival Rate; D016138:Walking