Report on the Japanese Orthopaedic Association's 3-year project observing hip fractures at fixed-point hospitals.
BACKGROUND
The aim of this study was to assess the disability and mortality of hip fractures 1 year after initial visit (postoperatively) at fixed-point hospitals selected by the Japanese Orthopaedic Association Committee on Osteoporosis.


METHODS
A total of 158 core orthopedic hospitals were selected for participation in this research. Subjects were all aged 65 years and older with hip fractures at the selected hospitals between January 1, 1999 and December 31, 2001. A prognostic survey of activities of daily living (ADL), assessed by the long-term care insurance criteria established by the Ministry of Health, Labour, and Welfare of Japan was performed 1 year after the initial visit.


RESULTS
A total of 1992 hip fractures in patients aged 65 to 111 years were treated over the 3 years from 1999 to 2001. Among the 1992 patients, 4537 had femoral neck fractures and 6217 had trochanteric fractures. Surgical treatment was chosen for 85.6% of the femoral neck fractures and 88.2% of the trochanteric fractures. The mean duration from fracture to admission was 3.1 days, and the mean duration from admission to surgery was 11.2 days. The mean duration from surgery to discharge over the 3-year period was 49.8 days. Before hip fracture, the ratio of patients with J1 ("able to go out freely utilizing public transportation") or J2 ("able to visit immediate neighbors independently") on the long-term care insurance criteria was 50.9%. At 1 year after the initial visit, that result represented a decrease of 24.1 percentage points before hip fracture. A total of 70 patients died before undergoing surgery. In the present study, the 1-year mortality rate for the entire patient population over the 3-year period was 10.1%.


CONCLUSIONS
Hip fracture patients show a decrease in the ADL score 1 year after the initial visit. Compared to other countries, the duration of hospitalization is longer in Japan, but the mortality rate is lower.
Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan.
Keizo
K
Sakamoto
Toshitaka
T
Nakamura
Hiroshi
H
Hagino
Naoto
N
Endo
Satoshi
S
Mori
Yoshiteru
Y
Muto
Atsushi
A
Harada
Tetsuo
T
Nakano
Seizo
S
Yamamoto
Kazuhiro
K
Kushida
Katsuro
K
Tomita
Mitsuo
M
Yoshimura
Hiroshi
H
Yamamoto
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods* / Q000401:mortality*; D017102:Fracture Healing / Q000502:physiology; D019538:Health Care Surveys; D006620:Hip Fractures / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D006760:Hospitalization / Q000706:statistics & numerical data; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D018570:Risk Assessment; D017678:Sex Distribution; D012955:Societies, Medical; D015996:Survival Rate; D016896:Treatment Outcome