title: Conservative Treatment for Fracture of the Proximal Femur with Complications.
abstract: We retrospectively compared two groups of patients with hip fractures and severe complications. One group had been treated surgically; the other group had been treated conservatively to prevent worsening of general status, with transfer to wheelchair as soon as possible. This study aimed to determine if early prognosis after conservative treatment would be worse than that following surgical treatment.
  
  
  METHODS
  Subjects were patients (n=230) with hip fracture who had been admitted and treated at our hospital from 1993 through 2006. Patients' medical records were retroactively investigated to obtain information on age, sex, complications, type of fracture, and course of subsequent hospitalizations. Additional information for conservatively treated patients included reasons for avoiding surgery and time-to-transfer to wheelchair. In case of death, the cause and timing of death were investigated.
  
  
  RESULTS
  Of the 230 patients, 22 (mean age, 83.5 years) were treated conservatively. Complications at admission included cardiac disease, respiratory disease, malignancy, renal disease, dementia, and other conditions. Multiple complications were commonly seen. The reasons for selecting conservative treatment were cardiac function disturbance in 13 cases and decision of patients' families in 9 cases. Almost all patients were able to transfer to wheelchair. A total of 9 patients died in the hospital: 8 were in the surgical treatment group and 1 was in the conservative treatment group. The patients who died in the surgical treatment group had a mean age of 80.3 years, and pneumonia was the main cause of death. The timing of death ranged from 12 to 129 days after surgery. The number of perioperative deaths was 3 (1.4%).
  
  
  CONCLUSIONS
  This study showed that in patients with hip fractures, severe complications, and poor general conditions, early prognosis after conservative treatment aiming for early transfer to wheelchair is no worse than that following surgical treatment. Thus, conservative treatment should be considered for patients with poor ability for activities of daily living.
authors.affiliation: Department of Orthopaedic Surgery, Nippon Medical School.
authors.forename: Hidemi
authors.initials: H
authors.lastname: Kawaji
authors.forename: Takuya
authors.initials: T
authors.lastname: Uematsu
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Oba
authors.forename: Shinro
authors.initials: S
authors.lastname: Takai
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D000072700:Conservative Treatment; D003704:Dementia / Q000150:complications; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006620:Hip Fractures / Q000150:complications / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D011014:Pneumonia; D011379:Prognosis; D012140:Respiratory Tract Diseases / Q000150:complications; D012189:Retrospective Studies; D014910:Wheelchairs