title: Hip fractures in the elderly: operative versus nonoperative management.
abstract: BACKGROUND
  Hip fractures are common in the elderly. Published studies have not shown significant differences in mortality rates between hip fracture patients who were managed nonoperatively and operatively. This retrospective study looked at 340 patients with hip fractures who were admitted to a local hospital over one year, and compared the long-term mortality between those treated operatively and nonoperatively.
  
  
  METHODS
  All patients with hip fractures were identified retrospectively from the hospital's hip registry. Mortality data was collected through nationwide electronic medical records and telephone interviews.
  
  
  RESULTS
  Overall mortality rates at one (14.4%) and two years (24.4%) were comparable to those of other studies. Hip fracture patients who were treated nonoperatively had a higher risk of mortality at both one (29.8%) and two years (45.6%) after fracture (p < 0.05). Their risk of mortality was four times higher at one year and three times higher at two years after fracture than the operative group. Patients with a higher American Society of Anesthesiologists (ASA) grade did not show an increased risk in mortality compared to patients with a lower ASA grade at both one year (p = 0.072) and two years (p = 0.360) after fracture.
  
  
  CONCLUSIONS
  Elderly patients with hip fractures should be managed surgically and counselled regarding the increased risk of mortality if treated nonoperatively.
authors.affiliation: Department of Orthopaedic Surgery, Alexandra Hospital, Singapore. eileen_tay@juronghealth.com.sg.
authors.forename: Eileen
authors.initials: E
authors.lastname: Tay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006620:Hip Fractures / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D012042:Registries; D012189:Retrospective Studies
keywords: hip fracture; mortality; nonoperative management