title: The difference in activity of daily living (ADL) and mortality in patients aged over 80 years with femoral neck fracture treated with hemiarthroplasty or osteosynthesis at 2 years of follow-up.
abstract: BACKGROUND
  Hip fractures are one of the major causes of morbidity and mortality in the elderly and outcomes following hip fracture have been the focus of several studies over recent decades. Among all types of fall-related injuries, hip fractures cause the greatest number of deaths, lead to severe health problems and reduce quality of life. Improving the outcome of hip fracture surgery has thus become one of the main areas of interest for orthopaedic surgeons. The aim of this study was to compare the difference in activity of daily living (ADL) and mortality between patients aged over 80 years with hip fracture treated with osteosynthesis versus prosthesis at 2 years of follow-up.
  
  
  METHODS
  The data were collected on admission and during in-hospital stay. Information recorded on admission included: age, sex, type and mechanism of fracture, functional and cognitive status, comorbidity, and severity of illness. Prefracture functional status was measured. The follow-up was clinical and radiographical, or was by telephone for patients who were not able to come to the clinic. Patients aged over 80 years who underwent a single surgical procedure treated with intramedullary nail or hemiarthroplasty were included in the study.
  
  
  RESULTS
  A total of 174 patients (45 male and 129 female) were included in the study. The two treatment groups were comparable for all preoperative parameters except for preoperative haemoglobin, which was an average of 1g/dl higher in the patients given hemiarthroplasty compared with those treated with intramedullary nail (t-test: p<0.05). The average observation period was 594.99days; the number of deaths was 62 of 164 contacted patients, and the survival rate at 2 years was 62.2%. There was increased mortality in patients who underwent hemiarthroplasty (Log-rank Mantel-Cox, p: 0,048). The difference in ADL between preoperative and follow-up is not statistically significant between the two groups.
  
  
  CONCLUSIONS
  In the literature, there are few specific studies that consider these parameters in this population. However, these findings are consistent with the findings from other studies.
  
  
  CONCLUSIONS
  Patients who received hemiarthroplasty have a higher mortality risk than those treated with intramedullary nail; there are no differences in ADL at follow-up.
authors: First Orthopaedics and Traumatology department, University of Pisa, Italy.
authors: Enrico
authors: E
authors: Bonicoli
authors: First Orthopaedics and Traumatology department, University of Pisa, Italy. Electronic address: frniccolai@icloud.com.
authors: Francesco
authors: F
authors: Niccolai
authors: Geriatric department, University of Pisa, Italy.
authors: Giuseppe
authors: G
authors: Pasqualetti
authors: Geriatric department, University of Pisa, Italy.
authors: Giacomo
authors: G
authors: Bini
authors: Geriatric department, University of Pisa, Italy.
authors: Fabio
authors: F
authors: Monzani
authors: First Orthopaedics and Traumatology department, University of Pisa, Italy.
authors: Michele
authors: M
authors: Lisanti
mesh_terms: D000203:Activities of Daily Living; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005265:Femoral Neck Fractures / Q000401:mortality* / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000401:mortality; D062785:Hemiarthroplasty / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D011788:Quality of Life; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: ADL; Hemiarthroplasty; Hip fracture; Mortality; Orthogeriatrics; Osteosynthesis