Department of Orthopaedics, Traumatology and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
Department of Physical Therapy and Rehabilitation, University of Leipzig, Leipzig, Germany.
BMC Musculoskelet Disord. 2021 Sep 16;22(1):799. doi: 10.1186/s12891-021-04683-x.
This study aims primarily to investigate the outcome following surgical management of pertrochanteric fractures of patients over 90 years compared to the outcome of a control group below 90 years under special consideration of the timing of surgery. The second aim was to analyze potential risk factors for early deaths in very old patients. This study allows us to draw conclusions to minimize complications linked to this particular age segment.
The study group consisted of very old patients aged 90 years and older. Geriatric patients aged between 60 and 89 years of age were part of the control group. Type A1 pertrochanteric fractures were typically treated by dynamic hip crews, type A2 and A3 fractures by femoral nails. Full weight bearing physiotherapy was initiated on the day after surgery to improve mobility and muscle strength.
A total of 71 patients belonged to the study group (mean age: 92.5 years ±2.3 years), whereas 223 patients formed the control group (mean age: 79.9 ± 7.4 years). The mortality rate and the number of detected and documented complications were significantly higher in the study group (p = 0.001; p = 0.009, respectively). Despite the significantly higher complication rate in the > 90-year-old patients, there was no significant difference in the mean length of in-hospital-stay between the both groups (> 90 yrs.: 12.1d; < 90 yrs.: 13.1 d) and the timing of surgery.
The number of co-morbidities, number of daily-administered medications and the time between admission and surgery have no impact on the outcome. We noticed a longer period between admission and surgery in very old patients who survived. Patients with pertrochanteric fractures should be screened for multimorbidity and cognitive disorders in a standardized manner.
本研究主要旨在调查 90 岁以上患者经手术治疗股骨转子间骨折的结果，并与 90 岁以下的对照组进行比较，特别关注手术时机。第二项目的是分析高龄患者早期死亡的潜在风险因素。本研究使我们能够得出结论，以尽量减少与这一年龄段相关的并发症。
研究组由 90 岁及以上的非常高龄患者组成。年龄在 60 至 89 岁之间的老年患者为对照组。A型 1 股骨转子间骨折通常采用动力髋螺钉治疗，A 型 2 和 A 型 3 骨折采用股骨钉治疗。术后第二天开始进行全负重物理治疗，以提高活动能力和肌肉力量。
共有 71 例患者属于研究组（平均年龄：92.5 岁±2.3 岁），223 例患者属于对照组（平均年龄：79.9 岁±7.4 岁）。研究组的死亡率和发现的并发症数量明显高于对照组（p=0.001；p=0.009）。尽管>90 岁患者的并发症发生率显著较高，但两组的平均住院时间（>90 岁组：12.1 天；<90 岁组：13.1 天）和手术时间无显著差异。
共病数量、每日用药数量以及入院和手术之间的时间均对结果无影响。我们注意到，存活的非常高龄患者从入院到手术的时间间隔更长。患有股骨转子间骨折的患者应采用标准化方式进行共病和认知障碍筛查。
