Malhotra R, Huq S S, Chong M, Murphy D, Daruwalla Z J
Department of Orthopaedics, National University Hospital of Singapore, Singapore.
Malays Orthop J. 2021 Nov;15(3):21-28. doi: 10.5704/MOJ.2111.004.
We aimed to assess the clinical outcomes in nonagenarians following a hip fracture. We also further investigated the factors that influence these outcomes, such as method of treatment (operative versus conservative), co-morbidities, and pre-morbid function.
We studied 65 nonagenarians that were identifiable from our hospital hip fracture database. We reviewed various parameters of these patients admitted after sustaining a hip fracture (neck of femur or intertrochanteric) and investigated how these parameters affected patient outcomes. The main outcomes studied were: inpatient morbidity, and mortality at one year.
Inpatient morbidity was more likely in patients with an ASA grade of 3 to 5. Urinary tract infection was the most common medical complication. The 1-year mortality was 15.4% and was significantly influenced by advancing age. Surgically managed patients had a 1-year mortality rate (14.3%) slightly less than non-operative patients (17.4%). Post injury mobility was significantly better in those who received operative treatment with 63% of surgical cases regaining ambulatory status versus 7% of conservatively managed patients.
We presented the outcomes of hip fractures in an extreme age group in the population. In nonagenarians with hip fractures surgery was associated with a 1-year mortality rate of 14.3% which is comparable to the general hip fracture population and less than the mortality rate of conservatively managed patients (17.4%). The primary advantage of surgery would be that two-thirds of patients return to ambulatory status. This information is useful to counsel patients and their families especially since the elderly are often more fearful of surgical intervention.
我们旨在评估百岁老人髋部骨折后的临床结局。我们还进一步研究了影响这些结局的因素，如治疗方法（手术与保守治疗）、合并症和病前功能。
我们研究了从我院髋部骨折数据库中识别出的65例百岁老人。我们回顾了这些髋部骨折（股骨颈或转子间骨折）后入院患者的各种参数，并研究了这些参数如何影响患者结局。研究的主要结局是：住院发病率和一年死亡率。
美国麻醉医师协会（ASA）分级为3至5级的患者住院发病率更高。尿路感染是最常见的医疗并发症。1年死亡率为15.4%，且受年龄增长的显著影响。手术治疗的患者1年死亡率（14.3%）略低于非手术患者（17.4%）。接受手术治疗的患者伤后活动能力明显更好，63%的手术病例恢复了行走状态，而保守治疗患者中这一比例为7%。
我们展示了该人群中一个极端年龄组髋部骨折的结局。在百岁老人髋部骨折患者中，手术治疗的1年死亡率为14.3%，与一般髋部骨折人群相当，且低于保守治疗患者的死亡率（17.4%）。手术的主要优势在于三分之二的患者恢复了行走状态。这些信息对向患者及其家属提供咨询很有用，尤其是因为老年人往往更害怕手术干预。
