Hafeez Kamran, Sohatee Mark Andrew, Harding Israel, Lewis James, Hutchinson James
University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter, UK.
Eur J Orthop Surg Traumatol. 2025 Jul 25;35(1):323. doi: 10.1007/s00590-025-04439-6.
To present the clinical outcomes of patients above 90 years of age admitted with periprosthetic fractures around hip.
This was a retrospective study, of prospectively collected data, including patients treated at a single institution during 2014 to 2024. Data were assessed for fractures type, mode of treatment, time to surgery, length of stay, post-op complications, discharge destination, reoperation, and 30-day and 12-month mortality.
There were 51 patients admitted during the study period. Mean age was 93.7 years. All were walking either independently or with support prior to their admission. Fractures were classified according to the unified classification system with type B1 (n = 23), and type C (n = 13) fractures were the most common fractures. Thirty patients underwent ORIF, five revision arthroplasty, and remaining patients were managed conservatively. Median time to surgery was 2 days. Overall, more than half of patients experienced post-op complications (n = 26). The reoperation rate was 5.7%. The median length of stay was 14 days. Twenty-two patients were discharged home, while 20 were discharged to residential care. Mean Charlson Comorbidity Index (CCI) was 5.78. Thirty-day mortality was 17.6%, and 12-month mortality was 45%. CCI of 5 or above was associated with higher 1-year mortality (p = 0.02).
We observed a significantly higher rate of post-op complications and mortality rate. Surgical stabilization / revision arthroplasty and early unrestricted weight bearing helps in reducing complications. We recommend prioritizing the management of these patients and initiating early mobilization to minimize the risk of complications and mortality.
介绍90岁以上因髋关节周围假体周围骨折入院患者的临床结局。
这是一项回顾性研究，对前瞻性收集的数据进行分析，包括2014年至2024年在单一机构接受治疗的患者。评估数据包括骨折类型、治疗方式、手术时间、住院时间、术后并发症、出院去向、再次手术情况以及30天和12个月死亡率。
研究期间共收治51例患者。平均年龄为93.7岁。所有患者入院前均能独立行走或借助辅助器具行走。骨折根据统一分类系统进行分类，其中B1型骨折（n = 23）和C型骨折（n = 13）最为常见。30例患者接受切开复位内固定术，5例接受关节置换翻修术，其余患者接受保守治疗。手术中位时间为2天。总体而言，超过一半的患者出现术后并发症（n = 26）。再次手术率为5.7%。中位住院时间为14天。22例患者出院回家，20例出院后入住养老院。平均查尔森合并症指数（CCI）为5.78。30天死亡率为17.6%，12个月死亡率为45%。CCI为5或以上与1年死亡率较高相关（p = 0.02）。
我们观察到术后并发症发生率和死亡率显著更高。手术稳定/关节置换翻修术以及早期无限制负重有助于减少并发症。我们建议优先处理这些患者，并尽早开始活动，以尽量降低并发症和死亡率风险。
