Al-Hano Hashim, Handcock Molly
Department of General Surgery, Royal Hampshire County Hospital, Winchester, GBR.
Cureus. 2025 Jul 19;17(7):e88310. doi: 10.7759/cureus.88310. eCollection 2025 Jul.
Introduction Hip fractures in patients aged ≥90 years pose distinct clinical and functional challenges due to advanced frailty and limited physiological reserve. While long-term outcomes are well documented in the elderly, short-term discharge-related functional outcomes remain underexplored in nonagenarians. This study evaluated post-operative mobility decline, discharge needs, and early mortality in this high-risk cohort. Methods We retrospectively reviewed 84 patients aged ≥90 years who underwent surgical fixation for radiologically confirmed hip fractures between August 2024 and April 2025 at a United Kingdom District General Hospital. Demographics, American Society of Anaesthesiologists (ASA) grade, fracture type, operative method, mobility (pre- and post-operative), discharge destination, length of stay, return to theatre, and 30-day mortality were analysed. Functional decline was defined as a drop in ordinal mobility score from baseline to discharge. Institutionalisation was defined as discharge to a care facility (rehabilitation, residential home, or nursing home) due to a decline in functional mobility. Results The mean age was 92.9 years (range 90-102); 69% were female. Intracapsular fractures comprised 57% of cases. Most patients (84.5%) were ASA grade 3. Hemiarthroplasty was the most common procedure (59.5%), followed by dynamic hip screws (21.4%), nail fixation (17.9%), and total hip replacement (1.2%). Functional mobility declined in 78% of patients and remained unchanged in 21%. Only one patient (1.2%) retained full independence. At discharge, 25% used a frame independently, 37% required one-person (AO1), and 16% required two-person (AO2) assistance. Thirty-day mortality was 8.3%; return to theatre occurred in 4.8%. Mean length of stay was 18.2 days. Discharge destinations included home (32%), rehab (26%), residential home (19%), and nursing home (13%). Institutionalisation due to mobility decline occurred in 41% of patients. Patients previously independent pre-fracture experienced the greatest average decline in mobility score (-2.35). Conclusion Hip fracture in nonagenarians is associated with high rates of early functional decline and institutionalisation. Despite established multidisciplinary care, outcomes suggest the need for age-specific discharge planning, tailored rehabilitation, and proactive functional risk stratification to support recovery.
由于身体极度虚弱和生理储备有限，90岁及以上患者的髋部骨折带来了独特的临床和功能挑战。虽然老年人的长期预后已有充分记录，但非agenarians（这个词有误，可能是nonagenarians，即九旬老人）的短期出院相关功能预后仍未得到充分研究。本研究评估了这一高风险队列术后的活动能力下降、出院需求和早期死亡率。
我们回顾性分析了2024年8月至2025年4月期间在英国一家地区综合医院接受手术固定治疗经放射学确诊髋部骨折的84例90岁及以上患者。分析了人口统计学资料、美国麻醉医师协会（ASA）分级、骨折类型、手术方法、活动能力（术前和术后）、出院目的地、住院时间、返回手术室情况以及30天死亡率。功能下降定义为从基线到出院时顺序活动评分的下降。机构化定义为因功能活动能力下降而出院至护理机构（康复机构、养老院或疗养院）。
平均年龄为92.9岁（范围90 - 102岁）；69%为女性。囊内骨折占病例的57%。大多数患者（84.5%）为ASA 3级。半髋关节置换术是最常见的手术方式（59.5%），其次是动力髋螺钉固定术（21.4%）、髓内钉固定术（17.9%）和全髋关节置换术（1.2%）。78%的患者功能活动能力下降，21%保持不变。只有1例患者（1.2%）保持完全独立。出院时，25%的患者可独立使用助行架，37%的患者需要一人协助（AO1），16%的患者需要两人协助（AO2）。30天死亡率为8.3%；4.8%的患者返回手术室。平均住院时间为18.2天。出院目的地包括回家（32%）、康复机构（26%）、养老院（19%）和疗养院（13%）。41%的患者因活动能力下降而被机构化。骨折前独立的患者活动评分平均下降幅度最大（-2.35）。
九旬老人髋部骨折与早期功能下降和机构化的高发生率相关。尽管已建立多学科护理，但结果表明需要针对年龄制定出院计划、量身定制康复方案以及进行积极的功能风险分层以支持康复。
