Document Type : Research Article
Aim: Study of mid and long term outcome of hip fracture in elderly operated within 48 hours versus conservative management.
Methods: A retrospective cohort study was conducted in the Department of Orthopaedics, A.N.Magadh Medical College and Hospital, Gaya, Bihar, India for 15 months. The study population comprised 200 patients (160 women and 40 men) categorized into the trochanteric fracture group (AO/OTA 31-A, n = 100) and the neck fracture group (31-B, n = 100). We evaluated the patients’ ambulation ability before injury, at discharge, and 6 months after injury from the medical records using the Functional Ambulation Category (FAC) score.
Results:All patients were divided into two groups; 100 had trochanteric fracture and 100 had neck fracture. The median age of all patients was 85 years (range, 31–98 years), and the patients with trochanteric fracture were significantly older than those with neck fracture (85 vs. 81 years, respectively; p = 0.04). Both types of fracture were more common in women (trochanteric fracture, 75%; neck fracture, 77%; p = 0.38). The main treatment for trochanteric fractures was osteosynthesis (82% of trochanteric fractures), and the main treatment for neck fractures was bipolar hip arthroplasty (58% of neck fractures). The numbers of patients treated conservatively were not significantly different between the two fracture types (14% of patients with trochanteric fracture and 16% of those with neck fracture, p = 0.81). The median presurgical duration and median hospital period were longer in patients with neck fracture than in those with trochanteric fracture (5 vs. 8 days and 17 vs. 22 days, respectively; both p<0.01). The main presurgical problems were severe diabetes requiring control (8%) and anticoagulation drug management (10%). The total mortality rate was 7% of patients with trochanteric fracture and 3% of those with neck fracture, p = 0.15).
Conclusion: In conclusion, we found patients with trochanteric fractures were older than those with neck fractures, which supports the findings of previous studies. Walking recovery 6 months after hip fracture was related to the FAC score before injury and at discharge from an acute-care hospital but not to the time until beginning to walk using parallel bars in both fracture types.