[Epidemiological and evolutionary aspects of patients aged 65 and over operated on for fracture of the upper end of the femur: prospective observational study].

Abstract

Fractures of the upper end of the femur (FUEF) are a serious complication for the elderly, affecting 1,3 million patients a year worldwide (1). Studies dedicated to the post-operative follow-up of patients operated on for hip fracture in the long term are rare. The aim was to determine the epidemiological and evolutionary profile focusing on morbidity and mortality (survival and functional and cognitive decline) in the year following surgery for FUEF in patients aged over 65. Methods: Prospective observational study. Geriatric data were collected at the time of surgical management of FUEF with postoperative assessment of vital, functional and cognitive status. Results: Over a period of 24 months, 119 patients underwent surgery in the Orthopaedics-Traumatology Department of the University Hospital of Annaba. The patients were initially all independent (Instrumental Activities of Daily Living [IADL] 4 ≥ 3) and had no pre-operative cognitive disorders. There were 32 men and 87 women. The mean age was (77,4 ± 8,2) years with extremes of 65 and 100 years. All lesions were unilateral, with a predominance on the right. Most were trochanteric fractures (72 %). The most common aetiological circumstances were falls following domestic accidents. Eighty-seven patients received spinal anaesthesia, 19 received a general anaesthetic and 13 received an epidural. The average intervention time was 5,11 ± 4,17 days, with extremes of zero and 18 days. Depending on the treatment performed, 14 Dynamic hip Screw (DHS), three centro-medullary nailings, 33 plate blades and 24 plate nails and 15 gamma nails, 28 Moore's prosthesis, 2 screwings. The average length of stay was seven days. The one-year mortality rate for the 119 patients was 19,3 %. Patients who died after one year were malnourished (13,2 %, p = 0,05) with high comorbidity (ASA 2(78 %) and ASA 3(13 %) (p < 0,01 and p = 0,05). Of the survivors, 27 % had postoperative cognitive decline. Death occurred on average at 82,17 days. Conclusion: FUEF remains a real public health problem in terms of its prevalence, prognosis and cost. The mortality rate of patients aged over 65 years at one year post-operatively following an ESF was 19 %, which calls for the creation of a specialised orthogeriatric unit.