Tratamiento de fracturas de cadera en pacientes de 100 años y mayores. (Inglés)

"Tratamiento quirúrgico para las fracturas de cadera en pacientes de 100 años de edad y más mayores: ¿Se justifica?"

Shabat, S. MD *; Mann, G. MD *; Gepstein, R. MD *; Fredman, B. MD +; Folman, Y. MD ++; Nyska, M. MD *

Abstract:

Objectives:
To evaluate a unique group of elderly patients over 100 years of age who had hip fractures.

Design:
Retrospective database analysis.

Settings:
Academic teaching hospital.

Patients:
All patients who had hip fractures between January 1990 and December 2001 and were over 100 years old were included.

Intervention:
In this study, we evaluated the age, gender, type of fracture, type of treatment, background disease, rehabilitation, and time until death of all patients over 100 years, whether treated operatively or nonoperatively.

Results:
Twenty-three patients (17 females and 6 males) were identified with ages ranging from 100 to 107 (mean: 101.8). The group had 4 subcapital and 19 pertrochanteric fractures and between 1 and 4 major background diseases. Four patients were treated nonoperatively (1 due to major pneumonia and 3 refused the operative procedure). Three of those 4 patients died in the same month of admission, and 1 patient died during the second month. Among the 19 patients who underwent operation, 17 patients have died, living between 0 and 78 months (mean: 13.8) postoperatively. Two are still alive (21 and 45 months) after the operation. Eight patients died prior to 6 months, and 11 lived more than a year after the operation. A comparison between these 2 groups showed greater major background disease in the patients who died prior to 6 months (P < 0.05).

Conclusions:
Most hip fractures in patients over100 years of age are pertrochanteric. Patients with 2 or more major background diseases have an increased risk for dying in the first 6 months after the operation. Most patients having operations in this age group had a postoperative reduction in mobility status and in performing basic activities of daily living.

Journal of Orthopaedic Trauma. 18(7):431-435, August 2004.