Mortality and ambulatory status after intertrochanteric fracture treated at Maharat Nakhon Ratchasima Hospital, Thailand
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Date
2010-10-27
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The Thai Journal of Orthopaedic Surgery
Abstract
Purpose: 1. To assess elderly intertrochanteric fracture patients for overall one-year mortality rate and for ambulatory ability two years after treatment. 2. To analyze factors that may affect one-year mortality and independent walking. 3. To compare one-year mortality, survival function, and independent walking between operative and home skin traction treatment.Methods: A retrospective cohort study of 496 intertrochanteric fracture patients at least 60 years of age, treated at Maharat Nakhon Ratchasima Hospital between October 2002 and September 2006, assessed one-year mortality rate and two-year ambulatory ability. The factors studied were treatment methods (251 operation, 245 home skin traction), gender (337 female, 159 male), age (mean 78 years, SD8.7), numbers of comorbidities (57% had one or more comorbidities), and ASA classification (ASA I, II, III, and IV were 55%, 36.7%, 7.5%, and 0.8% respectively).Results: The overall one-year mortality rate was 23.6%. The median survival time was 4.18 years after fracture. Of patients who were still alive two years later, 55.2% could walk independently, 27.7% needed assistance or gait aids, and 17.1% were confined to bed or wheelchair. Factors that significantly affected one-year mortality were nonoperative treatment, being male, and each additional year of age. The home traction group had a higher one-year mortality rate than the operative group (odds ratio 3.01; 95 % CI 1.8634, 4.8997 P 0.000). Independent walking depended on type of treatment only. The operative group had more independent walking (odds ratio 2.19; 95% CI 1.3009, 3.6917 P 0.003). Gender, age, numbers of comorbidities, and ASA class did not affect independent walking.Conclusion: Intertrochanteric fracture in the elderly is a terrible condition with a very high risk of one-year mortality and later dependence. Operative internal fixation is the treatment of choice, with a lower one-year mortality rate and more independent walking. Keywords: Elderly intertrochanteric fracture, one-year mortality, ambulatory ability, independent walking, home skin traction
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The Thai Journal of Orthopaedic Surgery; Volume 34 / Number 3-4 July-October 2010; 5 - 12