Perioperative complications of intertrochanteric fractures in patients aged 80 years and over

Abstract

Objective To investigate the prevention and management of perioperative complications of intertrochanteric fractures in elderly in-hospital patients(aged≥80 years). Methods Clinical data of 103 intertrochanteric fracture patients(31 male and 72 female)undergoing surgical treatment at our hospital from May 2010 to Nov.2015 were retrospectively analyzed.Their ages ranged from 80 to 99 years, with an average of 86.2 years.There were 3 Evan typeⅠ cases, 25 typeⅡ cases, 36 type Ⅲ cases, 37 type Ⅳ cases and 2 type Ⅴ cases.Of these, 82 received epidural anesthesia and 21 had general anesthesia.Intertrochanteric fractures were treated with proximal femoral nail(PFN)internal fixation in 101 patients and dynamic hip screw(DHS)internal fixation in 2 patients. Results The average operation duration and blood loss were 30 min and 60 ml in the PFN internal fixation group and 60 min and 150 ml in the DHS internal fixation group, respectively.The average hospitalization time was 16.7 days.One patient(0.9%)died after operation, 10(9.7%)had preoperative complications of bed rest with 3 cases involving the central nervous system and 4 cases involving the respiratory system, and 38 cases(36.9%)had postoperative complications with 13 involving the central nervous system.The average time from admission to operation was 6 days, with 65 cases above the average and 38 cases below the average, and there was a statistically significant difference in the incidence of postoperative complications between the two subgroups(30/65 or 46.2% for the former and 8/38 or 21.1% for the latter, χ2=6.49, P<0.05). Conclusions Elderly patients with intertrochanteric fractures should undergo surgery as soon as possible, preferably with epidural anesthesia.Proficiency in surgical kills, short operation time, close monitoring of preoperative and postoperative conditions, and proper and timely treatment are the key to ensuring surgical success. Key words: Aged, 80 and over; Femoral neck fractures; Perioperative care; Postoperative compeications