The clinical experience of the perioperative management of intertrochanteric fracture with elderly highrisk patients

Abstract

Objective To conclude clinical experience of the perioperative management of intertrochanteric fracture with advanced patients. Methods Data of 87 elderly patients with intertrochanteric fracture (over 80 years old) admitted from July 2008 to January 2016 in Nanfang Hospital of Southern Medical University were analyzed. Cardiopulmonary and cognitive abilities, preoperative activities, fracture type were carefully recorded, individualized surgical release (intramedullary nail, extramedullary fixation or external fixator) and anesthesia program (spinal anesthesia or fascia block) were designed accordingly. If surgery was not applicable conservative treatment would be used. The duration from to operation, blood loss, intro-operative time, mortality rate, complication rate, 30 d motality, 1 year motality, Harris score and SF-36 score were recorded for analysis. Results Seventy-eight cases were treated operatively, the average time from injury to surgery is (35±8) h (12-78 h). The average intro-operative time is (63±14) min (15-98 min), blood lose is (263±121) ml (47-795 ml). Patients were followed up for 1 year, 8 patients died within 30 days after injury, the mortality rate was 9.2% after 30 days. The other 15 patients died within 12 months after injury, the mortality rate within 1 year was 26.4%. Fifteen patients died of lung disease and 5 cases of heart failure, 2 cases out of urinary tract infection and 1 case of pulmonary embolism. 2 patients had operation-related complications resulting in internal fixation failure and no iatrogenic fracture. The Harris score at 1 year after operation was 66-87 points with an average of (73±4) points, SF-36 score was significantly improved compared with the preoperative. Conclusion Individualized preoperative comorbidities evaluation, individualized anesthesia and surgical protocols and ensure surgery performing within 48 hours for elderly patients with intertrochanteric fractures is possible to reduce mortality and improve patient quality of life. Key words: Aged, 80 and over; Hip fractures; Perioperative management