Conservative Treatment for Fracture of the Proximal Femur with Complications

Abstract

We retrospectively compared two groups of patients with hip fractures and severe complications. One group had been treated surgically; the other group had been treated conservatively to prevent worsening of general status, with transfer to wheelchair as soon as possible. This study aimed to determine if early prognosis after conservative treatment would be worse than that following surgical treatment. Materials and Methods:Subjects were patients (n=230) with hip fracture who had been admitted and treated at our hospital from 1993 through 2006. Patients' medical records were retroactively investigated to obtain information on age, sex, complications, type of fracture, and course of subsequent hospitalizations. Additional information for conservatively treated patients included reasons for avoiding surgery and time-to-transfer to wheelchair. In case of death, the cause and timing of death were investigated. Results:Of the 230 patients, 22 (mean age, 83.5 years) were treated conservatively. Complications at admission included cardiac disease, respiratory disease, malignancy, renal disease, dementia, and other conditions. Multiple complications were commonly seen. The reasons for selecting conservative treatment were cardiac function disturbance in 13 cases and decision of patients' families in 9 cases. Almost all patients were able to transfer to wheelchair. A total of 9 patients died in the hospital: 8 were in the surgical treatment group and 1 was in the conservative treatment group. The patients who died in the surgical treatment group had a mean age of 80.3 years, and pneumonia was the main cause of death.The timing of death ranged from 12 to 129 days after surgery. The number of perioperative deaths was 3 (1.4%). Discussion and Conclusion:This study showed that in patients with hip fractures, severe complications, and poor general conditions, early prognosis after conservative treatment aiming for early transfer to wheelchair is no worse than that following surgical treatment. Thus, conservative treatment should be considered for patients with poor ability for activities of daily living. (J Nippon Med Sch 2016; 83: 2 5)

Outcomes of an accelerated nonsurgical management protocol for hip fractures in the elderly

“…Many studies have shown that surgical management still leads to the best outcomes in patients with hip fractures, 4,5 with some studies showing non-inferiority of nonsurgical management as compared to surgery in low-grade fractures. 6,7 At our center, while surgery remains the mainstay of treatment for hip fracture patients, there remain a significant number of patients who are unsuitable for surgery due to multiple high-risk comorbidities. 8,9 There are also some patients or families who refuse surgery because of their fear of surgery or surgical risks, which may be attribute to local culture and the lower educational status of elderly patients.…”

One-year postoperative mortality rate among the elderly with hip fractures at a single tertiary care center

“… 11 A recent study that compared surgical treatment versus conservative treatment concluded that conservative treatment is not superior to surgery in terms of complications. 12 Moreover, a systematic review and meta-analysis that evaluated the timing of surgery to the rate of morbidity and mortality found that earlier surgical intervention is associated with a reduced rate of mortality, fewer perioperative complications, and a 20% lower 1-year mortality rate. 13 Several recommendations have been developed regarding the optimal time for surgery.…”

Outcome of nonoperative treatment for hip fractures in elderly patients: A systematic review of recent literature

“…Recently, one study showed that in patients with hip fractures, severe comorbidities, and poor general conditions, early prognosis after nonoperative treatment aiming for early transfer to wheelchair is no worse than that following surgical treatment. 6 Hossain et al 10 reported that nonoperative management after hip fracture is suitable for medically unfit patients and does not result in statistically significant difference in functional outcome. However, in elderly patients with multiple comorbidities and hip fracture, the potential benefit of surgery should be considered together with the patients’ goals of care, and there is an opportunity to improve quality of care.…”

“…4 Several studies also demonstrated that nonoperative management of hip fractures can produce acceptable results because a considerable number of patients were free of pain and could mobilize. 5,6 Kawaji et al 6 suggested that nonoperative treatment should be considered for patients with poor ability for activities of daily living. However, the question whether nonsurgical treatment is appropriate for most fragile, elderly patients, with regard to quality of life, poses an ethical dilemma which should be addressed in an individualized manner.…”