Early Results of a Geriatric Hip Fracture Program in India for Femoral Neck Fracture

Abstract

Geriatric hip fractures are a challenging clinical problem throughout the world. Hip fracture services have been shown to shorten time to surgery, decrease the cost of admissions, and improve the outcomes. We instituted a geriatric hip fracture program for comanagement of these injuries by orthopedic and internal medicine teams at our hospital in India. From January 2010 till December 2011, 119 patients with a femoral neck fracture were treated with cemented modular hemiarthroplasty under this program using a cost-effective Indian implant. The cohort included 63 males and 56 females with a mean age of 70.7 years (range 55-98 years). Hypertension (n ¼ 42) and diabetes mellitus (n ¼ 29) were the most common comorbidities. The follow-up period ranged from 12 to 37 months with an average of 24 months. The surgery was performed within 24 hours of admission in 60.5% (n ¼ 72) patients. The use of antiplatelet drugs was the most common reason for delay of surgery. The mean length of hospital stay was 10.4 days (range 3-24 days) with 77% (n ¼ 92) of patients discharged within 1 week of admission. On follow-up, good to excellent Harris hip scores were seen in 88% of patients with 76% of patients returning to the preinjury ambulatory status. The mortality rate was 6% at 6 months follow-up and 10.9% at 2 years. Our study shows that a hip fracture program can be instituted in India. The program helped us in achieving the goal of early surgery, mobilization, and discharge from hospital with decreased mortality.

Outcomes of Fast-Track Multidisciplinary Care of Hip Fractures in Veterans: A Geriatric Hip Fracture Program Report

“…Even if we presume that all of the patients lost to follow-up (11 patients) had died, the 1-year mortality rate of our study will be less than 18%, which is still comparable to those reported in the Western studies. In another domestic study, Jain et al20) followed up patients with a very similar geriatric hip fracture. In the study, the 6-month mortality was 6% and the 2-year rate was 10.9%, which are comparable to our 1-year rate of 7.7%.…”

Preoperative Factors Influencing Decision Between Hemiarthroplasty and Total Hip Arthroplasty in Femoral Neck Fractures in Indian Patients—Retrospective Single-Center Study

“…6 – 8 Few studies elicit the problem of hip fractures in India, highlighting the clinical and socioeconomic challenges in the management of hip fractures. 20 , 21 On admission, the prime target would be to optimize the patient for surgery, needing the care of an orthogeriatric team, as rightly highlighted by Lau et al, Jain et al, and Rocca et al 20 , 22 , 23 Identifying the key elements in this orthogeriatic assessment is of vital importance to provide a targeted approach for individual patient, as highlighted by popular established guidelines. 6 – 8 , 24 Our search of literature showed that controversy exists in deciding between HHA and THA when considering patient’s age, with evidence supporting both.…”

Morbidity and Mortality Ratio in Surgically Treated Fragility Fractures of Hip in Elderly Population at Goa Medical College Hospital, Goa, India (2011 - 2015)

“…Hip fracture programme was implemented by Deepak Jain et al study which showed goal of early surgery, mobilisation and discharge from hospital with decreased mortality is achievable in Indian setting. 14 44.9% patients received preoperative transfusions and 20.57% patients received postoperative, this was as per the liberal transfusion protocol followed in our Institution wherein preoperatively Hb was raised to 10 and postoperatively patient received transfusion if Hb was less than 8 or severe pallor, major bleeding intraop. As we know, allogeneic blood transfusion is associated with significant cost and risks there is need to follow restricted transfusion protocol, wherein patient receives transfusion only if Hb is less than 7 which is safe and effective as per Cochrane review.…”