Hip fractures in nonagenarians—a study on operative and non-operative management

Ooi, Lai Hock; Wong, Ting Hway; Toh, Cheng-Hong; Wong, Ho Poh

doi:10.1016/j.injury.2004.05.030

Cited by 72 publications

(87 citation statements)

References 8 publications

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“…The increased intracapsular pressures and resultant tamponading effect to the femoral neck vasculature has been well cited [6][7][8][9][10][11]. Open reduction techniques decompress the intracapsular hematoma by definition, but in the case of a successful closed reduction, one could argue the role of percutaneous capsulotomy to relieve the pressure.…”

Section: Indication For Capsulotomymentioning

confidence: 99%

“…The associated medical complications of nonoperative treatment with prolonged bedrest include pneumonia, decubitus ulcers, urinary tract infection, and thromboembolic events [55][56][57]. Discretion should be used when considering conservative management in the cognitively impaired as even higher mortality and complication rates have been shown in this cohort [8,58].…”

Section: Implant Choicementioning

confidence: 99%

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Contemporary management of femoral neck fractures: the young and the old

Forsh

Ferguson

2012

Curr Rev Musculoskelet Med

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The optimal management strategy for femoral neck fractures remains highly debated. The femoral neck is intracapsular and the vascular supply is fragile. Furthermore, the curvature of the proximal femur results in high mechanical stresses through the femoral neck. Poor outcomes of nonunion and avascular necrosis (AVN) are common. This chapter reviews the current evidence with respect to the treatment principles of femoral neck fractures in two distinct patient populations: "young" and "old." Contemporary controversies including surgical timing, choice of implant, arthroplasty options, nonoperative management, capsulotomy, and associated complications will be discussed.

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Section: Indication For Capsulotomymentioning

confidence: 99%

Section: Implant Choicementioning

confidence: 99%

Contemporary management of femoral neck fractures: the young and the old

Forsh

Ferguson

2012

Curr Rev Musculoskelet Med

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“…No es una lesión sobre un sustrato anatómico sano sino, por lo general, larga y profundamente enfermo. Por ello las series muestran porcentajes variables de no operados [23][24][25] . La selección dirigida de estos casos genera un grupo de pacientes con mayor riesgo vital, que es a la vez la causa de la decisión no quirúrgica.…”

Section: Discussionunclassified

“…La selección dirigida de estos casos genera un grupo de pacientes con mayor riesgo vital, que es a la vez la causa de la decisión no quirúrgica. Por ello es difícil establecer si la mayor mortalidad que ocurre entre los no operados se debe a no haberse operado o es la consecuencia esperable de su mal estado previo [23][24][25] . En nuestra serie, la mayor mortalidad entre no operados puede deberse a que ese grupo tiene significativamente mayor edad, cantidad de varones, porcentaje de pacientes ≥ 90 años y nú-mero de comorbilidad que el de operados.…”

Section: Discussionunclassified

Características epidemiológicas y clínicas de las fracturas de cadera en adultos mayores en un hospital público chileno: Experience in 647 Chilean patients aged 60 years or more

et al. 2015

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“…At present, some surgeons [8][9][10][11] had adopted the non-operative treatment to reduce the peri-operative risks even when patients have indications for arthroplasty (GARDEN III or GARDEN IV (a) in femoral neck fractures). Over the past years, surgeons in China have always found it confusing to assess the postoperative risks (morbidity and mortality) for arthroplasty among elderly patients due to the absence of specific guidelines that is needed to be adopted in their assessment.…”

Section: Introductionmentioning

confidence: 99%

Risk Assessments for Elderly Patients with Hip Arthro-plasty Using POSSUM and P-POSSUM

Li¹,

Dib²,

Zhang³

et al. 2013

OJO

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Background: The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) is a scoring system previously validated in vascular and general surgical patients. The Portsmouth physiological and operative severity score for the enumeration of mortality and morbidity (P-POSSUM) is a reliable tool derived from POSSUM to improve the prediction of mortality. In this paper, we utilized both models to determine the most suitable and feasible one that could be utilized in orthopedic surgery in China mainland. Methods: In this retrospective study, patients' files were extracted randomly from the medical records department of the First Hospital Affiliated with Dalian Medical University for those underwent hip replacements between 1999 and 2006. The mortality and morbidity rates were predicted by P-POSSUM and POSSUM, respectively. A comparative analysis was performed between the observed and the predicted values as well as the Observed/Expected ratio (O:E). Results: A total of 206 patients were selected for this study after fulfilling the inclusion and exclusion criteria. The predicted mortality by P-POSSUM were not significantly different from the observed values (X 2 = 2.10, P = 0.552). POSSUM appeared to be better with the observed morbidity (X 2 = 2.766, P = 0.598), but had overestimated mortality. Conclusion: The POSSUM morbidity equation satisfactorily estimated the risk of postoperative complications, and the P-POSSUM mortality equation appeared to stratify the risk of death more accurate than the POSSUM.

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Hip fractures in nonagenarians—a study on operative and non-operative management

Cited by 72 publications

References 8 publications

Contemporary management of femoral neck fractures: the young and the old

Contemporary management of femoral neck fractures: the young and the old

Características epidemiológicas y clínicas de las fracturas de cadera en adultos mayores en un hospital público chileno: Experience in 647 Chilean patients aged 60 years or more

Risk Assessments for Elderly Patients with Hip Arthro-plasty Using POSSUM and P-POSSUM

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