Survival of Fracture Neck of Femur Patients Hyponatremia at Admission

Abstract

Fracture neck of femur is one of the most common fractures in the elderly. It is known that this type of fracture has severe impact on quality of life and mortality. Currently operative treatment is the best treatment of this fracture. It is advocated that early operative intervention might yield the better outcome. Anyway, surgical intervention is also depended on patients’ condition eventhough some patients were treated with the non-operative treatment. Of interest, small studies reported the mortality of non-operative patients was not much poorer than that of operative patients. Therefore factors that reflect patients’ physiologic condition and relate to mortality may be useful for therapeutic decision and planning are strongly required. We retrospective studied of the medical records of fracture hip patients who were admitted in Lerdsin General Hospital during 1 January 2011 to 31 December 2015. From the first serum sodium within 24 hour of admission. Hyponatremia were defined as the level of serum sodium lower than 135 mmol/L. We recorded the demographic, serum sodium and dead date from medical record of the patient also from the phone called and The National Registration. The patients who were admitted in our hospital with fracture hip are 405 cases. Among them were excluded 49 cases. Therefore 356 cases included in this study, the mean age was 59.5±21.8 years. 52.2% were female and 47.8 % were male. The patients were operated 89% and Frail 57.9%. Of these 55.3% patients were over age 60. The mean of Sodium level at the first visit of the patients were 135.9± 4.2. The normal value is 135-145 mmol/L. The prevalence of Hyponatremia were 30.1% and mean 131.2± 3.8 mmol/L (Sodium Level <135 mmol/L). The mean age of Hyponatremia was 64.2 ± 21.8 years. The death rate was 17.1%. We followed the survival until 1 June 2016. Median of survival, who got operation were 46.2 months. The survival in hyponatremia patients at 48 month were 74% associated with significantly (p=0.001). After we adjusted factors of age, sex, sodium level, cause of fracture and operation we found age was associated with survival rate significant at p=0.002. The hazard ratio of the age over 60 were increased 1.4 of the age less than 60 (95%CI for HR: 0.06, 0.3). Causes of fracture were associated with survival rate statistic significant at p=0.006. We have sufficient evidence for supporting that hyponatremia and survival rate were associated.