Mortality and ambulatory status after intertrochanteric fracture treated at Maharat Nakhon Ratchasima Hospital, Thailand

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Published: Oct 31, 2010
Keywords:
Elderly intertrochanteric fracture one-year mortality ambulatory ability independent walking home skin traction

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Lewsirirat S, MD
Department of Orthopaedics, Maharat Nakhon Ratchasima Hospital, School of Medicine, Nakhon Ratchasima, Thailand
Thanomsingh P, MD
Department of Orthopaedics, Maharat Nakhon Ratchasima Hospital, School of Medicine, Nakhon Ratchasima, Thailand

Abstract

Purpose: 1. To assess elderly intertrochanteric fracture patients for overall one-year mortality rate and for ambulatory ability two years after treatment.


  1. To analyze factors that may affect one-year mortality and independent walking.

  2. To compare one-year mortality, survival function, and independent walking between operative and home skin traction treatment.

Methods: A retrospective cohort study of 496 intertrochanteric fracture patients at least 60 years of age, treated at Maharat Nakhon Ratchasima Hospital between October 2002 and September 2006, assessed one-year mortality rate and two-year ambulatory ability. The factors studied were treatment methods (251 operation, 245 home skin traction), gender (337 female, 159 male), age (mean 78 years, SD8.7), numbers of comorbidities (57% had one or more comorbidities), and ASA classification (ASA I, II, III, and IV were 55%, 36.7%, 7.5%, and 0.8% respectively).


Results: The overall one-year mortality rate was 23.6%. The median survival time was 4.18 years after fracture. Of patients who were still alive two years later, 55.2% could walk independently, 27.7% needed assistance or gait aids, and 17.1% were confined to bed or wheelchair. Factors that significantly affected one-year mortality were nonoperative treatment, being male, and each additional year of age. The home traction group had a higher one-year mortality rate than the operative group (odds ratio 3.01; 95 % CI 1.8634, 4.8997 P 0.000). Independent walking depended on type of treatment only. The operative group had more independent walking (odds ratio 2.19; 95% CI 1.3009, 3.6917 P 0.003). Gender, age, numbers of comorbidities, and ASA class did not affect independent walking.


Conclusion: Intertrochanteric fracture in the elderly is a terrible condition with a very high risk of one-year mortality and later dependence. Operative internal fixation is the treatment of choice, with a lower one-year mortality rate and more independent walking.

Article Details

Issue
Vol. 34 No. 3-4 (2010): July-October
Section
Original Articles

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