Hip fracture in centenarians: Retrospective analysis of an orthogeriatric unit reveals the limitations of the current research

Abstract

Life expectancy of Italian people is among the highest in the world, at 80 years for males and 85 years for females. Estimates from the National Institute of Statistics show that people aged 65 years and older represent more than 21% of the Italian population. Among them, centenarians represent the age group with the highest growing rate. Hip fracture incidence increases with advancing age, and currently represents one of the major causes of hospitalization in the elderly. Many studies regarding hip fracture in the elderly have been published, but research focusing on centenarians is still very limited despite their growing trend. This manuscript reviews the activity of the Orthogeriatric Unit at San Gerardo University Hospital (Northern Italy) from its establishment in 2007 until the present, and enlightens the limitations of the research in this area reviewing the literature currently available.Over a 7-year period, we admitted a small population of 10 centenarian female patients, all of whom underwent surgery. Their in-hospital (1 out of 10) and 1-year mortality rates (8 out of 10) are consistent with the existing literature.Centenarians pose an increasing challenge to physicians and surgeons. Rates of recovery of the pre-fracture condition are undoubtedly lower than those in younger geriatric patients, but surgery and early rehabilitation should not be denied solely due to the extreme age of these subjects. However, the research in this area presents several limitations up to now. The available studies are sparse, describe small populations, and are generally a single-center retrospective review of the local hospital admissions registry. Moreover, the objectives and outcome measurements vary considerably between studies, making a statistical comparison unfeasible.In this scenario, the implementation and analysis of large-scale databases would allow appropriate research among centenarians, including cost-effectiveness of specific surgical treatments.

Clinical and Demographic Characteristics of Centenarians versus Other Age Groups Over 75 Years with Hip Fractures

“…3,4 Studies on hip fractures in centenarians are limited in number of patients and show contradictory results. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Differences have been described in relation to the type of fracture, [2][3][4][5][6][7][8] the relationship between time to surgery and outcomes 5 and the risk of complications during hospitalisation. 9 Discrepancies have also been published regarding short and long-term outcomes.…”