The assessment of mortality and quality of life after intertrochanteric fracture of femur in elderly patients

Abstract

Objective:To investigate the mortality and disability rates after surgical treatment of intertrochanteric fractures in patients older than 60 years old.Method:In this retrospective study, 385 patients aged 60 or older who were admitted because of intertrochanteric fracture to treatment and teaching center of Emam Khomeini hospital of Ahvaz, Iran between Mar. 2010 to Feb. 2015 and underwent surgery were included. All the patients were treated by open reduction and internal fixation by dynamic hip screw. Two hundred and six patients were men (53.5%) and 179 were women (46.4%). Age of patients was between 60 to 89 years old with the average of 75.2 years old. Minimum time required after surgery to enter this study was one year. Results were gathered based on examination of patient or calling patients and their families by phone number.Result:Rate of mortality was 36.9%, including 54.9% for men and 41.9% for women. In eleven patients (2.85%), initial reduction was lost because of failure of fixation device. For these patients reoperation was performed, and 7 of them (63.63%) expired within the mean of 10.1 months after reoperation. Time delay for surgery after occurrence of the fracture was in range of 2 to 15 days with an average of 4.8 days.24 patients (6.23%) went under surgery later than one week after fracture had been happened which seven of them (29.16%) expired. Highest mortality rate was in the age group of 80-89 years old with 50 patients (63.01%) and lowest one was in the group of 60-69 years old with three patients (4.67%). Disability rate and quality of life of the patients was measured by Modified Harris Hip Score and divided in 3 group of good (with a score of 71 to 90), fair (with a score of 51 to 70) and weak (with a score of 0 to 50). Patients who had good score consisted of 35.54% of patients with the average age of 64.63 years old and majority of male patients, fair group consisted of 30.5% of patients with average age of 73.45 years old and equal percentage of male and female patients and for Weak group it was 34.2% and 73.45 years old and by majority of male patients.Conclusion:Mortality rate of intertrochanteric fracture of femur is high even after treated with surgery and it’s highly related to age of patient. Furthermore, quality of life after surgery is still low and follow up of the patients should be improved.

Evaluation of quality of life and associated factors in patients with intertrochanteric femoral fracture

“…The QoL of trauma patients and those with fractures and bone and soft tissue injuries has not been well studies in Iran, and most of the available studies are from the Western countries (18). However, regarding intertrochanteric fractures, there were some studies from Iran that assesses the outcomes of treatment of these injuries and QoL of patients having the injury (6,7,15). In a study in Iran on 385 patients aged≥60 years-old who had intertrochanteric fracture and were treated surgically by open reduction and internal fixation by dynamic hip screw, the mortality rate after surgery was 36.9% with higher figures among males (54.9%) compared to females (41.9%), and only 33.5% of the patients had good score of QoL based on the Modified Harris Hip Score, concluding that QoL even postoperatively remains low in this patients and needs appropriate follow up to improve the treatment outcomes and patient-reported QoL (7).…”

“…However, regarding intertrochanteric fractures, there were some studies from Iran that assesses the outcomes of treatment of these injuries and QoL of patients having the injury (6,7,15). In a study in Iran on 385 patients aged≥60 years-old who had intertrochanteric fracture and were treated surgically by open reduction and internal fixation by dynamic hip screw, the mortality rate after surgery was 36.9% with higher figures among males (54.9%) compared to females (41.9%), and only 33.5% of the patients had good score of QoL based on the Modified Harris Hip Score, concluding that QoL even postoperatively remains low in this patients and needs appropriate follow up to improve the treatment outcomes and patient-reported QoL (7). In another study on 110 patients with intertrochanteric fracture from Iran who were treated by dynamic hip screw and the QoL was assessed by the SF-36 similar to our study, reported no association between the overall score of QoL and its physical and mental subscales with patients' sex; however, mortality after surgery and QoL was negatively associated with patients' age , which their findings were comparable to our results (6).…”

Evaluation of the clinical efficacy of 3D Printing technology assisted surgery combined with early postoperative comprehensive rehabilitation in the treatment of Senile Intertrochanteric Fractures

“… 11 The higher disability rate is caused by intertrochanteric fractures, so that the quality of life of patients is seriously affected and the survival rate is greatly reduced. 12 Despite a relatively abundant intertrochanteric blood circulation and easier healing after treatment, serious pathological consequences may be caused to patients due to unsatisfactory reduction and healing. 13 …”

Evaluation of quality of life and associated factors in patients with intertrochanteric femoral fracture

“…Malignancy, failure of the operated device such as protrusion of the device or sinking of the rod in the hip joint, shortening of the limbs, nonunion, and in rare cases avascular necrosis of the femoral head could be associated with intertrochanteric fractures (10,11). Intertrochanteric fractures cause a lot of morbidity and mortality, so knowing about postoperative complications can help patients have a better quality of life (QoL) (7).…”