Hip fracture is one of the most common traumatic fractures in geriatric patients. With the increase in the geriatric population, physicians are more concerned about anesthetic management of these patients and a lot of articles have been published in relation to geriatric hip fracture. Due to age related comorbidities and physical status, perioperative management of these patients are complex and related to mortality and morbidity. Anesthesia and pain control for these patients are directly related to the postoperative outcome. This article summarizes the most recent opinions about perioperative management of geriatric hip fracture patients at the point of preoperative evaluation, anesthetic managements, and pain control.
Anesthesia ; Arthroplasty, Replacement, Hip ; Comorbidity ; Hip Fractures ; Hip* ; Humans ; Mortality

PURPOSE: To evaluate the rate of mortality for the elderly patients after treatment of hip fractures and analyze the associated risk factors which might affect their mortality rate. MATERIALS AND METHODS: About the clinical records on 305 patients who had undergone the treatment in hip fractures, we evaluated the mortality rate of the total number of 248 patients whose age between 70 and 103 who were followed more than 12 months of period between March 1994 and March 2003. The mean age was 81.3 years. The composition of each female and male were 176 and 72 cases respectively. 99 cases were femoral neck fractures, and 149 cases were femoral intertrochanteric fractures. The operation included bipolar hemiarthroplasty and internal fixation using multiple cannulated screws, compression hip screws and Ender nails. We compared and analyzed the relating factors for the mortality rate. RESULTS: The mean postoperative mortality rate was 14.1% (35 cases). The highest mortality rate showed for the postoperative 3 months which was 57.1% (20 cases), between 4 and 6 months was 25.7% (9 cases), and 17.1% (6 cases) were presented for 7 and 12 months. The postoperative mortality rate within 1 year was affected by underlying diseases, ASA (American society of Anesthesiologists) and cemented bipolar hemiarthroplasty. but, there were no significant difference of the other factors such as the age, gender, osteoporosis and delayed operation. CONCLUSION: The variable factors which affect the mortality rate of the hip fractures in the elderly patients whose age over 70 were mostly determined by underlying diseases, ASA grade, and cemented bipolar hemiarthroplasty. Further study should be necessary for the factors influencing on the mortality rate.
Aged* ; Female ; Femoral Neck Fractures ; Hemiarthroplasty ; Hip Fractures ; Hip* ; Humans ; Male ; Mortality* ; Osteoporosis ; Risk Factors

Purpose: The purpose of this study was to evaluate the mortality of patients over eighty years old with femoral neck fractures that have been treated with bipolar endoprostheses. Materials and Methods: We retrospectively studied 37 patients out of a total of 83, who suffered from hip fractures and were treated with surgery from 2000 through December 2004. We attempted to distinguish the differences between the 8 patients who died (Group A) and the 29 patients who lived (Group B). The variables that we analyzed, were: age, sex, operative time, the time period from admission to surgery, the time period from admission to discharge, the ASA score, and any medical comorbidities. Results: In Group A, 2 patients died within 1 month, 2 died between 1 and 6 months, 1 died between 6 and 12 months, and 3 died after 1 year. There were statistical differences between Group A and Group B with respect to two variables: the time period from admission to, and medical comorbidities. Conclusion: There were significant correlations with an increase in the mortality rate among patients with lung disease, female patients in general, and delays in surgery. Therefore, particular care should be paid to patients with these variables.
Comorbidity ; Female ; Femoral Neck Fractures ; Hip Fractures ; Hip* ; Humans ; Lung Diseases ; Mortality* ; Operative Time ; Retrospective Studies

PURPOSE: The purpose of this study was to compare the general characteristics that affect the prognosis and evaluate the influence of stroke on one-year postoperative mortality and recovery of ambulatory status in elderly patients over 65 years old with femoral intertrochanteric fracture. MATERIALS AND METHODS: This study included 80 patients who were followed-up for one year after proximal femoral nailing for femur intertrochanteric fracture between January 2008 and December 2013. We analyzed the relationship among the one-year postoperative mortality, recovery of ambulatory status and the associated factors (age, gender, associated underlying disease, American Society of Anesthesiologists [ASA] grade, comminution of the fracture, dementia). RESULTS: The one-year postoperative mortality rate in all patients and patients with stroke was 28.8% and 42.9%, respectively. The one-year postoperative mortality rate was significantly higher in patients with stroke, high ASA grade, and unstable fracture. Decrease of the one-year postoperative ambulatory status was 50.9% in all patients and was significantly associated with grade III or IV ASA rating. No significant relationships were observed between the one-year postoperative recovery of ambulatory status and stroke. CONCLUSION: Stroke, ASA grade, and unstable fracture were prognostic factors associated with one-year postoperative mortality following intertrochanteric fracture. ASA rating was the only prognostic factor affecting one-year postoperative recovery of ambulatory status.
Aged ; Femur ; Hip Fractures* ; Humans ; Mortality ; Prognosis* ; Stroke*

PURPOSE: This study evaluated the rate of mortality and analyzed the associated risk factors in elderly patients treated with bipolar hemiarthroplaty for the hip fractures. MATERIALS AND METHODS: Between March 1994 and March 2010, the clinical records of 246 patients(278 cases) older than 75 years of age who underwent bipolar hemiarthroplaty after hip fractures were reviewed. The mean age of the subjects was 83.7 years(75-103 years). The relationship between the postoperative one year mortality and the related factors (age, gender, type of hip fractures, the timing of surgery, the associated medical condition, ASA grade, osteoporosis, walking ability and residence type) were analyzed. The subjects were divided into the dead group and survivor group. RESULTS: The mean postoperative mortality rate within 1 year was 17.2%(48 cases). The highest mortality rate was observed at postoperative 3 months(9.7%, 27 cases), followed in order by between 4 and 6 months(5.4%, 15 cases) and 7 and 12 months(2.1%, 6 cases). The postoperative mortality rate within 1 year was affected by the timing of the operation, ASA grade, patient's walking ability, and residence type, but there were no significant difference of the other factors, such as age, gender, osteoporosis, and type of hip fractures. CONCLUSION: The ASA grade, timing of the operation, walking ability, and residence type are factors associated with the mortality rate in elderly patients with hip fractures.
Aged* ; Hemiarthroplasty* ; Hip Fractures* ; Hip* ; Humans ; Mortality* ; Osteoporosis ; Risk Factors ; Survivors ; Walking

PURPOSE: To investigate postoperative incidence of complications and functional results between two groups, primary bipolar hemiarthroplasty and internal fixation with compression hip screw on unstable intertrochanteric fractures of the femur with severe osteoporosis in elderly patients. MATERIALS AND METHODS: 78 cases treated under unstable intertrochanteric fractures of the femur with severe osteoporotic elderly patients from March 1997 to August 2001 who have been followed up for more than a year were evaluated retrospectively between the group of bipolar hemiarthroplasty, 38 cases out of 60 cases and group of compression hip screw, 40 cases out of 59 cases. The incidence of complications and functional ability according to Merle d'Aubigne scale and the mortality rate were compared using student t-test. RESULTS: The means of Merle d'Aubigne scale for the hemiarthroplasty group and the compression hip screw group were at the last follow up, 15.0 and 13.6 respectively. The differences were statistically significant (p=0.04). Bipolar group revealed significant differences in general (18%) and mechanical complications (5%) between two groups (p<0.05). The mortality rates were 28% and 22% respectively and there were no significant differences statistically (p>0.05). CONCLUSION: We consider that primary bipolar hemiarthroplasty would be better method in the treatment of the unstable femoral intertrochanteric fracture with severe osteoporosis but we need much longer follow up.
Aged* ; Femur* ; Follow-Up Studies ; Hemiarthroplasty* ; Hip Fractures* ; Hip* ; Humans ; Incidence ; Mortality ; Osteoporosis ; Retrospective Studies

OBJECTIVE: To identify the prevalence of malnutrition in elderly hip fracture and to investigate the relationship between hip fracture patients and malnutrition on functional recovery and mortality. METHODS: All hip fracture patients age >65 years admitted to a rehabilitation unit were recruited from July 2015 to June 2016. Nutritional status was assessed by Mini-Nutritional Assessment Short-Form (MNA-SF) within 72 hours of admission. Patients were reassessed at 6 months for functional status and place of residence. Length of hospital stay, in-patient mortality rate, and 6-month mortality rate were also recorded. RESULTS: There were 218 patients recruited. The mean age was 83.5±7.5 years. According the MNA-SF, 46 (21.1%) were well nourished, 115 (52.6%) were at risk of malnutrition, and 57 (26.1%) were malnourished. Malnourished individuals were significantly older, had lower Mini-Mental State Examination score and albumin level, were functionally more dependent and were more likely to reside in elderly care facility. A higher proportion of elderly care residents were at-risk or were malnourished on admission, discharge and at 6 months. Functional recovery was slower in the malnourished group. In-patient mortality was higher in malnourished individuals compared to those at risk of malnourishment and well-nourished individuals. CONCLUSION: The prevalence of malnutrition is high and is associated with poor functional recovery and elderly care placement. Residents of elderly care facilities are especially at risk due a higher prevalence of malnourishment. Health authorities are encouraged to evaluate the dietetic component in elderly care facilities and initiate nutrition supplementation in their planning of healthcare resources.
Aged* ; Delivery of Health Care ; Hip Fractures* ; Hip* ; Humans ; Length of Stay ; Malnutrition ; Mortality ; Nutritional Status* ; Prevalence ; Rehabilitation

PURPOSE: The purpose of this study was to evaluate the effectiveness of bipolar hemiarthroplasty for unstable intertrochanteric fracture in patients over the age of 80 years. MATERIALS AND METHODS: Sixty-two patients (62 cases) who had unstable comminuted intertrochanteric fractures between January 2007 and February 2012 were evaluated. All patients were over 80 years old at the time of the diagnosis, and were followed-up for at least 12 months. Patients were divided into two groups: those who received cementless stems (group 1, n=32) and those who received cemented stems (group 2, n=30). Functional results including Harris hip score, thigh pain, Koval's ambulatory classification, postoperative mortality rate, operation time, and the amount of blood loss were evaluated. RESULTS: The operation time and the amount of blood loss were significantly lower in group 1 compared to group 2. The Harris hip score was 82.1+/-8.6 points for group 1 and 83.4+/-7.5 points for group 2 at the final follow-up. One patient with poor cement press-fit level in group 2 experienced thigh pain. Twenty-seven patients (84.4%) in group 1 and 25 patients (83.3%) in group 2 recovered pre-injury ambulatory status. During the follow-up period, overall, 6 patients (18.8%) in group 1 and 8 patients (26.7%) in group 2 died. No significant differences in follow-up mortality rates were observed between the two groups. CONCLUSION: Considering the satisfactory clinical results, cementless bipolar hemiarthroplasty may be a good treatment option for patients over 80 years old with unstable intertrochanteric fracture.
Classification ; Diagnosis ; Femur* ; Follow-Up Studies ; Hemiarthroplasty* ; Hip ; Hip Fractures ; Humans ; Mortality ; Thigh

Most of femur intertrochanteric fractures occured in elderly patients with predisposing osteoporotic bone change and general weakness. This group is exposed to the high postoperative morbidity and mortality. Many devices were developed for these purposes, Gamma nail is relatively acceptable on above considerations because of some benefits; lower blood loss, lower risk of infection, shorter operation time, early weight bearing and rigid internal fixation. We reviewed 19 cases of compression hip screw fixation(group 1) from March 1990 to October 1991 and 19 cases of unreamed type Gamma nail (group 2) from March 1990 to May 1993. The following results were obtained; 1. The mean union time was 15.1 weeks on group 1 and 15.4 weeks on group 2. 2. The mean amount of intraoperative bleeding was 511ml on group 1 and 303ml on group 2. 3. The mean timing of nonweight bearing ambulation was at postoprative 5.3 days on group 1 and at 2.2 days on group 2. 4. The complications were 4 cases on group 1 and 3 cases on group 2. 5. We obtained satisfactory results in femur intertrochanteric fracture using unreamed type Gamma nail. So, We suggest application of this method for treatment of femur intertrochaneric fracture if skilled technique is used.
Aged ; Femur ; Hemorrhage ; Hip Fractures ; Hip ; Humans ; Methods ; Mortality ; Walking ; Weight-Bearing

OBJECTIVES: Osteoporotic hip fractures are associated with high mortality in the older population. Few population studies have reported the long-term trends of incidence and mortality rate of hip fracture among the older in Korea. This study assessed the incidence and mortality rate within 1 year after hip fracture from 2006 to 2015 in South Korea. METHODS: The National Health Information Database was used to identify adults aged 60 years and older with a diagnosis of hip fracture and died within 1 year from hip fracture. Regression analyses were performed to estimate the change of the incidence of hip fracture and the related mortality rate. RESULTS: The events causing hip fracture increased 1.85 times (1.91 times in women and 1.71 times in men), and the incidence of hip fracture increased 1.23 times (1.30 times in women and 1.11 times in men) from 2006 to 2015. The mortality rate after hip fracture decreased by 10% in women; however, it increased by 13% in men. These trends were more prominent in the older population. CONCLUSIONS: Although the mortality rate after hip fracture in women decreased, other parameters associated with hip fracture have worsened during the last decade. Nationwide programs were urgently needed to reduce the future socioeconomic burdens of hip fractures.
Adult ; Cohort Studies ; Diagnosis ; Female ; Hip Fractures ; Hip ; Humans ; Incidence ; Korea ; Male ; Mortality ; Osteoporosis