Prognosis of proximal femoral fractures in elderly patients
1. Introduction
The elderly patient often comes with comorbidities. The most common is osteoporosis.
After surgery, the outcomes of greatest concern are:
- Mortality (related to comorbidities)
- Loss of independence
- Decrease in mobility
- Residual pain
2. Mortality
Mortality generally occurs within the first six months after fracture; studies have shown that these rates range from 12–37%.
Predictors of higher mortality rates are patients who are:
- Older
- Male
- Have other comorbid conditions (eg, cardiac failure, diabetes, and chronic airflow limitation)
- Have cognitive disorders
3. Decrease in mobility
In most patients (60%), the postoperative level of walking is decreased by one degree. Only 10–20% of, usually physically fit, patients regain their former function.
4. Ability to return home
Besides mortality, the ability to return home is also an important outcome for patients with hip fractures. Studies have shown that as few as 50% of patients were able to return home and that mortality rates are lower in those who return home compared with rates in those transferred to nursing homes or rehabilitation centers.
Predictors of returning home include:
- Younger age (< 85 years)
- Ability to walk independently preoperatively
- Ability to perform activities of daily living preoperatively
- Living with another person
- Ability to walk independently at the time of discharge from the hospital
