John Libbey Eurotext

Gériatrie et Psychologie Neuropsychiatrie du Vieillissement

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Mortality and functional independence one year after hip fracture surgery: extracapsular fracture versus intracapsular fracture Volume 17, issue 2, Juin 2019

Authors
1 Service de chirurgie orthopédique et traumatologique, CHU Dijon Bourgogne, France
2 Service de médecine interne gériatrie, Pôle personnes âgées, CHU Dijon Bourgogne, France
3 UMR Inserm, U1093 cognition, action, plasticité sensorimotrice, Université de Bourgogne Franche-Comté, Dijon, France
* Correspondance

Objectives: Outcome in hip fracture patients tends to be poor, with an associated death rate of 20 to 33%. The primary aim of our monocentric retrospective study was to compare mortality rates one year after surgery in patients with extracapsular fracture versus patients with intracapsular fracture of the proximal femur. Our secondary aims were the evaluation of functional independence and the rate of institutionalization one year after surgery. Methods: We compared two groups of 100 patients. The first group had an average age of 83.2 years, and the patients underwent total hip replacement for intracapsular fracture. Patients in the second group, who underwent osteosynthesis for extracapsular fracture, were aged 83.6 years on average. Results: One year post-surgery, there was not a significant difference in mortality between the two groups (23% for extracapsular fracture vs 22% for intracapsular fracture). The rate of independent walking was significantly better in the intracapsular fracture group (42.3% vs 27.3%, p=0.047), and the rate of institutionalization was significantly higher in the extracapsular fracture group (35.8% vs 17.3%, p=0.043). Conclusion: Elderly patients with hip fracture are prone to poor outcomes. When compared with osteosynthesis, total hip replacement does not lead to higher mortality rates though it is a more complex surgery. Our findings raise questions regarding of treatment for extracapsular fracture and the choice between osteosynthesis or total hip replacement with a reconstruction of the proximal femur.