Main Implications of Early Surgical Treatment of Elderly Hip Fractures and Their Influence on Mortality

Abstract

Vinicius De Brito Rodrigues, Valeria Lima Botelho, Ingridy Caroline Ferreira Silva, Thiago Rhangel Gomes Teixeira, Indiry Caroline Ferreira Silva and Rodrigo Jorge de Souza da Fonseca

Aim: The present literature review aimed to investigate the main indications and implications of early surgical treatment of hip fractures (proximal femur) and their influence on mortality in the elderly.

Introduction: In Brazil estimates show that about 100,000 hip fractures occur annually in the elderly, being a major public health problem. When examining mortality, it is observed that the average mortality after one year of fracture is about 30%. Studies show that the surgical approach is the key element in its treatment, and in general the surgical approach time should occur as soon as possible, preferably within 24 to 48 hours of admission. Such interval allows clinical stabilization of the patient, and the time of surgical approach may affect the patient's evolution, delay surgical treatment resulting in delayed mobilization and thus affect the patient's functional recovery. On the other hand, failure of clinical stabilization before surgery may increase the risk of perioperative complications.

Methodology: Due to the implications involved in the surgical treatment of proximal femur fractures in the elderly, both peri and postoperatively, an investigation in the literature produced in the last 10 years using SCIELO, PUBMED, and COCHRANE as databases. They were selected produced in English or Portuguese. Advanced research was performed using the following descriptors in English: proximal femur fracture, surgery, elderly, Brazil, hospital, trauma and mortality. About 280 articles were found. A title reading was performed, followed by a summary and 20 articles pertinent to the theme of this systematic review were selected at the end.

Results and Discussion: The present literature review showed that many studies showed that the lack of immediate surgical treatment of the proximal femur fracture resulted in an increase in the mortality rate of about 10% and a complication rate of about 23% in 30% days. Complications due to late surgical treatment included urinary tract infection, pneumonia, thrombosis, as well as other cardiorespiratory problems, and other comorbidities.

Conclusion: This review concludes from the studies analyzed that surgical treatment should be performed on the patient no later than 48 hours after hip fracture or soon after the patient's clinical stabilization, and the mortality rate found after 30 days of surgery. Surgical treatment of proximal femur fracture was about 10% in the elderly. In addition, complications are present in about 23% of postoperative patients, which implies increased health costs involved in rehabilitation, postoperative complications and readmissions.

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