Three-Year Retrospective Analysis of Mortality and Mobility Status in Operatively Versus Non-Operatively Managed Extracapsular Hip Fractures in The Elderly
Ana Margarita C. Guevara, MD, -MBA; Josephus C. Reynes, MD
Objectives. An estimated 90% of intertrochanteric fractures occur in patients aged 65 and above, and these constitute 7% of all osteoporotic fractures. Studies regarding outcomes after conservative versus operative treatment of these fractures have conflicting results, with some reporting higher mortality rates for conservatively managed fractures, and other studies not identifying any significant difference in terms of mortality rate between operatively and nonoperatively managed patients.
Methods. Patients aged 60 and above admitted in the Philippine Orthopedic Center from 2016-2018 with a diagnosis of a low-energy extracapsular hip fracture were included. Hospital records of patients were reviewed, and demographic data, length of hospital stay, co-morbid status, and type of management (conservative vs operative) were recorded. Patients were contacted, chart data were verified, and information about the patient’s status and New Mobility Score (NMS) were gathered.
Results. 86 participants were included in this study. 4 patients (4.7%) died, all from the non-operative group. The overall grand median NMS for all patients is 7. The median NMS for non-operatively managed patients is 3. Those operatively managed have higher median scores (NMS of 9 and 7 for those undergoing closed and open operative reduction, respectively). There is a significant difference between NMS among the those conservatively and operatively managed (Kruskal-Wallis = 46.121, p < 0.001). Using binomial regression, there was no association between mortality status and PMS, sex, age, comorbidity status, smoker status, type of operation, and hospital length of stay (all p > 0.05).
Conclusion. While there was no significant difference between the mortality rates of those patients who underwent conservative versus operative intervention, it is still prudent to manage these patients surgically given this study’s evidence on overall functionality of surgically managed patients as reflected by the NMS.