[Therapy of para-articular hip fractures in the elderly]

Fractures of the hip in old patients are life-threatening events. A steady increase of that fracture type is likely in the near future. Surgical therapies and strategies have to consider the special requirements and problems of geriatric patients to achieve better results. They have to be designed together with new concepts of geriatric rehabilitation programmes.

In 1992 148 patients with hip fractures were treated at the department of traumatology, University Ulm. Follow-up parameters were daily activities in life pre- and postoperatively as well as mortality, type of fracture and surgical treatment.

There were 79 femur fractures of the collum and 69 fractures of the trochanteric region. Mean age was at 81.2 and 81.9 years respectively (68 f/11 m versus 52 f/13 m). At the time point of accident 84 patients lived at home whereas the remaining stayed at a nursing home. The highest mortality was found in patients living in a nursing home (93%). The overall mortality one year following the trauma was 26%. 50% of the patients had hip prosthetic replacement, the remaining received a gliding screw, 9 patients a proximal femoral nail or lag screws (n = 6).

Our results demonstrate that hip fractures in geriatric patients have a high mortality, especially in those living in a nursing home. The surgical concepts should aim to reduce that number and to allow the same daily activity of life as preoperatively. The main part in these concepts is an early start of geriatric rehabilitation. There are at least two groups. On the one hand, the active old patient who acquires his fracture during an activity. In this cases the aim must be the full rehabilitation and afterwards returning to normal environment. On the other hand there are the patients living in a nursing home who have the highest risk of injury related death. In these patients the first aim must be prevention of the accident.