[Surgical treatment of hip fractures in 90-year-olds]

During 1973-1987 178 patients of 90 years and over were operated for a fracture of the hip in the Diaconesseninrichting 'Bronovo', The Hague. Fifty patients were suffering of senile dementia which made reactivation difficult and contributed to 43% of the mortality. The overall in-hospital mortality was 18% and the survivors were discharged after 35 days on average. Patients with lateral and pertrochanteric fractures were treated according to McLaughlin (6), to Ender (74) and with a dynamic hip screw (17) and medial fractures with a dynamic hip screw (54) or a prosthesis (27). The in-hospital mortality rates were 16, 28, 6, 11 en 11% respectively. Postoperatively 7 Ender pins sagged out and 6 patients treated with a dynamic hip screw secondarily needed a prosthesis, 3 of them after discharge. It is advised to use Ender pins in lateral or pertrochanteric fractures in inactive patients only, and a dynamic hip screw in active patients; in medial fractures a dynamic hip screw only in inactive patients and in others a prosthesis. An increase in the number of very old people with hip fractures is to be expected in the near future.