[Acute management of para-articular hip fractures in geriatric patients]

Coxal femoral fractures in the elderly present a growing problem due to the increasing life expectancy of the population. The most rapid intervention possible with an implant best tailored to the individual's needs and general medical condition, followed by early mobilisation and individual physiotherapeutic management are the basic prerequisites in the attempt to achieve a decrease in the post-operative complication rate, the mortality rate and spiraling costs. Preoperative management, the choice of surgical procedure according to strict indication criteria and post-operative measures are discussed on the basis of an analysis of 719 patients admitted to our department between August 1992 and December 1993. The mean age of the patients was 79.9 years and the ratio of women to men was 4:1. Operation took place on average 14.2 hours after admission and the patients were discharged on average 15.6 days after hospitalisation. 37 of 620 (5.9%) patients operated on during the first 24 hours (group 1) and 9 of the 99 (9.1%) delayed operation patients (> 24 h = group 2) died in hospital. The findings are discussed in the light of the shortage of hospital beds, an aging population and rising hospital costs.