Dr. Tomichan M. C
Mortality after surgical treatment of hip fracture at the end of one-year ranges from 5- 50% according to western literature. Very few studies on this issue have been done in India. This study aims to answer these questions in addition to whether ASA score, pre-operative co-morbidities, type of anaesthesia, early mobilisation and post-operative complications affect mortality and morbidity. A prospective observational study of 122 consecutive patients aged > 65 years who underwent surgery for intertrochanteric fractures of hip in Government Medical College, Kottayam from August 2015 to April 2016 was done. Follow up was done at 1, 3, 6 months and one year. Morbidity was assessed by Harris Hip Score. 1 month, 3 months, 6 months and one-year mortality were 11%, 20%, 24% and 30% respectively. Factors affecting mortality were age above 80 years, multiple co-morbidities, high ASA score, history of coronary artery disease and presence of postoperative complications. Average Harris hip score at 6 months was 84 (good outcome). Factors affecting poor outcome (low Harris hip score) were higher age group, female sex, higher ASA score and associated co-morbidities. Cardiac arrest and pneumonia were the leading causes of death. We recommend early surgical intervention and early mobilisation of the patients with intertrochanteric fractures especially females. Special care and attention should be given to those patients whose age is above 80 years with multiple co-morbidities to prevent mortality and morbidity. MATERIALS AND METHODS This is a prospective observational study of 122 patients with intertrochanteric fractures admitted in Government Medical College, Kottayam, Department of Orthopaedics, from August 2015 to April 2016. All patients were informed about the study in all respects and informed written consent was obtained. RESULTS The mean age of the study population is 75.7±9.2 years, ranging from 65 to 102 years. Majority are females (55%). Mechanism of injury in majority of them is due to trivial fall like slip and fall occurring in and around home (78%). According to Boyd & Griffin classification, most of the patients were type 1 and type II (34% and 35%). Average preoperative hospital stay is 9 days, ranging from 4 days to 32 days. CONCLUSION Post-Operative Mortality rate at 1 year is 30%. Factors affecting mortality are age above 80 years, multiple co-morbidities, high ASA score, history of coronary artery disease and the presence of postoperative complications.
