OUTCOME OF PROXIMAL FEMORAL FRACTURES IN ELDERLY PATIENTS. Dr. Makena Mbogori- Medical Officer, Orthopaedic Surgery. Dr. Michael Maru- Consultant Orthopaedic Surgeon P.C.E.A. Kikuyu Hospital

OUTLINE Introduction Background Aim Objectives Methodology Results and Discussion Conclusion

Introduction Proximal Femur fractures common among the elderly It is now recommended to surgically manage them so as to relieve pain, facilitate mobilization and reduce complications as VTE, Bed Sores and Pneumonia. The elderly have comorbidities contribute to the overall outcome There is paucity of local data on the outcome of these patients after 1yr in terms of Morbidity and Mortality.

AIM OF STUDY To Illustrate the Morbidity and Mortality rates following operative management of Proximal Femoral Fractures in patients over 60years at P.C.E.A Kikuyu Hospital

Objectives To Establish the demographic characteristics common mechanisms of injury Comorbidities nature and patterns of fractures different surgeries performed post-op complications encountered morbidity encountered after surgery based on change in mobility overall 30 day Mortality and 1 year Mortality Rates

Methodology A retrospective review Case notes and Radiological investigations Follow up telephone calls to the patients or next of kin to investigate mobility and mortality within one year of surgery. Inclusion criteria: All patients over the age of 60years with Proximal Femur Fractures that were repaired surgically. No Exclusion Criteria

RESULTS AGE- Mean Age: 75years TOTAL NO OF PATIENTS- 122

GENDER FEMALE:MALE 1.26:1

CHARACTERISTICS OF INJURY

SIDE OF FRACTURE

SITE OF FRACTURE EXTRACAPSULAR-66

INTRACAPSULAR-56

CORMOBIDITIES

DURATION FROM INJURY TO ADMISSION

DURATION FROM ADMISSION TO SURGERY

SURGERIES PERFORMED

PROTOCOLS 1. Pre-op/Post-op DVT prophylaxis- upto 6weeks i.e SC Clexane 40mg OD the PO ASA 150mg OD 2. Post-op Antibiotics- IV Ceftriaxone for 3 days 3. Post-op Analgesia- NSAIDs plus PRN Opiods 3. Physiotherapy for Mobilization- WBAT

POST-OP HOSPITAL STAY Average- 3.85days RANGE- 2-11days

POST-OP COMPLICATIONS- 23patients

Comparison of Pre-op vs Post-op Mobility

MORTALITY RATE 30 DAYS ONE YEAR

DURATION OF FOLLOW UP AT CLINIC AVERAGE- 13WEEKS(APPROX 4 MONTHS) RANGE- 2WEEKS-76WEEKS

DISCUSSION Survival and functional outcomes after hip fracture among nursing home residents Mark D. Neuman, MD1,2, Jeffrey H. Silber, MD, PhD1,2,3,4,5, Jay S. Magaziner, PhD6, Molly A.Passarella, MS3, Samir Mehta, MD7, and Rachel M. Werner, MD, PhD2,8 47% mortality rate at 365 days Time to surgery- 4days 26.6% had Charlson score >4

CONCLUSION Our results show that our mortality rate is comparably less than that of the western world, this could be explained by the limited number of comorbidities affecting the elderly in our country compared to the Western world The rates of Morbidities(Post-op Morbidity) are however higher most likely due to delayed presentation, delayed time to surgery, lost to follow up and absconding of physiotherapy which usually arise due to financial constraints

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