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Trauma: G. Holt, D. Macdonald, M. Fraser, and A. T. Reece Outcome after surgery for fracture of the hip in patients aged over 95 years J Bone Joint Surg Br 2006; 88-B: 1060-1064 [Abstract] [Full text] [PDF]

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Cognitive impairment may affect outcome after surgery for fracture of the hip

Samuel G Molyneux, Thomas Barwick, Robert Gregory.   (14 September 2006)

Data is available on outcome of very eldery hip fractures

Christopher W. Oliver, Christopher Burke   (7 August 2006)

Cognitive impairment may affect outcome after surgery for fracture of the hip 14 September 2006
Samuel G Molyneux, SHO Orthopaedics , Thomas Barwick, Robert Gregory. Send letter to journal: Re: Cognitive impairment may affect outcome after surgery for fracture of the hip sgmolyneux{at}yahoo.co.uk Samuel G Molyneux, et al.	Sir, Holt et al present an interesting review of outcomes following surgery for hip fracture in patients aged 95 and over. Their work highlights once again the difficulties and cost implications of treating this growing population. Based on a search of the literature, they have also gathered information on predictors of mortality, and looked at diabetes mellitus, congestive cardiac failure, cardiac arrhythmia, ischaemic heart disease, cerebrovascular disease, renal impairment, malignancy, Parkinson’s disease, hypertension, COPD and anticoagulation use. They also looked at ASA grade, and the number of co-morbidities. They quote these as being the most important predictors of outcome. Unfortunately, there is no mention of cognitive function, which has been shown to be the single most important variable affecting outcome in hip fractures.1,2 The prevalence of dementia is as high as 68% in the over 95s,3,4 and this is therefore likely to be a particularly powerful prognostic indicator in this group. As our population ages,5 this will become increasingly important. It would be interesting to know how much the early mortality of this study group was linked to dementia. Holt et al also found a marked reduction in independence following a fracture, shown by a reduction in the number of patients living independently from 62% pre-injury to just 4% at final follow-up (29 months). The active life expectancy (ie. the duration for which people are able, independently, to perform activities of daily living) has been shown to be just 2.9 years in those aged over 85.6 It may well be, therefore, that the loss of function represents a normal progression for this group, rather than being a direct result of hip trauma. S.G.Molyneux, MRCS, T.W.Barwick, MRCS, R.J. Gregory, FRCS(ORTH), University Hospital of North Durham, Durham, UK. 1. Horgan NF, Cunningham C, McSorley G, Sexton M. Rehabilitation Following Hip Fracture: The Impact Of Cognitive Impairment. J Am Ger Soc 1998;46:S108. 2. Ions GK, Stevens J. Prediction of survival in patients with femoral neck fractures. J Bone Joint Surg [Br] 1987;69-B:384-387. 3. Paykel ES, Brayne C, Huppert FA, et al. Incidence of dementia in a population older than 75 years in the United Kingdom. Arch Gen Psych 1994;51:325-332. 4. Fratiglioni L, De Ronchi D, Aguero-Torres H. Worldwide prevalence and incidence of dementia. Drugs Aging 1999;15:365-375. 5. Hebert LE, Beckett LA, Scherr PA, Evans DA. Annual incidence of Alzheimer disease in the United States projected to the years 2000 through 2050. Alzheimer Dis Assoc Disord 2001;15:169-173. 6. Katz S, Branch LG, Branson MH, et al. Active life expectancy. N Engl J Med 1983;309:1218-1224.
Data is available on outcome of very eldery hip fractures 7 August 2006
Christopher W. Oliver, Consultant Orthopaedic Trauma Surgeon Edinburgh Orthopaedic Trauma Unit, Christopher Burke Send letter to journal: Re: Data is available on outcome of very eldery hip fractures cwoliver{at}rcsed.ac.uk Christopher W. Oliver, et al.	Sir, The authors of this article state that "despite the increase in numbers of the extreme elderly, little data is available regarding their outcome after surgery for fracture of the hip". We would dispute this statement in that there are several other good papers in the English literature which contain broadly similar data in peer reviewed journals. These papers appear to have been overlooked.1-5 C.W. Oliver, Consultant Orthopaedic Trauma Surgeon, C. Burke, Edinburgh Orthopaedic Trauma Unit, Edinburgh, UK. 1. Oliver CW, Burke C. Hip fractures in centenarians. Injury 2004;35:1025-30. 2. Alarcon T, Gonzalez-Montalvo JI, Barcena A, Saez P. Further experience of nonagenarians with hip fractures. Injury 2001;32:555–558. 3. Forster MC, Calthorpe, D. Mortality following surgery for proximal femoral fractures in centenarians. Injury 2000;31:537–539. 4. Jennings AG, Boer P. Should we operate on nonagenarians with hip fractures?. Injury 1999;30:169–172. 5. MacCollum MS, Karpman RR. Approaches to senior care. Hip fractures in nonagenarians. Orthop. Rev. 1989;18:471–477.