Abstract
Background The clinical standards board in Scotland has recognized hip fractures as the most common injury in older people. Hip fracture care is now emerging as a case study for clinical governance in Scotland. Aims/Methods The results of a prospective audit of 1177 hip fractures admitted to Wishaw General Hospital over a 36 month period are presented. All aspects of care from admission to discharge are analyzed, and patients followed up for 4 months after discharge. Results Pre Fracture The most common age group of patients was 80–90 Yrs (40.9%). 10 % of patients were over 90 Yrs.80.3% were female. There was no significant difference in side involved (L 53.3%: R 46.7%).60.1% patients were admitted from own home.71 patients (6%) originated from other wards within the hospital.39.6% patients were found to be living alone. Only 25.9% patients walked alone out of doors before fracture, while 39.1% walked alone indoors but not out of doors.43.8% could walk with out aids. Surgery 52.9% underwent osteosynthesis with screws and plate.34.2% had hemiarthroplasty.3.4% had total hip replacement. 4.1% was treated conservatively.48.3% had general anaesthetic and 47.4% regional anaesthetic.93 % received thromboembolic prophylaxis, and 96% antibiotic prophylaxis. The post operative wound infection rate was 3.2%. 4.9% required a second surgical procedure within 4 months. These included 14 patients who had dislocated prosthesis reduction, 14 conversions to total hip replacement, 9 conversions of osteosynthesis to hemiarthroplasty and 5 refixations. Post Fracture (4 Months) 41.9 % returned to their own home, while 14.7 went into nursing homes.11% were able to walk out of doors alone, and 28% could walk in doors alone. Only 7% could mobilize without and aids, 19.2% used one aid and 30.2% required a walking frame.41.6 % had no hip pain, 18.2 % complained of slight or intermittent discomfort.
Conclusions Older patients (80 Yrs +) are at significant risk of sustaining hip fractures. The risks are greater in patients living alone and in females. Patients with significant co morbidity may have to be treated conservatively. There is a considerable risk of requiring a second surgery. Only about 69 % of patients living in their own homes are able to do the same after fracture. Only about 50 % of previously independent patients were able to regain the same level of mobility.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
