Aims: The purpose of the study was to determine the relationship of preoperative health status and surgery delay on postoperative complications and mortality in patients with hip fracture Methods: 195 patients with hip fracture were admitted to the Institute between 1997 and 2001. Information on the demographics, pre-existing medical conditions, type of fracture, operation and anesthesia, and postoperative complications during hospitalization was obtained from the medical records. Preoperative health status was assessed by the ASA classification. Medical records and the telephone interviews were used for follow-up on the patient’s vital status. Results: Analysis include patients who were 65 and older, cognitively intact, living at home and able to walk before surgery. 64% were female with femoral neck fracture. More than half had two or more pre-existing medical conditions and ASA grade III or IV. Follow-up period averaged 24 months (6 to 60). The overall mortality was 15% at one year, 23% at two years and 30% at three years. The three year mortality was less for ASA I and II patients than for ASA III, IV and V group. We found difference in mortality between patients having surgery within 24 hours of admission (25%) and those with operative delay beyond 24 hours of admission (45%). Conclusions: Operative treatment within 24 hours of admission showed lower mortality rate than in patients having surgery beyond 24 hours of admission in conjunction with preoperative ASA classification

The purpose of this study was to assess the regional variation in the incidence of hip fractures in patients over 65 years. in New Zealand. Data from the National Minimum Data Set (NMDS) for hip fractures from 1 July 1998 to 31 June 2000 was obtained. The data was divided into 21 District Health Board (DHB) regions by mapping from domicile code to DHB. Population of interest as at 30 June 1999 was estimated on the basis of previous census in 1996. The incidence of hip fracture per 100,000 for each region was calculated and divided into age and sex cohorts.

There is a significant difference between DHBs in the sex and age adjusted incidence of hip fractures. The rates ranged from 556 per 100,000 to 838 per 100,00. As expected there was a higher fracture rate in women and the fracture rate increased with age. There was a weak correlation with sunshine hours (p=0.029) with increasing fracture incidence as sunshine hours decrease.

This study demonstrates a large variation in the incidence of hip fractures per DHB region. The cause for this is unclear, but the cost implications are significant. DHB’s with a high incidence of hip fractures in their region may wish to investigate strategies for reducing the incidence.

There is controversy regarding the best way to manage fit, independent patients with acute hip fractures. The aim of this study was to compare, nationally, the early complication rates of total hip arthroplasty (THA) in those patients with an acute fractured neck of femur (NOF) with a similar group of THA’s performed in patients with a diagnosis of osteoarthritis.

Using the National Hip Joint Register and the New Zealand Health Information Service Database, 200 patients with acute hip fractures undergoing THA were identified and compared to 1102 THA’s performed on osteoarthritis patients. The mortality, revision, dislocation and infection rates were analysed at a minimum of one year.

Acute THA had a 7.5% one-year mortality rate compared with 2.5% in the OA group (p < 0.01). The revision rate was 2.5% vs 1.8% in the acute and OA groups respectively. The dislocation rate was 4.3% for the whole group with a 8.5% for the acute group and 3.5% for the OA group (p< 0.01). In the acute group the dislocation rate using the posterior approach was 17.1 % compared to 3.1% for the lateral approach (p< 0.01).

We conclude that acute THA is a useful procedure in fit patients with a fracture of the neck of the femur but that a posterior approach should be avoided.