gms | German Medical Science

Objectives: Our hospital group has two orthopedic clinics with only one offering an additional orthogeriatric fracture service. Patients from both units were treated with the same implants, surgical procedures and surgeon team. We compared the 1 year results of proximal femur fractures treated either in our fracture unit (OG) or the normal orthopedic (O) unit.

Methods: We included all patients (age >70) with femoral neck fractures and pertrochanteric fractures, treated between February 15 and December 16. Patients with other fractures (periprothetic and subtrochanteric) were excluded. Patients were treated with a dynamic hip screw (DHS), Y- or TFNA-nail, hemiarthroplasty or total hip arthoplasty (THA). In the OG unit, patients were treated interdisciplinary, co-managed by the orthopedic team and the geriatric team simultaneously.

We retrospectively analyzed all patient records included in the study. End point was the out-patient consultation 1 year after surgery. If this consultation was missing, patients, their relatives or their care facility were contacted.

For primary outcome we compared the 30 day- and 1 year mortality, the complication rate and severity of the complications, time to surgery, length of stay and rate of rehospitalization (same reason or other).

Result: In the OG unit (n=150), 78 patients were treated for pertrochanteric fractures with 77 closed reduction and internal fixation (CRIF;8 DHS, 48 TFNA- and 9 Y-nails) and 1 THA. 72 femoral neck fractures were treated with 7 CRIF (3 cannulated screws and 4 DHS), 40 hemiarthroplasties and 25 THAs. Mean age at operation was 85.6 years (range 70–99).

In the O unit (n=181), 104 patients were treated for pertrochanteric fractures with CRIF (10 DHS, 34 TFNA- and 60 Y-nails). 77 femur neck fractures were treated with 2 CRIF (DHS), 56 hemiarthroplasties and 19 THAs. Mean age at operation was 83.3 years (range 70–100).

Patients treated in the OG unit and the O unit were discharged to (3.3%;2.8%) home, (59.3%;56.4%) rehabilitation, (16%;32%) back to nursing home, (8%;2.8%) newly admitted to nursing home and (8%;4,4%) was the in house mortality. The length of stay was 16 days (range 2–43) in the OG vs. 8.7 days (range 1–23) in the O unit.

Patients in the OG unit and the O unit had no complications (50%;47.5%), (2.7%;6.1%) grade 1, (32.7%;70.2%) grade 2, (18.7%;11%) grade 3, (0%;1.1%) grade 4 and (8.7%;4.4%) grade 5 with (38.7%;26.5%) having 1 complication, (7.3%;15.5%) having 2 complications, (1.3%;6.6%) having 3 complications and (0%;3.9%) having 4 complications.

30 day mortality rate was (10.9%;8.3%) while 1 year mortality rate was (27.6%;27.6%) (n=0;n=1) patients were lost for 6 week follow-up and (n=5,n=3) patients were lost for 1 year follow-up.

Conclusion: Our results show that we can achieve less complications with the OG treatment. The 6 weeks mortality was slightly higher in the OG unit, likely due to patient selection which excluded healthier patients with less comorbidities or frailty from the OG. In spite of this there was no difference in 1-year mortality between the two groups.