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. 2015 Jun 27;50(4):371-7.
doi: 10.1016/j.rboe.2015.06.007. eCollection 2015 Jul-Aug.

Epidemiology of fractures of the proximal third of the femur in elderly patients

Daniel Daniachi  1 , Alfredo Dos Santos Netto  1 , Nelson Keiske Ono  1 , Rodrigo Pereira Guimarães  1 , Giancarlo Cavalli Polesello  1 , Emerson Kiyoshi Honda  1
Affiliations

Epidemiology of fractures of the proximal third of the femur in elderly patients

Daniel Daniachi et al. Rev Bras Ortop. .

Abstract
in English, Portuguese

Objective: This was an epidemiological study on fractures of the proximal third of the femur in elderly patients who were treated at a teaching hospital in the central region of São Paulo.

Methods: The subjects were patients over the age of 60 years who were attended over a 1-year period. A questionnaire seeking basic sociodemographic data and information on comorbidities presented and medications used was drawn up. The circumstances of the fractures and their characteristics, the treatment instituted and the intra-hospital mortality rate were evaluated.

Results: The 113 patients included in the study presented a mean age of 79 years. The ratio between the sexes was three women to each man. Only 30.4% of the patients reported having osteoporosis and only 0.9% had had treatment for the disease. Low-energy trauma was the cause of 92.9% of the fractures. Femoral neck fractures accounted for 42.5% of the fractures and trochanteric fractures, 57.5%. Five patients did not undergo operations; 39 underwent joint replacement; and 69 underwent osteosynthesis. The mean length of hospital stay was 13.5 days and the mean length of waiting time until surgery was 7 days. The intra-hospital mortality rate was 7.1%.

Conclusion: The patients attended at this institution presented an epidemiological profile similar to what is found in the Brazilian literature. Chronic kidney failure is a significant factor with regard to intra-hospital mortality. Preventive measures such as early diagnosis and treatment of osteoporosis and regular physical activity practices were not implemented.

Objetivo: Estudo epidemiológico das fraturas do terço proximal do fêmur em pacientes idosos, tratados em hospital-escola na região central de São Paulo.

Métodos: Pacientes a partir 60 anos atendidos no período de um ano. Questionário foi elaborado com informações sociodemográficas básicas, comorbidades apresentadas e medicações em uso. Foram avaliadas circunstâncias da fratura e suas características, tratamento instituído e taxa de mortalidade intra-hospitalar.

Resultados: Os 113 pacientes incluídos no estudo apresentavam 79 anos em média. A proporção entre os sexos foi de três mulheres para cada homem. Somente 30.4% dos pacientes relataram osteoporose e somente 0.9% tratavam a doença. Trauma de baixa energia foi a causa de 92,9% das fraturas. Fraturas do colo do fêmur representaram 42,5% das fraturas e trocantéricas 57,5%. Cinco pacientes não foram operados, 39 foram submetidos a substituição articular e 69 foram submetidos a osteossíntese. O tempo médio de internação foi de 13,5 dias e de espera até a cirurgia sete dias. A taxa de mortalidade intra-hospitalar foi de 7,1%.

Conclusão: Pacientes atendidos na instituição apresentam perfil epidemiológico semelhante àqueles encontrados em literatura nacional. Insuficiência renal crônica é um fator significativo para mortalidade intra-hospitalar. Medidas preventivas como diagnóstico precoce e tratamento da osteoporose e prática regular de atividades físicas não são adotadas.

Keywords: Elderly people; Epidemiology; Hip fractures.

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Figures

Fig. 1
Fig. 1
The only risk factor that was found to separately increase mortality in the hospital was chronic kidney failure. The percentage of patients with kidney failure was significantly greater among the patients who died than among those who did not die.
Fig. 2
Fig. 2
There was a difference between the percentage of patients who reported having osteoporosis and the percentage presenting osteoporosis on radiography, such that the percentage of patients with osteoporosis seen on radiography was greater than the percentage reporting osteoporosis. Furthermore, the kappa coefficient value was less than 0.5 (50%), which indicates that there was low concordance between reported and radiographic osteoporosis.
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References

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