Abstract
Introduction: In order to improve functional recovery of hip fractures and to optimize the use of resources, all the patients belonging to our district have been enclosed in a specific protocol.
Material and methods: The program provides that all the patients, except contra-indications, have operated by 24 hours. Osteosynthesis or prosthesization techniques have to allow an early and complete weight bearing. At the time of the admission, an informative card is sent to house assistance team of the district. After the operation, patients are examined by a physician, who prescribes the rehabilitation protocol and estimates the possibility of a domiciliary physiotherapy. Discharging from hospital occurs usually between third and fifth day post-op, toward patient home or an intermediate structure. In the first case, the local health district provide the patient with nursing and rehabilitation services. Ambulatory controls follow the specific requirements for each kind of implant.
Results: In the period 1–9/2004 we have recruited 341 subjects aged over 65 years (mean 81,5), males 25,5%, female 74,5%. Type of fracture: femoral neck 58,4%, trochanteric region 41,6%. Surgical treatment: cephalic endoprosthesis 35,2%, arthroprosthesis 8,6%, gamma nail 43,2%, cannulated screws 9,5%, dynamic plaque 0,9%, Ender nails 0.9%, none operation 2,4%. Type of hospital discharging: previous residence 69,5%, rehabilitation structures 26,2%, intensive care unit 3%, death 0.6%, other 0,6%. Waiting time before surgery: 2,7 days. Reasons of an extended waiting are anti-coagulation therapies and hospital admission during week end. Mean time of hospitalisation: 12,1 days. Main cause of an extended time of hospitalisation is relative absence. A phone follow-up at 6 months points out that 33,3% of patients doesnt go out of home or is completely unfit, while before only 7,8%. Pain is absent or modest/tolerable in 93% of cases. Comparing to previous sample of patients (2002), we observed a reduction of the pre-surgical time (2 days), of the total hospital time (3 days) and an improvement of the final performance.
Discussion and conclusions: Modern surgical and anaesthesiological techniques reduce peri-surgical death rate to very low level. Then an aggressive, integrated treatment of patients with hip fractures allows to improve functional performance, backing to normal social life, and besides to reduce costs.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
