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[Emergency operation for the treatment of intertrochanteric fractures in elderly patients].

OBJECTIVE
To evaluate the emergency therapeutic effects of intertrochanteric fractures in elderly patients.


METHODS
A retrospective study was designed. From March 2006 to March 2012, 254 patients with intertrochanteric fractures treated in Mianyang Central Hospital were reviewed. The patients with old fractures, pathological fractures, multiple trauma and severe medical comorbidities of admission were excluded. So 127 patients with intertrochanteric fractures over 70 years old were included in the study, including 38 males and 89 females, and the patients were divided into 2 groups: 56 patients underwent emergency operation within 24 h after injury (emergency operation group), 71 patients underwent an operation more than 24 h after injury (not emergency operation group). The following data were collected retrospectively for all patients: (1) in-hospitalcomplications, including electrolyte disturbance, hidden blood loss, delirium, deep vein thrombosis, upper gastrointestinal hemorrhage, pulmonary infection, urinary tract infection, cardiovascular and cerebrovascular disease, bedsore. (2) prognosis, ineluding in-hospital mortality, mortality in the 1st year, length of hospital stay, fracture healing times, hip score. Comparisons between the two groups were made using SPSS13.0. The quantitative data and categorical data were analyzed by t test and chi2 test, respectively.


RESULTS
The main medical complications in emergency operation group were hidden blood loss, delirium, pulmonary infection, electrolyte disturbances, urinary tract infections, and in not emergency operation group followed respectively by hidden blood loss, lung infection, electrolyte disturbances, delirium, and pulmonary infection. In-hospital mortality was zero, and 1 in the 1st year in emergency operation group; while in not emergency operation group were 4 and 7 respectively. An average length of hospital stay with (9 +/- 3) d in emergency operation group was lower than (17 +/- 8) d in not emergency operation group. Fracture healing time was (12 +/- 2) weeks in both groups. The significant variables with P < 0.05 between the two groups were electrolyte disorders, delirium, deep venous thrombosis, pulmonary infection, urinary tract infection, bedsore, in-hospital mortality, mortality in the 1st year, and length of hospital stay. The differences of hidden blood loss, upper gastrointestinal hemorrhage, cardiovascular and cerebrovascular disease, fracture healing times, hip score between the two groups had no significant differences (P > 0.05).


CONCLUSION
The emergency surgery (within 24 h after injury) reduces length of hospital stay, and may also reduce complications and mortality.