Controversias en el manejo de la fractura de cadera en el adulto mayor. Encuesta nacional a Traumatólogos especialistas en cirugía de cadera.

MANAGEMENT OF HIP FRACTURE IN OLDER PEOPLE. A NATIONAL SURVEY AMONG TRAUMATOLOGISTS

Author
Zamora, Tomás; Departamento de Ortopedia y Traumatología. Escuela de Medicina, Pontificia Universidad Católica de Chile.

Klaber, Ianiv; Departamento de Ortopedia y Traumatología. Escuela de Medicina, Pontificia Universidad Católica de Chile.

Bengoa, Francisco; Departamento de Ortopedia y Traumatología. Escuela de Medicina, Pontificia Universidad Católica de Chile.

Botello, Eduardo; Departamento de Ortopedia y Traumatología. Escuela de Medicina, Pontificia Universidad Católica de Chile.

Schweitzer, Daniel; Departamento de Ortopedia y Traumatología. Escuela de Medicina, Pontificia Universidad Católica de Chile.

Amenábar, Pedro; Clinica Alemana de Santiago, Chile.

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http://www.revistamedicadechile.cl/ojs/index.php/rmedica/article/view/7087
Abstract
Background: As the population ages, patients exposed to osteoporotic fractures increase, especially hip fracture, which is the most severe and costly. Aim: To characterize surgical practices in the management of hip fractures in older patients through a nationwide survey of specialized hip surgeons dedicated to the care of these patients. Material and methods: A survey composed of 32 questions was formulated, including demographic factors, preoperative evaluation, definitive treatment, and postoperative management. It was sent to 140 specialists. 84 of them replied (61%), and 71 answers were included. Results: Eighty six percent of respondents agreed that orthogeriatric management is fundamental in the outcome of these patients, but only 73% had the collaboration of an internist or a geriatrician. Although 97% considered 72 hours or less the ideal time to perform surgery, only 52% of the respondents declared performing surgery within that timeframe, with differences between private and public system. Regarding surgical treatment, 94-98% of femoral neck fractures are treated with an arthroplasty and 98-99% of per-subtrochanteric fractures are treated with internal fixation and osteosynthesis. Osteoporosis treatment is only carried out by 51% of the respondents and with significant variation. Conclusions: This survey shows that there is agreement in surgical practice between specialists treating these patients, but clear differences in preoperative optimization, treatment timeframe, and post fracturemedical treatment.
 
Background: As the population ages, patients exposed to osteoporotic fractures increase, especially hip fracture, which is the most severe and costly. Aim: To characterize surgical practices in the management of hip fractures in older patients through a nationwide survey of specialized hip surgeons dedicated to the care of these patients. Material and methods: A survey composed of 32 questions was formulated, including demographic factors, preoperative evaluation, definitive treatment, and postoperative management. It was sent to 140 specialists. 84 of them replied (61%), and 71 answers were included. Results: Eighty six percent of respondents agreed that orthogeriatric management is fundamental in the outcome of these patients, but only 73% had the collaboration of an internist or a geriatrician. Although 97% considered 72 hours or less the ideal time to perform surgery, only 52% of the respondents declared performing surgery within that timeframe, with differences between private and public system. Regarding surgical treatment, 94-98% of femoral neck fractures are treated with an arthroplasty and 98-99% of per-subtrochanteric fractures are treated with internal fixation and osteosynthesis. Osteoporosis treatment is only carried out by 51% of the respondents and with significant variation. Conclusions: This survey shows that there is agreement in surgical practice between specialists treating these patients, but clear differences in preoperative optimization, treatment timeframe, and post fracturemedical treatment.
 
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