الفهرس 
Overview of hip fractureOnly 14 pages are availabe for public view
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Abstract
Hip fracture is a devastating injury affecting a vast majority of
the elderly individuals. The geriatric hip fracture occurs in a
patient population subjected to the bone weakening by
osteoporosis. The incidence of such fracture increases with age
after the sixth decade.
A large number of studies have concluded that hip fracture is
associated with high incidence of postoperative mortality and
morbidity rates. The high mortality, particularly in the first
three months, is probably due to the combination of trauma,
major surgery in elderly people with concurrent medical
problems, and a low physiological reserve.
Our study aimed to determine the capability of the
Physiological and operative severity score for enumeration of
mortality and morbidity score (POSSUM) to predict mortality
and morbidity following hip fracture surgery .To determine the
role of geriatric tools in predicting mortality and to determine
mortality rates after hip fracture We recruited 100 elderly patients admitted to inpatients
orthopedic wards for surgical correction of hip fracture. All
patients were subjected to cognitive assessment (pre and
postoperative), screening for depression, assessment of
prefracture functional status by ADL and IADL, pain
assessment by numerical pain scale and postoperative delirium.
POSSUM scale was fulfilled. Patients were followed up by
telephone calls at 30 days, 3 months and 6 months interval to
determine observed and predicted morbidity and mortality and
postoperative rehabilitation and ambulance.
The following results were revealed in this study:
I. Observed mortality rates found in the current
study were (9.2%) at 30 days postoperative,
(16.5%) at 3 months follow up, and (21%) at 6
months follow up. These rates are almost similar
to those found in literature.
II. POSSUM did not predict mortality well in our
population mostly due lack of computerized data
bases and failure of documenting intraoperative
events.As regards motality POSSUM predicted 3 deaths versus 21 observed mortality with a
sensitivity of 5.6%. The model can be used to
predict survivors with specificity of 97.3%.
III. POSSUM predicted 50 postoperative
complications versus 38 observed. POSSUM
proved of moderate value in predicting morbidity
with a sensitivity of 59.4 % and a specificity of
57.1%.
IV. Geriatric assessment tools proved to be related to
mortality. Mini-mental status examination
(MMSE) scores were higher among survivors
(mean 25±5) compared to (mean 20±5) among
non survivors.
V. Prefracture functional status assessment revealed
positive relationship between postoperative
mortality and prefracture functional status
assessed by (ADL) and Instrumental activities of
daily living (IADL) with a higher independency
among survivors in all items. These tools are simple and applicable and were significantly
related to mortality in this current study.
VI. Delerium is a serious postoperative complication
in hip fracture elderly patients (22%) of
participants in this study developed delirium
postoperatively.
VII. Postoperative delirium (22%), pressure sores
(39%), falls (7%) and urinary incontinence (50%)
were the most common complications seen in the
studied population.