Retrospective Study Of Surgical Risk And Safety Assessment Of Elderly Patients With Proximal Femoral Fractures

Purpose To analyze the risk of operative treatment of proximal femoral fractures in elderly patients and evaluate the safety of the operation.Materials and Methods Retrospective analysis patients with proximal femoral fractures in the First Affiliated Hospital of Dalian Medical University traumatic orthopedic department between January 1,2015-December 31,2017.Preoperative examinations were performed to improve the control of comorbidities within the acceptable range and to exclude surgical contraindications after surgical treatment.Except for conservative treatment,patients younger than 85 years old,active infections,pathological fractures,cachexia.Recorded age,diagnosis,surgical methods,admissionsoperation time(days),preoperative and postoperative daily activities(ADLs scores)including: bathing,dressing,toileting,going out,eating,and the ability to use complex items,scoring(independent 1,semi-independent 0.5,totally dependent on 0),preoperative plasma total protein,plasma albumin,arterial oxygen partial pressure in nonoxygenated state,alveolar arterial oxygen partial pressure difference and pH,preoperative hemoglobin,Postoperative hemoglobin HB,preoperative and postoperative hematocrit,total bilirubin,anesthetic risk score(ASA),preoperative combined systemic disease,chronic medication status,left ventricular ejection fraction,operative time,intraoperative bleeding Volume,Perioperative Infusion of Red Blood Cell,Perioperative Infusion of Plasma,Postoperative Adverse Events,Harris Hip Score,White Blood Cell Count,Red Blood Cell Count,Serum Natrium,Potassium,Calcium,Chloride Ion Concentration,Fasting Blood glucose,serum creatinine,D-dimer,prothrombin time,activated partial thromboplastin time,international normalized ratio,atrial natriuretic peptide,creatine kinase,creatine kinase isoenzyme,hypersensitive muscle Protein I and AIS-ISS scores.Analyze the risk factors associated with surgery and postoperative adverse events and assess the safety of the operation.Results According to the inclusion criteria,a total of 94 patients were enrolled in the study.All of them were closed unilateral proximal femoral fractures.The causes of injury were fall,including 67 cases of femoral intertrochanteric fractures and 27 cases of femoral neck fractures.All the operations were general anesthesia.The average age was 89.04±3.06 years(85-98 years old).A total of 81 patients were followed up and 13 patients were lost.The reason was contact changes and number shutdown.Among the patients who were followed up,18 were males and 63 were females.At the time of followup,13 patients had died and the rest of the patients had an average follow-up time of 15.00±10.45 months(1.53-37.03 months).When T-BIL is higher than 27.75umol/L,Ddimer is higher than 2005ug/L,CK is higher than 108.5U/L,PaO2 is lower than 80 mmHg,AaDO2 is lower than 32.1mmHg,and EF is lower than 55.5%.An increase in grade indicates a poor prognosis.Conclusions Patients with proximal femoral fracture aged ?85 years old can predict their surgical risk and prognosis by measuring total bilirubin,D-dimer,arterial oxygen partial pressure,alveolar arterial oxygen pressure difference,and myocardial markers and ejection fraction,and to detect abnormal indicators,treat their causes,reduce preoperative risk;improve related examinations,control complications within the accepted range of surgery is safe,and surgery is crucial for them,surgery Treatment can improve the prognosis,improve the quality of life,and reduce the patient's own psychological burden.