Sep 13

Características epidemiológicas y clínicas de las fracturas de cadera en adultos mayores en un hospital público chileno Hip fracture / Experience in 647 Chilean patients aged 60 years or more

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Rev Med Chil. 2015 Dec;143(12):1552-9. doi: 10.4067/S0034-98872015001200008
[PubMed – in process]

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Background: Hip fractures (HFx) are an important geriatric syndrome, with a high incidence in developing countries. Aim: To describe characteristics of a group of Chilean patients with HFx. Patients and Methods: In a cross-sectional study we included patients aged 60 years or more with a HF admitted to an orthopedic service along three years. Age, incidence, location, seasonality, hospital stay, time between HFx and surgery, mortality, prior treatment for osteoporosis, anatomical location, etiology and type of surgery were evaluated. Results: We reviewed 647 patients with a median age of 81 years (76% women). The calculated incidence of hip fracture for people aged ≥ 65 years was 177/100,000. Sixty six percent of fractures were extracapsular. Mean hospital stay was 17 days and the mean lapse between the fracture and surgery was 19 days. Eighty four percent of patients had osteoporosis and only 5% were receiving treatment. Eighty three percent of patients were operated. Osteosynthesis was mainly used for extracapsular fractures and arthroplasty for intracapsular lesions. Intracapsular HFx tended to occur more commonly during warm seasons (Odds ratio = 1.534). Mortality at one year was 24%. It was higher among non-operated patients in whom the proportion of males and number of comorbidities were significantly higher. Conclusions: A high proportion of patients with HFx have osteoporosis albeit a reduced number is receiving treatment. Non-operated patients had a higher risk profile and higher mortality.

Key words: Geriatrics; Hip Fractures; Orthopedics.


 

Las fracturas de cadera (FC) son una gravísima consecuencia de la fragilidad ósea. Su importancia radica en su alta incidencia, alto impacto funcional, socialy económico, y alta morbimortalidad. Sus costes y mortalidad equivalen a la suma de costes y mortalidad por enfermedades cardiovasculares y neoplasias1-3.

Las publicaciones chilenas describen aspectos como su prevalencia en institucionalizados4, evolución de la incidencia5 y diferencias étnicas6. Contreras et al (1991)7, describieron aspectos epidemiológicos de la FC en el marco de una descripción general de las fracturas en Chile. Valdivia et al (1996)8, realizaron un estudio de casos y controles para identificar factores de riesgo para FC en población chilena. Una muestra revisada por Riedemann y Neira (2001-2006), fue incluida en el estudio con que Kanis et al (2012)9, revisaron la incidencia de FC en el mundo. Finalmente, Jiménez et al (2013)10, reportaron características epidemiológicas de 938 pacientes con FC.

En el mundo, las características de las FC varían según el nivel de envejecimiento poblacional y desarrollo económico9. En países desarrollados se ha trabajado sobre aspectos organizacionales, como optimización de la oportunidad de acceso al manejo quirúrgico11,12 y colaboración entre especialidades13,14. Además, se discute temas como las diferencias entre fracturas intra (FIC) y extracapsulares (FEC)15,16 y relaciones entre mortalidad y distintas variables17-19.

Como la literatura destaca diferencias regionales incluso en un mismo país9, consideramos interesante comprobar si se mantienen las tendencias descritas en otros trabajos chilenos. También nos pareció relevante contrastar nuestros resultados con los de series internacionales, definiendo líneas de trabajo que optimicen el manejo actual y aportando información en los temas actualmente en discusión.

Así, nuestros primeros objetivos son descriptivos: Caracterizar los sujetos con FC de nuestra serie, y contrastar los resultados con estudios nacionales e internacionales.

Finalmente, nos propusimos buscar significación en temas actualmente en discusión: FEC vs FIC, y relaciones entre mortalidad, oportunidad quirúrgica, tiempos de estancia hospitalaria y decisión de no operar.

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