Femur fracture is one of the pathologies of greatest impact and severity affecting the geriatric population, as can be seen from the latest figures published in the map of hip fractures in Spain: 50,000 femur fractures per year in our country, which corresponds to an annual rate of 5.9 per 1. This corresponds to an annual rate of 5.9 per 1,000 inhabitants over 65 years of age, and where the marked longevity of the people affected is noteworthy, with an average age of 87 years, mostly women, and in 37% of cases with associated cognitive impairment. Its seriousness lies in the significant loss of functional capacity of individuals, with the consequences that this implies for their autonomy and the medical complications that may arise, with a mortality rate of 24% one year after the intervention, which justifies the importance of the role of the geriatric physician in the care of the elderly person with a femur fracture.
How should a femur fracture in the elderly be approached?
Femur fracture requires surgical treatment in 97% of cases, even in those who were previously unable to ambulate, in order to control pain. It is a type of surgery that justifies a hospital stay requiring an average stay of 10 days and where we can already find the first complications, generally linked to the clinical fragility profile of the elderly. Acute confusional syndrome, characterized by episodes of delirium and agitation, may even require the prescription of mechanical restraint in bed due to the risk of new falls, as well as the administration of psychotropic drugs to control these symptoms, which are usually temporary, mainly during the first days of admission.
Anemia secondary to bleeding during surgery will probably require a transfusion during the first two postoperative days. Respiratory infections, usually in the context of bronchoaspiration in people with cognitive impairment, or urinary tract infection, related to bladder catheterization performed prior to surgery, are other possible complications that may be encountered in the hospital. In fact, 5% of people with femur fractures die during hospitalization. For this reason, given the complexity of its clinical management, multidisciplinary orthogeriatric units have been created, composed of orthopedic surgeons, internists or geriatricians and rehabilitation specialists, already present in most of our hospitals.
Care of a femur fracture after hospital discharge and loss of autonomy
After surgery and hospital discharge, the process does not end. On the contrary, the prolonged rehabilitation process begins, either at home or in socio-health care convalescence units, which will force 17% of the patients to move to a residential center to replace their home. It should be noted that only 50% of the elderly will move around alone one month after surgery and probably with the help of a crutch, cane or walker. This is the significant impact on people’s autonomy.
Given the numbers surrounding femur fractures, it is clear that we must focus on prevention. Two key words are linked to preventing hip fractures: osteoporosis and falls. Here the usual question arises: did you fall first and break your femur, or did you break your femur first and therefore fall? Osteoporosis, or the loss of bone mass leading to bone fragility, affects mainly women, and represents one of the main causes of femur fractures that can be prevented with a set of drugs. Likewise, 29% of people over 65 years of age will fall once a year and 10% will fall two or more times a year due to multiple factors, both intrinsic and extrinsic, which are important to know in order to try to act on them and prevent future falls, such as loss of muscle mass, visual or hearing acuity, the distribution of furniture in the home… But we will be able to explain all of this better in future articles.