Narayana Murthy S, Cheruvu MS, Siddiqui RS, Sharma N, Dass D, Ali A. Survival analysis in nonagenarian patients with non-hip lower limb fractures. World J Orthop 2023; 14(8): 621-629 [PMID: 37662665 DOI: 10.5312/wjo.v14.i8.621]
Corresponding Author of This Article
Sanjay Narayana Murthy, MBBS, Surgeon, Department of Trauma and Orthopaedics, Royal Stoke University Hospital NHS Trust, Newcastle Road, Stoke-On-Trent ST4 6QG, United Kingdom. sanjayn293@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Sanjay Narayana Murthy, Manikandar Srinivas Cheruvu, Nikhil Sharma, Debashis Dass, Ashique Ali, Department of Trauma and Orthopaedics, Royal Stoke University Hospital NHS Trust, Stoke-On-Trent ST4 6QG, United Kingdom
Raheel Shakoor Siddiqui, Department of General Surgery, Birmingham Heartlands Hospital, Birmingham B9 5SS, United Kingdom
Author contributions: Narayana Murthy S, Siddiqui RS and Cheruvu MS conceptualized, designed, reviewed the existing literature, did the statistical analysis, wrote the manuscript and prepared the first draft; Dass D and Sharma N critically reviewed the first draft and gave their expert suggestions; Ali A reviewed the final draft before submission and suggested further changes.
Institutional review board statement: This is an observational study which does not include any of the patient identifiable data. Additionally, as there are no interventions, there was no need to obtain an institutional board review statement.
Informed consent statement: Consent for an original study involving humans is not necessary as we have not included any patient identifiable details in our manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: As no patient identifiable data is shared in the manuscript, this is not required. No additional data is available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Noncommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sanjay Narayana Murthy, MBBS, Surgeon, Department of Trauma and Orthopaedics, Royal Stoke University Hospital NHS Trust, Newcastle Road, Stoke-On-Trent ST4 6QG, United Kingdom. sanjayn293@gmail.com
Received: January 26, 2023 Peer-review started: January 26, 2023 First decision: April 28, 2023 Revised: May 30, 2023 Accepted: July 27, 2023 Article in press: July 27, 2023 Published online: August 18, 2023 Processing time: 202 Days and 18.7 Hours
ARTICLE HIGHLIGHTS
Research background
There is paucity of literature pertaining to the management and survival of non-hip fractures in the nonagenarian population. This is significant, given the rising nonagenarian population in the United Kingdom.
Research motivation
This study aims to analyze the prognosis/survival in a level 1 major trauma centre, in managing non-hip fractures in nonagenarian population in the United Kingdom.
Research objectives
To summarize the survival prognosis on nonagenarian population with non-hip fractures in a level 1 major trauma centre.
Research methods
We referred to the hospital electronic database between 2015 and 2016 to include all patients with age ranging from 90 to 99 years, who had lower limb long bone fractures, including periprosthetic fractures. We excluded all hip fractures, soft tissue trauma, foot and ankle fractures. Both conservative and operative management were considered depending on the anaesthetic fitness and medical background. 30-d, 1-year and 2-year mortality were calculated for both surgical and conservative groups and compared using Fisher’s exact test.
Research results
Out of 28 patients, 23 patients (24 fractures) had surgical intervention and 5 patients (6 fractures) were for conservative treatment. The mean time from admission to definitive fracture treatment was 2.5 d (range 2-3 d). In surgical cohort, only 2 patients went home post-discharge, the rest all were transferred to rehabilitation institutions. In the conservative cohort, all patients were transferred to an institution. The 30-d, 1-year and 2- year mortality risks were 1/23, 6/23 and 9/23 (4%, 26% and 39%) in the surgery group and 0/5, 1/5 and 2/5 (0%, 20% and 40%) in the conservative group, with no evidence for a difference between the two groups at any time point.
Research conclusions
Surgery was more likely to be offered to patients with fewer comorbidities and both conservative and surgical groups had similar length of hospital stay and mortality risks. Early planning for institutional rehabilitation and socio-economic support is utmost needed in the management of these patients.
Research perspectives
Standard national guidelines for lower limb fractures in the nonagenarian population would streamline the diagnosis, management, and rehabilitation.
