Published online Aug 19, 2023. doi: 10.5498/wjp.v13.i8.533
Peer-review started: May 6, 2023
First decision: May 19, 2023
Revised: June 15, 2023
Accepted: July 5, 2023
Article in press: July 5, 2023
Published online: August 19, 2023
Processing time: 103 Days and 3.1 Hours
Given the current high perioperative risk of extremely unstable hip fractures (EUHFs) in elderly patients and the unsatisfactory treatment outcomes, there is an urgent need to propose new treatment strategies to treat these patients.
To improve the efficacy and clinical outcome of EUHFs in the elderly, it is necessary to explore and optimize the relevant treatment strategies.
This study focuses on the clinical application effects of two surgical treatment modalities in older adults with EUHFs.
First, 60 older adults consecutively diagnosed as EUHFs between September 2020 and January 2022 in the Chongqing University Three Gorges Hospital were selected as the research participants, among which 30 cases in the control group (Con) received conventional treatment (general consultation + fracture type-guided internal fixation) and the other 30 cases in the research group (Res) received novel treatment [perioperative multi-disciplinary treatment (MDT) diagnosis and treatment + individualized surgical plan + risk prediction]. Information on hip function (Harris hip score, HHS), perioperative risk of orthopedic surgery (Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity, POSSUM), CF (Montreal cognitive assessment scale, MoCA), postoperative delirium (mini-cognitive, Mini-Cog), AEs (internal fixation failure, infection, nonunion, malunion, and postoperative delirium), clinical indicators (OT; postoperative hospital length of stay, HLOS; ambulation time; intraoperative blood loss, IBL) were collected from both groups for comparative analyses.
The HHS scores were similar between both groups. The POSSUM score at 6 mo after surgery was significantly lower in the research group compared with the control group, and MoCA and Mini-Cog scores were statistically higher. In addition, the overall postoperative complication rate was significantly lower in the research than in the control group, including reduced OT, postoperative HLOS, ambulation time, and IBL.
With comparable efficacy in fracture healing, the new treatment modality has some clinical advantages over the conventional treatment, such as less IBL, faster functional recovery, more effectively optimized perioperative quality control, improved postoperative cognitive function, mitigated postoperative delirium, and reduced operation-related adverse events.
The novel treatment model of MDT diagnosis and treatment + individualized surgical plan + risk prediction can improve the therapeutic efficacy and experience of elderly patients with EUHFs, providing more accurate evidence to guide the management of EUHFs in clinical practice.