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In recent decades an increase in the number of fractures of the proximal femur was recorded in this country and world-wide. The majority of patients with this diagnosis is above 70 years of age and their treatment comprises in addition to the medical aspect also economic and social problems. The objective of the present work is to summarize briefly the results achieved during the five-year trial focused on socio-economic problems of treatment of patients with fractures of the proximal femur. The investigated group comprised 244 patients hospitalized at the Orthopaedic Department of the Third Faculty of Medicine Charles University in 1997 with 248 fractures of the proximal femur. Thirty-nine fractures were treated conservatively, 116 by internal fixation and in 93 cases an arthroplasty was implanted. In the course of the first year of treatment 85 patients died. The therapeutic results after one year were evaluated in 159 patients. The total annual costs of the investigated group were 15.9 million crowns. The mean annual costs of treatment of one fracture of the proximal femur was 64,000 crowns. The ratio of deaths rose with age (p = 0.003), it did not depend on the social background of the patient (p = 0.16) and the quality of locomotor activity before the injury (p = 0.16). No type of fracture was associated with a higher or lower mortality (p = 0.09). A statistically significant higher mortality was recorded in patients included in the higher class of the ASA score (p < 0.001) and in conservatively treated patients (p < 0.001). The type of anaesthesia did not affect the mortality. The functional results were significantly worse in patients living before the injury in a dependent position (0.01 < p < 0.05) and with restricted physical activity (p < 0.01). The type of fractures did not affect significantly the functional results (p > 0.05). Poorer functional results were recorded in patients with ischaemic heart disease (p < 0.001) and neurological disease in their history (p < 0.001). Also inclusion into a higher class of surgical risk according to the ASA score was associated with poorer functional results (p < 0.001). Different types of anaesthesia and different methods of surgical treatment did not affect the quality of functional results. However the functional results were better in operated patients as compared with conservatively treated patients (p < 0.001).

Purpose of the Study: The authors present an overview of mortality of patients with proximal femur fractures treated at the authors' Department in 1997 in dependence on different factors relating to the preinjury condition and the treatment itself. The aim of the work was to determine the impact of these factors on the risk of mortality and compare the findings with the data published by other authors dealing with the same issue., Material: In the given year 244 patients with 248 proximal femur fractures, 58 men (24%), 186 women (76%), average age 77 years were treated. There were 115 (47%) fractures of femoral neck, 117 (47%) pertrochanteric fractures and 16 (6%) intertrochanteric (high subtrochanteric) fractures. Thirty-nine fractures (16%) were treated conservatively, internal fixation was performed in 116 fractures (47%), i.e. 6 times by a plate, 94 times by a DHS, 16 times by the Gamma nail, and 93 fractures (37%) were treated by arthroplasty (62 times by hemiarthroplasty and 31 times by total hip arthroplasty)., Methods: The following data was recorded in all patients of the monitored group: age, sex, social environment and physical activities of the patient prior to the injury, mechanism of the injury, type of fracture, surgical risk expressed by the respective class of the ASA score, therapeutic procedure, type of anesthesia and interval between the injury and operation. Recorded was also the number of mortality in the course of primary hospitalisation and one year after the injury or operation. At the end of the one-year monitoring statistical evaluation was made of the relation between mortality and the above mentioned monitored factors and the results were compared with those published in similar types of study., Results: In the period of one year after the injury or operation 85 patients died of the total number of 244 (56 women and 29 men). The number of decreased patients was increasing in individual age decades and the highest number was recorded in case of men in 9th decade (80%) and 10th decade (100%). The lowest number of mortality related to patients who lived with their families prior to the injury (26.5%) and the highest number was in patients from social care institutes (43.8%). Patients with impaired mobility already prior to the injury and not leaving their homes accounted for 46.7% of mortality. In the course of one year after the injury 33.0% died of fracture of femoral neck, 30.7% of pertrochanteric and 35.7% of intertrochanteric (high subtrochanteric) fracture. Dependence of mortality on ASA score was as follows: ASA I-0%, ASA II-4.3%, ASA III-21.3%, ASA IV-42.1%, ASA V-68.9%. The highest number of mortality of operated on patients was in the group treated by hemiarthroplasty (41.1%). After spinal anesthesia 26.6% of patients died within one year and after general anesthesia 26.7% of them. There was an evident increase in the number of mortality in patients operated on in the interval longer than 3 days after the injury., Discussion: The mortality in the followed up group was statistically significantly influenced by the age (p = 0.003), sex (p < 0.01) and ASA score (p < 0.001). This corresponds to the results of other studies. The dependence of mortality on environment and mobility prior to the injury, type of the fracture, type of surgical treatment and type of anesthesia has not been proved., Conclusion: Based on the evaluation of the data monitored in the group a conclusion was made that absolute mortality risk in the first year after the injury related to patients with pathological fractures due to metastasis. A higher risk related to male patients older than 80 years with the surgical risk of ASA IV and higher and this risk rate was the highest in the time interval within 3 months after the injury or operation.