Should we operate on nonagenarians with hip fractures?

Studies on fractured necks of femurs usually have a cut off point at the age of 85. However, in view of an ageing populace it seems reasonable to look at the nature of hip fractures in the nonagenarians. In previous studies mortality and morbidity of 90-year-olds has been high. It has also been suggested that operating on the demented and institutionalised is not particularly effective. A 4-year review of 164 nonagenarian patients with hip fractures was therefore conducted at York district hospital. Access to the records of 136 (83%) patients was obtained with limited admission and mortality data from a further 28. Mortality rates at six months were 43% (24% in hospital) increasing to 46% at one year. Sixty-two patients had some complication of which 35 were dead within 6 months. Sixty-two per cent of patients returned to their pre admission residence. The mortality rates in this review are lower than in some previous studies and of those that survived 6 months 53% had no postoperative complications. It would therefore seem reasonable to operate on nonagenarians.