[Risk and prognosis of hip para-articular fractures. A comparison of treatment results of femoral neck and pertrochanteric femoral fractures].

Fractures of the femoral neck and the intertrochanteric region account for 7.2% of our surgically treated trauma-patients. Thanks to gentle anaesthetic methods, pre- and postoperative intensive care, and using dynamic hip screws for stabilizing intertrochanteric fractures or total hip replacement in hybrid technique for fractures of the femoral neck, hospital mortality has decreased to 4.8%. A rate of 8.5% local complications, 5% of them needing revisional surgery, did not influence the final outcome. However, success of rehabilitation of the elderly patients is limited by pre-existing multimorbidity. Despite of achieved weight bearing strength of reconstruction, the number of people confined to bed increases from preoperative 4.9% to postoperative 11.5% at the end of 4 weeks hospitalization and up to 22.6% after 1 year. The need for permanent help in daily life activities, provided by the family or nursing homes increases from 50% to 80% after hospital discharge, usually with an increasing need for care. In the future--besides more and better organized out-patient physiotherapy--only more possibilities to look after the patients in their own families or the supply with an increasing number of places in nursing homes will give a chance, to provide a maximum of rehabilitation for these patients.