Abstract:
Objective: This study assessed the state of current care given to patients admitted with low
energy hip fracture to a tertiary care center in Southern Sri Lanka.
Material and Methods: Consecutive patients with an incident hip fracture (within 30 days)
admitted to Teaching hospital, Karapitiya in Southern Sri Lanka were included in the study.
Fractures resulting from major trauma, falls from heights, pathological fracture and
readmissions due to the same fracture were excluded. Patients were observed during the
hospital stay and until 3 months post discharge and data were collected using a pre-designed
questionnaire.
Results: There were 469 patients (339 women) admitted during study period and the sites of
fracture were intertrochanteric (41%), femoral neck (39%) and subtrochanteric the rest. The
mean (SD) age of patients was 76.6 (9.6) years and the time from injury to admission to hospital
(median and IQR) was 1 (1-7) days. Surgery was performed in 236 (51%) patients while others
were managed conservatively (non-surgical). The median (IQR) time from admission to
operation was 11 (7-21) days. The mean (IQR) duration of hospital stay was 11 (3-14) and
nearly one third of patients developed complications while in the hospital. Patients who
underwent surgery had less complications (32% with one complication or more) compared to
those managed conservatively (68% with one complication or more) (p<0.001). No difference
was found in the in-hospital mortality between patients who were managed surgically and non surgically but mortality at 3 month was lower among those who underwent surgery (3.7% vs
5.6%, p<0.001). Patients managed surgically had higher physical independence (mean Barthel
index 89.1 and SD 17.6) compared to those managed non-surgically (mean Barthel index 67.9
and SD 29.6) and the difference was significant (p<0.001).
Conclusions: A substantial delays in admission and operation of patients after hip fracture was
observed. High proportion of patients was managed non-surgically and this was associated with
higher mortality and physical dependence at 3 months post, discharge.
