New preoperative evaluation system of the physical findings of aged patients with femoral neck fracture

Abstract

We devised our own method of evaluating a patient’s general condition at admission, and estimated the usefulness of this method for evaluating patients with femoral neck fractures and its relationship to prognosis, in particular, factors influencing poor functional and vital prognoses. We examined 83 patients between January 1992 and March 1996 who had been treated for more than 30 days after injury and had no malignant tumor as an underlying disease. The new criteria for systemic status evaluation at admission were chosen by reference to the preoperative status classification system of the American Society of Anesthesiologists. Three evaluation grades were established for each of eight items (pulmonary function, heart disease, hypertension, glucose tolerance impairment, renal function, hepatic function, anemia, and hypoproteinemia). Pulmonary function and heart disease were evaluated on a 20-point scale, and the other six items on a 10-point scale; the maximum possible score was 100 points. Scores were statistically analyzed in relation to functional and vital prognoses. Poor prognosis factors were determined and ranked. We found that the factors associated with a poor functional prognosis were heart disease, glucose tolerance impairment, and pulmonary dysfunction, and those associated with a poor vital prognosis were renal dysfunction and glucose tolerance impairment.