Fractures of the hip: a three-year survey in one hospital, including experience with the Pugh nail procedure.

Records were reviewed on 445 patients with fracture of the hip admitted to St. Paul's Hospital, Vancouver, Canada, during the period 1973--1975 inclusive. The epidemiologic factors were analyzed: age, sex, where and when the accident occurred, site of the fracture, the treatment procedure, length of time in hospital, complications, associated conditions, and final placement of the patient. Of the patients, 286 (64 percent) were more than 70 years of age. Among the 260 causal accidents in the patients' home living space or in the hospital, 35 involved toileting. The great majority of the fractured hips (330) were treated by open operation and internal fixation with the Pugh nail; the remainder were treated by conservative methods, various other devices, or arthroplasty. Within 30 days, 121 patients were discharged to their own homes and 68 to a major rehabilitation hospital. A total of 289 patients eventually returned to their own homes. The Pugh nail method of fixation permits early physiotherapy and early walking exercises, beginning within the first few days postoperatively. This largely accounts for the low complication rate, rapid achievement of functional status, and reduced hospital stay. Among the 445 patients there were 43 deaths, including 10 which occurred before operation could be undertaken.