| Hip fractures are common orthopaedic traumas and mostly occur in the old patients and the risk increases with age.The old patients often had maladies of the heart, liver and kidney before the trauma, therefore the mortality and the morbidity are higher than other fractures.Following improvement of the living standard and elongation of the mean longevity, the risk of two kinds of fractures have also the increasing trend, Aimed at the diseases like hip fracture which have higher risk than others, we need a scoring system which can exactly estimate operative mortality and morbidity to assess the results of the operation.Nowadays, worldwide public and political interest has been turned on the assessment of quality of care and surgical outcome.especially on the hip fracture whose operative risk are higher in orthopaedic traumas.The focus of debates is the degree of influence on prognosis by the complexity of cases, operative equipment and the ability of doctor.A report recently warns that simply considering the factors of operation itself can't draw a reasonable conclusions in that factors of patients themselves are also very important.during the period between 1996 and 1998 Copeland et al applied the method similar to the original POSSUM scoring system acquiring in the former article, and get modified POSSUM scoring system suitable to the orthpaedic system, Although both of them are different in some factors and the measurement standard, Their whole scoring models areapproximate.According to the orthopaedic characteristics, the original POSSUM scoring system is modified in some indeces: contamination replace peritoneal soiling in operative severity score; definitions of operative complexity are given as following: Minor: fasciotomy, ganglion/bursa, tenotomy/tendon repair, arthoscopic surgery, carpal tunnel/nerve release, removal of metal, closed reduction of fracture Intermediate:excision/osteotomy , small bone , minor joint replacement, amputation digit/digits, closed reduction with external fixation, open reduction of fracture of small bone. Majonosteotomy long bone, ligamentous reconstruction+prosthesis, arthrodesis large joint, major joint replacement, amputation limb, disc surgery, open reduction of fracture of long bone Major+:radical tumourectomy, major spinal reconstruction, revision prosthetic replacement, major joint hindquarter /forequarter amputation.Methods :295 patients in the orthopaedics department of the first affiliated hospital of Jilin university were retrospectively analyzed with the mordified POSSUM surgical scoring system.The comparison between the observed and the predicted morbidity and the comparison between the observed and the predicted mortality were made With in 30 days after operation.Result:In the complication group and noncomplication group, the mean age of the patients were 66.59 and 62.28, respectively. In the complication group , both the physiological scores and the operative severity scores of POSSUM scoring system were significantly higherthan the no complication group[ (18.96+4.83 ) vs (15.65+3.66) in pysiological score and ( 13.47+2.01 ) vs (11.74+2.26) in operative severity score], In the dead group and living group , the mean age of the patients were 77.89 and 63.25, respectively. In the dead group , both the physiological scores and the operative severity scores of POSSUM scoring system were significantly higher than the living group [ ( 25.56+3.78 ) vs ( 16.46+4.09 ) in pysiological score and ( 14.22+0.67 ) vs ( 12.25+2.33 ) in operative severity score ].Though POSSUM scoring system overpredict the overall risk of death , it produces a very close fit in the high risk band(10per cent or more).There was perfect agreement between the observed and the predicted morbidity as calculated by published predictor equation for morbidity.and agreement for mortality in the high risk band.Conclusions :Modified POSSUM scoring msystem may beappropriately used to predict the morbidity in patients of hip fracture.furthermore P...
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