Functional Improvement in Geriatric Hip Fractures

Abstract

Introduction:The “Integrated Care Pathway” for geriatric intertrochanteric (IT) fractures in Singapore’s Tan Tock Seng Hospital has shown significant functional recovery in patients’ activities of daily living. However, the influence of preoperative vitamin D on functional recovery remains equivocal. This retrospective study therefore aims to determine whether patients with preoperative vitamin D deficiency have poorer functional outcomes.Method:A total of 171 patients who had surgical treatment for IT fractures were recruited in the study. They were categorized into group A (vitamin D deficient) and group B (normal vitamin D). Charlson Comorbidity Index (CCI) score and nutritional parameters including hemoglobin, albumin, and adjusted calcium levels on admission were recorded. The Modified Barthel Index (MBI) score was used to measure functional recovery at the following time intervals: at pre-fall, at discharge after surgery, at 6 months, and at 1-year follow-up.Results:The mean age of both the groups (A: 79.7 years, n = 45; B: 83.0 years, n = 126) was statistically different (P < .05). However, the mean CCI (A: 9.42 and B: 10.13), hemoglobin (A: 12.4 and B 11.1), adjusted calcium (A: 2.39 and B: 2.38), and mean albumin (A: 33.6 and B: 33.0) of the groups were not significantly different. Furthermore, the MBI scores were not significantly different for both groups at preinjury (A: 91.5 and B: 89.4), at discharge (A: 55.2 and B: 58.9), at 6 months (A: 70.9 and B: 75.1), and at 1 year (A: 75.8 and B: 79.4).Conclusion:In our cohort, patients with vitamin D deficiency were younger. However, vitamin D deficiency at time of injury had no significant influence on functional recovery in patients with surgically treated hip fracture in our Integrated Care Pathway. In addition, patients who had a normal vitamin D levels had similar functional scores and improvement postoperatively and at 1 year (A: 82.8% and B: 88.9%).

The Efficiency of Antiosteoporosis Medicine after Intertrochanteric Fracture Surgery: A Retrospective Study of Refracture Rate, Function Recovery, Complications, and Mortality in the Chinese Elderly Population

“…Seng et al's findings suggest that vitamin D deficiency, though crucial in many physiological processes, did not significantly hamper functional recovery post-hip fracture surgery. 29 A vital component of the postoperative functional recovery metric is pain management, a predominant criterion in both Harris and EQ-5D evaluations. 14,16 Knopp-Sihota et al's meta-analysis highlighted calcitonin's efficacy in mitigating acute pain, especially within the first month postsurgery, but its efficacy waned in managing chronic pain.…”

Role of Cachexia and Fragility in the Patient Candidate for Cardiac Surgery

“…A score from 17 to 23.5 points is an indicator of a risk of malnutrition, while a score ≤17 points indicates malnutrition. In the appraisal of the general health status, the assessment of the sarcopenia [ 29 ], osteoporosis [ 30 ], and serum albumin [ 31 ] is important. Beside the instruments used to estimate fragility in general population, it is necessary to mention the main tests used in hospital environment.…”