Functional outcomes after the treatment of hip fracture

Abstract

Osteoporotic hip fracture is a major public health issue. Estimation of the outcome and maximization of functional recovery after fracture is very important in the treatment of older patients. The purposes of this study were to clarify the functional outcomes after the treatment of hip fracture and to identify the factors that influence functional recovery. In the present study, 228 patients admitted to an acute-care hospital from January 2016 to June 2018 were evaluated. The patients were categorized into a trochanteric fracture group (n = 128) and a neck fracture group (n = 100). We retrospectively reviewed their ambulation ability 6 months after fracture using the Functional Ambulation Category (FAC) score. The other survey items were the presurgical duration, length of hospital stay, time until beginning to walk using parallel bars, complications affecting treatment, and mortality rate. The 6-month follow-up rate was 54.4% (n = 124). The results showed that the patients with trochanteric fracture were significantly older than those with neck fracture (86 vs. 82 years, respectively; p = 0.03). In total, 85.0% of patients with trochanteric fracture and 92.2% of patients with neck fracture were independent ambulators before injury (FAC score of 4 or 5). The FAC score 6 months after fracture was positively correlated with the FAC score before fracture and at discharge (all p<0.001) and negatively correlated with patient age (p<0.001) and presurgical duration for patients with neck fracture (p = 0.04). There was no statistically significant correlation with the length of hospital stay or the time until beginning to walk using parallel bars. In conclusion, patients with trochanteric fractures were older than those with neck fractures. In both fracture types, walking recovery 6 months after hip fracture was related to the FAC score before injury and at discharge from an acute-care hospital but not to the time until beginning to walk using parallel bars.

Prognostic Factors of 1-Year Postoperative Functional Outcomes of Older Patients with Intertrochanteric Fractures in Thailand: A Retrospective Cohort Study

“…Although an early surgery did not result in a significant improvement of the functional outcome in this study, the surgical operation should still be performed as soon as possible, or within 48 h, in this domain of patients, as it was proven to reduce the length of hospital stay, postoperative complications, and mortality [ 30 ]. Ambulatory status at discharge time positively affected the 1-year postoperative outcome of the patients, similar to the previous study [ 28 ].…”

“…In contrast, only functional status at discharge were significantly associated with both study endpoints. This finding emphasizes the importance of adequate postoperative rehabilitation, which positively influences the patient’s long-term functional outcome [ 28 ]. Patients aged less than 80 years were more likely to return to their preinjury functional status.…”

“…For patients with an intertrochanteric fracture who underwent surgery, their baseline functional status both before the injury and at discharge were identified as important predictors for their postoperative ambulatory status, which was in consistent with previous evidence. The better the pre-injury ambulatory status, the better the functional outcome would be postoperatively [ 28 ]. Patients with lower BMI were more likely to ambulate at one year.…”

Frailty assessment, hip fracture and long‐term clinical outcomes in older adults

“…However, an understanding of the influence of hip fracture on functional and walking recovery is seemingly of the same utmost clinical importance to drive better pathways of care, especially in very old individuals after hip fracture 5 …”

Factors Associated with Recovered Functionality After Hip Fracture in Non-Institutionalized Older Adults: A Case-Control Study Nested in a Cohort

“…In several studies, advanced age, 4 the type of fracture, 5 hip pain, nutritional status, 7 comorbidities, 8 and functionality prior to the fracture 9 have played a part in functional recovery at different moments after discharge. Others have evaluated factors related to the psychosocial context, such as social network, occupational level, emotional state and cognitive state.…”