The Fragility Fracture Postoperative Mobilisation multicentre audit

Abstract

Aims The purpose of this study was to determine the weightbearing practice of operatively managed fragility fractures in the setting of publically funded health services in the UK and Ireland. Methods The Fragility Fracture Postoperative Mobilisation (FFPOM) multicentre audit included all patients aged 60 years and older undergoing surgery for a fragility fracture of the lower limb between 1 January 2019 and 30 June 2019, and 1 February 2021 and 14 March 2021. Fractures arising from high-energy transfer trauma, patients with multiple injuries, and those associated with metastatic deposits or infection were excluded. We analyzed this patient cohort to determine adherence to the British Orthopaedic Association Standard, “all surgery in the frail patient should be performed to allow full weight-bearing for activities required for daily living ”. Results A total of 19,557 patients (mean age 82 years (SD 9), 16,241 having a hip fracture) were included. Overall, 16,614 patients (85.0%) were instructed to perform weightbearing where required for daily living immediately postoperatively (15,543 (95.7%) hip fracture and 1,071 (32.3%) non-hip fracture patients). The median length of stay was 12.2 days (interquartile range (IQR) 7.9 to 20.0) (12.6 days (IQR 8.2 to 20.4) for hip fracture and 10.3 days (IQR 5.5 to 18.7) for non-hip fracture patients). Conclusion Non-hip fracture patients experienced more postoperative weightbearing restrictions, although they had a shorter hospital stay. Patients sustaining fractures of the shaft and distal femur had a longer median length of stay than demographically similar patients who received hip fracture surgery. We have shown a significant disparity in weightbearing restrictions placed on patients with fragility fractures, despite the publication of a national guideline. Surgeons intentionally restrict postoperative weightbearing in the majority of non-hip fractures, yet are content with unrestricted weightbearing following operations for hip fractures. Cite this article: Bone Joint J 2022;104-B(8):972–979.

Tibial plateau fractures in older adults are associated with a clinically significant deterioration in health-related quality of life

“…A recent national survey of weightbearing restrictions following lower limb fracture surgery found that only 13.7% of consultants allowed unrestricted weightbearing after surgical fixation of proximal tibial fractures in the elderly. 26 …”

“…A recent national survey of weightbearing restrictions following lower limb fracture surgery found that only 13.7% of consultants allowed unrestricted weightbearing after surgical fixation of proximal tibial fractures in the elderly. 26 Limitations of this study include its retrospective nature. As examined and discussed, recalled prefracture scores likely overestimate baseline prefracture functioning and lead to bias when comparing against current scores.…”

Distal femur fractures: basic science and international perspectives

“… 46 The treatment of geriatric fracture patients has evolved to encourage robust fixation or arthroplasty constructs to allow early weight-bearing and mobilization. 47 Several case series and small randomized controlled trials have examined the safety of early weight-bearing for geriatric distal femoral fracture patients and demonstrated that early weight-bearing can be considered appropriate for most patients. 48 , 49 A recent audit of fragility fracture management in the United Kingdom showed that 96% of patients with hip fracture were prescribed weight-bearing as tolerated after surgery, while only 32% of nonhip fracture patients were similarly prescribed full weight-bearing.…”

“… 48 , 49 A recent audit of fragility fracture management in the United Kingdom showed that 96% of patients with hip fracture were prescribed weight-bearing as tolerated after surgery, while only 32% of nonhip fracture patients were similarly prescribed full weight-bearing. 47 For patients with distal femur fracture, this varied based on the fixation method used and was noted to be 92% with arthroplasty treatment, 67% with use of an intramedullary nail, and 35% with plate fixation. Early mobilization and early surgery has been shown to reduce mortality rates in the elderly hip fracture population.…”

Barriers and facilitators of weight bearing after hip fracture surgery among older adults. A scoping review

“…The British Orthopaedic Association proposed an even earlier timeframe of within 36 hours of admission [14]. Indeed, it is widely accepted that mobilising from bed early is essential for older adults to prevent complications of prolonged immobility, such as blood clots and pressure sores [15][16][17]. Restricted weight bearing may inhibit this early mobility as older adults with frailty may struggle to mobilise under partial-or non-weight bearing orders [18].…”