Hemiarthroplasty using a lateral approach predisposed to the need for ambulatory aids 1 year after hip fracture. The posterior approach, however, predisposed to hip dislocation. Patient selection must be considered when deciding the appropriate surgical approach.

BackgroundInstitutionalization after hip fracture is a socio-economical burden. We examined the predictive value of Instrumental Activities of Daily Living (IADL) and Mini Mental State Examination (MMSE) for institutionalization after hip fracture to identify patients at risk for institutionalization.MethodsFragility hip fracture patients ≥65 years of age (n = 584) were comprehensively examined at a geriatric outpatient clinic 4 to 6 months after surgery and followed 1 year postoperatively. A telephone interview with a structured inquiry was performed at 1, 4, and 12 months after hip fracture.ResultsAge-adjusted univariate logistic regression analysis revealed that IADL and MMSE scores measured at the outpatient clinic were significantly associated with living arrangements 1 year after hip fracture. Multivariate logistic regression analysis established that institutionalization 1 year after hip fracture was significantly predicted by institutionalization at 4 months (odds ratio [OR] 16.26, 95 % confidence interval [CI] 7.37–35.86), IADL <5 (OR 12.96, 95 % CI 1.62–103.9), and MMSE <20 (OR 4.19, 95 % CI 1.82–9.66). A cut-off value of 5 was established for IADL with 100 % (95 % CI 96 %–100 %) sensitivity and 38 % (95 % CI 33 %–43 %) specificity and for MMSE, a cut-off value of 20 had 83 % (95 % CI 74 %–91 %) sensitivity and 65 % (95 % CI 60 %–70 %) specificity for institutionalization. During the time period from 4 to 12 months, 66 (11 %) patients changed living arrangements, and 36 (55 %) of these patients required more supportive accommodations.ConclusionIADL and MMSE scores obtained 4 to 6 months after hospital discharge may be applicable for predicting institutionalization among fragility hip fracture patients ≥65 years of age at 1 year after hip fracture. An IADL score of ≥5 predicted the ability to remain in the community. Changes in living arrangements also often occur after 4 months.

Purpose For femoral neck fractures, recent scientific evidence supports cemented hemiarthroplasty (HA) over uncemented HA and suggests that total hip arthroplasty (THA) should be performed more frequently. We report the current surgical trends in treating femoral neck fractures in Finland. Methods The study was conducted using the Finnish National Hospital Discharge Register and included all Finns at least 50 years of age who underwent surgery for femoral neck fractures from 1998 through 2011. Age-and sex-specific incidence rates and annual proportion of each treatment method were calculated. Results During 1998-2011, a total of 49,514 operations for femoral neck fracture were performed in Finland. The proportion of uncemented HA increased from 8.1 % in 2005 to 22.2 % in 2011. During the same time, the proportion of cemented HA decreased from 63.9 to 52.5 %, internal fixation decreased from 23.2 to 16.1 % and THA increased from 4.9 to 9.2 %. Conclusions Between 2005 and 2011, the proportion of uncemented HA for femoral neck fractures increased markedly in Finland, while cemented HA and internal fixation declined. During this time, the use of THA nearly doubled. The current evidence-based guidelines for treatment of femoral neck fractures were mainly followed, but the increase in uncemented HA procedures contradicts recent scientific evidence.

Background Hip fracture causes not only physical injury but also psychological trauma. Fear of falling (FoF) is related to poor recovery, loss of mobility and mortality. There is limited data on the clinical factors affecting post-hip fracture FoF and its consequences. Objective To investigate the factors associated with and 1-year outcomes of post-hip fracture FoF. Methods An observational prospective cohort study. Data were collected on hospital admission, at a geriatric outpatient assessment 4–6 months post-hip fracture and by telephone interviews 1 year after the index fracture. FoF was assessed with a dichotomous single-item question. Logistic regression analyses were conducted to examine the age, gender and multivariable-adjusted association between baseline and the geriatric assessment domains with FoF. Follow-up outcomes included changes in mobility, living arrangements and mortality. Results Of the 916 patients included, 425 (49%) had FoF at the time of their geriatric assessment. These patients were predominantly female and were living alone in their own homes with supportive home care. They scored lower on tests of physical performance. Less FoF was documented in patients with diagnosed cognitive disorders before the index fracture and in those with Clinical Dementia Rating ≥ 1. After adjusting for age and gender, no association was observed between FoF and any of the 1-year follow-up outcomes. Conclusion Post-hip fracture FoF is common and associated with female gender, polypharmacy, poor daily functioning, poor physical performance and depressive mood. Patients with cognitive disorders have less FoF than those without. FoF appears to have no impact on the follow-up outcomes.

Introduction: The effect of delays before surgery of 24 hours, 48 hours, and 72 hours on short- and long-term survival has been investigated comprehensively in hip fracture patients, but with controversial results. However, there is only limited evidence for how a threshold of 12-hour delay before hip fracture surgery affects survival. Materials and Methods: A prospective observational study of 884 consecutive hip fracture patients (age ≥ 65 years) undergoing surgery was carried out in terms of 30- and 365-day survival. A Cox hazard regression survival model was constructed for 724 patients with American Society of Anesthesiologists score ≥3 with adjustments of age, gender, cognition, number of medications on admission, hip fracture type, and prior living arrangements. Results: Patients who underwent surgery within 12 hours had better chances of survival than did those with 12 to 24 hours (hazard ratio [HR]: 8.30; 95% confidence interval [CI]: 1.13-61.4), 24 to 48 hours (HR: 7.21; 95% CI: 0.98-52.9), and >48 hours (HR: 11.75; 95% CI: 1.53-90.2) delay before surgery. Long-term survival was more influenced by nonadjustable patient features, but the adverse effect of >48 hours delay before surgery was noticed with HR: 2.02; 95% CI: 1.08-3.80. Increased age and male gender were significantly associated with worse short- and long-term survival. Discussion/Conclusions: Early hip fracture surgery within 12 hours of admission is associated with improved 30-day survival among patients with ASA score ≥3. Delay to surgery of more than 48 hours has an adverse effect on 365-day survival, but factors related to patients’ comorbidities have a great influence on long-term survival.