Effects of early mobilization and weight bearing on postoperative walking ability and pain in geriatric patients operated due to hip fracture: a retrospective analysis

Kuru, Tolgahan; Olçar, Hacı Ali

doi:10.3906/sag-1906-57

Cited by 23 publications

(30 citation statements)

References 32 publications

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“…Of the surgical factors that can be changed, early surgery is strongly recommended, and although there is debate about this period, it is recommended that surgery is performed together with the application of internal treatments within 48 hours [26,27]. In the current study, fracture types were an unchangeable factor which did not affect mortality.…”

Section: Discussionmentioning

confidence: 67%

Proximal femur fracture, analysis of epidemiology, complications, and mortality: A cohort with 380 patients

Yaradılmış¹,

Okkaoğlu²,

Ateş³

et al. 2021

Journal of Surgery and Medicine

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Background/Aim: Among all orthopedic injuries, hip fractures continue to have high morbidity and mortality. While the epidemiological features of proximal femoral fractures (PFF) have often been defined, there are studies which examine the relationship between the complications of the types of PFF and mortality. The aim of this study was to determine the frequency of PFF types and investigate the relationship between complications of subtypes and mortality. Methods: This study included 380 patients aged >40 years who underwent surgery for a PFF. The fractures were classified according to localization as intertrochanteric femur fracture (ITFF), femoral neck fracture (FNF) and subtrochanteric fracture (STF). Patient demographic data (age, gender, comorbidities) were recorded, and modified Charlson comorbidity scores were calculated. Major surgical complications (infection, dislocation, implant failure) were defined as those requiring additional surgery, and minor surgical complications (cellulitis, wound site problems, pressure sores, deep vein thrombosis) as those not requiring surgery. Mortality rates were examined at 1, 3 and 12 months postoperatively. The fracture subtypes were compared with respect to surgical complications (major and minor), non-surgical complications and mortality rates. Mortality risk factors were determined according to final mortality status. Results: The patients included 235 females and 136 males (F/M=2/1) with a mean age of 78.5 (12.1) years. Three hundred and thirty (86.5%) patients were aged >65 years and 50 (13.5%) were aged <65 years. The fractures were classified as 225 (60%) ITFF, 120 (32%) FNF, and 26 (7%) STF. Surgical complications and complications not related to surgery were seen in 35 (9.2%) and 25 (6%) patients, respectively. Mortality occurred within one month in 17 (4.6%) patients, in three months in 32 (8.6%) and within the first year in 97 (26%). No significant difference was found between fracture types with respect to mortality in 1, 3, and 12 months (P=0.51, P=0.641, P=0.2 respectively). The mortality rates of ITFF and FNF were highly similar (1, 3, 12-month mortality: P=0.943, P=0.939, P=0.946 respectively). In the comparison between the surviving and non-surviving groups, age, Charlson comorbidity index, prolonged stay in intensive care, and non-surgical complications were significantly increased in the non-surviving group (P<0.001, P<0.001, P=0.03, P=0.005 respectively). Conclusion: ITFF is common among PFF. While there was no relationship between fracture types in PFF, complication and mortality, a correlation was found between mortality and age, Charlson comorbidity score, prolonged stay in intensive care, and non-surgical complications.

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Section: Discussionmentioning

confidence: 67%

Proximal femur fracture, analysis of epidemiology, complications, and mortality: A cohort with 380 patients

Yaradılmış¹,

Okkaoğlu²,

Ateş³

et al. 2021

Journal of Surgery and Medicine

View full text Add to dashboard Cite

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“…In another retrospective study (52 patients aged >65 years who underwent HFS, 23 patients who underwent early rehabilitation within one day after surgery and 29 patients who started rehabilitation later than 1 day after surgery), the early rehabilitation group showed a shorter hospital stay (5.4 vs. 6.9 days, p=0.026). One month after surgery, the Harris score (84.0 vs. 71.1) and the pain sub-score of the Harris score (36.8 vs. 24.4) was significantly improved with early treatment [ 57 ]. Among the three hospitals that performed HFS in patients aged >75 years, the model of early rehabilitation within 3 days after surgery and transfer/access to a rehabilitation facility after discharge resulted in less ADL loss and higher prediction of independent walking at 6 months post-surgery [ 58 ].…”

Section: Resultsmentioning

confidence: 99%

Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures

et al. 2021

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Objective The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. Methods Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. Results A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. Conclusion This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.

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“…These differences are related to many factors. Arthroplasty can allow patients to get out of bed early; promote the recovery of limb function; avoid complications such as bedsores caused by long-term bed rest[ 27 , 28 ]; significantly reduce the length of hospital stay and the economic burden of patients; help patients recover their mental health and return to normal life; and quickly improve their quality of life. This is why, in recent years, an increasing number of clinicians have considered arthroplasty to treat unstable IFFs in elderly patients.…”

Section: Discussionmentioning

confidence: 99%

Arthroplasty vs proximal femoral nails for unstable intertrochanteric femoral fractures in elderly patients: a systematic review and meta-analysis

Chen¹,

Guo²,

Gao³

et al. 2021

WJCC

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BACKGROUND Proximal femoral nails (PFNs) are the most common method for the treatment of unstable intertrochanteric femoral fractures (IFFs), but postoperative bed rest is required. There is a large amount of blood loss during the operation. Osteoporosis in elderly patients may cause nonunion of fractures and other complications. Arthroplasty can give patients early weight bearing and reduce financial burden, but whether it can replace PFNs remains controversial. AIM To compare the clinical outcomes of arthroplasty and PFNs in the treatment of unstable IFFs in elderly patients. METHODS A search was conducted in the PubMed, Embase, and Cochrane Library databases and included relevant articles comparing arthroplasty and PFN. The search time was limited from January 1, 2005 to November 1, 2020. Two investigators independently screened studies, extracted data and evaluated the quality according to the inclusion and exclusion criteria. According to the research results, the fixed effect model or random effect model were selected for analysis. The following outcomes were analyzed: Harris Hip score, mortality, complications, operation time, blood loos, hospital stay, weight-bearing time, fracture classification and type of anesthesia. RESULTS We analyzed four randomized controlled trials that met the requirements. A total of 298 patients were included in these studies. According to the AO/OTA classification, there are 20 A1 types, 136 A2 types, 42 A3 types and 100 unrecorded types. Primary outcome: The Harris Hip Score at the final follow-up of the PFN group was higher [mean difference (MD): 9.01, 95% confidence interval (CI): 16.57 to 1.45), P = 0.02]. There was no significant difference between the two groups in the rate of overall mortality [risk ratio (RR): 1.44, P = 0.44] or the number of complications (RR: 0.77, P = 0.05). Secondary outcomes: blood loss of the arthroplasty group was higher (MD: 241.01, 95% CI: 43.06–438.96, P = 0.02); the operation time of the PFN group was shorter (MD: 23.12, 95%CI: 10.46–35.77, P = 0.0003); and the length of hospital stay of the arthroplasty group was shorter [MD: 0.97, 95% CI: 1.29 to 0.66), P < 0.00001]. There was no difference between the two groups in the type of anesthesia (RR: 0.99). There were only two studies recording the weight-bearing time, and the time of full weight bearing in the arthroplasty group was significantly earlier. CONCLUSION Compared with PFN, arthroplasty can achieve weight bearing earlier and shorten hospital stay, but it cannot achieve a better clinical outcome. Arthroplasty cannot replace PFNs in the treatment of unstable IFFs in elderly individuals.

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Effects of early mobilization and weight bearing on postoperative walking ability and pain in geriatric patients operated due to hip fracture: a retrospective analysis

Cited by 23 publications

References 32 publications

Proximal femur fracture, analysis of epidemiology, complications, and mortality: A cohort with 380 patients

Proximal femur fracture, analysis of epidemiology, complications, and mortality: A cohort with 380 patients

Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures

Arthroplasty vs proximal femoral nails for unstable intertrochanteric femoral fractures in elderly patients: a systematic review and meta-analysis

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