Prognostic Factors Predicting Early Recovery of Pre-fracture Functional Mobility in Elderly Patients With Hip Fracture

Abstract

ObjectiveTo investigate the prognostic factors predicting the recovery of pre-fracture functional mobility, we evaluated this by the use of ambulatory assistive devices in short-term follow-up.MethodsFive hundred and fifty-three elderly patients who had undergone hip fracture operations from January 2006 to June 2013 were enrolled in this retrospective study. Clinical characteristics and predicted factors affecting functional recovery, such as the delay of rehabilitation after the operation, were reviewed. The functional status of the gait was classified as either a bedridden state, wheelchair-bound state, walker gait, single cane gait, and self-gait without any ambulatory assistance device. When this functional grade in patients who recovered after the surgery was compared to before the surgery, this state was considered 'functional recovery'.ResultsOne hundred and ninety-two patients (34.7%) showed recovery of preoperative mobility in the first month after their operation. Multiple logistic regression analysis identified that the following four factors were significantly associated with a deterioration of functional recovery: old age (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.92-0.97), delays in rehabilitation after operation (OR, 0.94; 95% CI, 0.89-0.98), the presence of cognitive dysfunction (OR, 0.36; 95% CI, 0.18-0.71), and trochanteric fracturing (OR, 0.58; 95% CI, 0.36-0.94).ConclusionWe found that old age, cognitive dysfunction, trochanteric fracture type, and delay of rehabilitation were associated with the deterioration of functional recovery after a hip fracture operation in the short-term. Therefore, early rehabilitation was required to acquire functional recovery after a hip fracture operation in the short-term.

Prediction of Ambulatory Status After Hip Fracture Surgery in Patients Over 60 Years Old

“…Type of fracture was found to be related to the postoperative ambulatory capacity, consistent with other studies [1720]. Our study showed a higher incidence of intertrochanteric and subtrochanteric fractures than that of femoral neck fracture.…”

Preinjury Factors that Influence the Outcome of Patients with Hip Fracture

“…Several studies examined factors that affect functional outcome and mortality; such factors include age, preinjury walking ability, comorbidities, cognitive function, gender, the surgical modality, the fracture type, the duration from injury to operation, postoperative delirium, pressure ulcers, and nutritional status [3,11,[17][18][19][20]. These studies report that older age or walking disability prior to injury are risk factors for mortality and functional deterioration, meaning that a patient cannot be discharged home [11,17,18]. Age greater than 85 years is a risk factor for a less satisfactory functional outcome and a low chance of home discharge after hip fracture [8,11].…”

Influence of Anaesthesia on Mobilisation following Hip Fracture Surgery: An Observational Study

“…(2) This study was primarily aimed at evaluating the influence of anaesthesia on postoperative mobilisation. Considering weight bearing and walking after hip fracture surgery is hugely influenced by the pre-fracture mobility status of patients with hip fracture, the fracture type (extra or intra-capsular), and operative fixation (hemiarthroplasty, dynamic hip screw, or intramedullary nail) performed; 25 and are therefore, are more relevant as an outcome measure to evaluate the impact of surgical factors on postoperative mobilisation. (3) Although pain is considered as a limiting factor for postoperative rehabilitation following hip fracture surgery, 14 it is the dynamic pain (associated with mobilising patient out-of-bed) 13 which is more relevant to postoperative rehabilitation and is influenced by anaesthetic techniques.…”