The effect of postoperative weight-bearing status on mortality rate following proximal femoral fractures surgery.
Femoral neck fracture
Mortality
Partial-weight bearing, fixation, surgery
Pertrochanteric fracture
Proximal femoral fractures
Subcapital fracture
Weight-bearing
Journal
Archives of orthopaedic and trauma surgery
ISSN: 1434-3916
Titre abrégé: Arch Orthop Trauma Surg
Pays: Germany
ID NLM: 9011043
Informations de publication
Date de publication:
Jun 2022
Jun 2022
Historique:
received:
03
08
2020
accepted:
06
12
2020
pubmed:
9
1
2021
medline:
19
5
2022
entrez:
8
1
2021
Statut:
ppublish
Résumé
Proximal femur fractures are associated with an increased mortality rate in the elderly. Early weight-bearing presents as a modifiable factor that may reduce negative postoperative outcomes and complications. As such, we aimed to compare non-weight-bearing, partial-weight-bearing and full weight-bearing cohorts, in terms of risk factors and postoperative outcomes and complications. We retrospectively reviewed our database to identify the three cohorts based on the postoperative weight-bearing status the day of surgery from 2003 to 20014. We collected data on numerous risk factors, including age, cerebrovascular accident (CVA), pulmonary embolism (PE), surgical fixation method and diagnosis type. We also collected data on postoperative outcomes, including the number of days of hospitalization, pain levels, and mortality rate. We performed a univariate and multivariate analysis; P < 0.05 was the significant threshold. There were 186 patients in the non-weight-bearing group, 127 patients in the partial-weight-bearing group and 1791 patients in the full weight-bearing group. We found a significant difference in the type of diagnosis between cohorts (P < 0.001 in univariate, P < 0.001 in multivariate), but not in fixation type (P < 0.001 in univariate, but P = 0.76 in multivariate). The full weight-bearing group was diagnosed most with pertrochanteric fracture, 48.0%, and used Richard's nailing predominantly. Finally, we found that age was not a significant determinant of mortality rate but only weight-bearing cohort (P = 0.13 vs. P < 0.001, respectively). We recommend early weight-bearing, which may act to decrease the mortality rate compared to non-weight-bearing and partial weight-bearing. In addition, appropriate expectations and standardizations should be set since age and type of diagnosis act as significant predictors of weight-bearing status.
Identifiants
pubmed: 33417019
doi: 10.1007/s00402-020-03721-y
pii: 10.1007/s00402-020-03721-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
947-953Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.
Références
Veronese N, Maggi S (2018) Epidemiology and social costs of hip fracture. Injury 49(8):1458–1460
doi: 10.1016/j.injury.2018.04.015
Royi B et al (2018) The epidemiology and economic burden of hip fractures in Israel. Israel J Health Policy Res 7(1):38
doi: 10.1186/s13584-018-0235-y
Downey C, Kelly M, Quinlan JF (2019) Changing trends in the mortality rate at 1-year post hip fracture-a systematic review. World J Orthopedics 10(3):166
doi: 10.5312/wjo.v10.i3.166
Scott S et al (2010) The 1-year mortality of patients treated in a hip fracture program for elders. Geriatric Orthop Surg Rehabilit 1(1):6–14
doi: 10.1177/2151458510378105
Westerman RW et al (2008) The physiological cost of restricted weight bearing. Injury 39(7):725–727
doi: 10.1016/j.injury.2007.11.007
Malik AT et al (2019) Incidence, risk factors and clinical impact of postoperative delirium following open reduction and internal fixation (ORIF) for hip fractures: an analysis of 7859 patients from the ACS-NSQIP hip fracture procedure targeted database.”. Eur J Orthop Surg Traumatol 29(2):435–446
doi: 10.1007/s00590-018-2308-6
Kim JW, Byun SE, Chang JS (2014) The clinical outcomes of early internal fixation for undisplaced femoral neck fractures and early full weight-bearing in elderly patients. Arch Orthop Trauma Surg 134(7):941–946
doi: 10.1007/s00402-014-2003-y
Pfeufer D et al (2019) Training with biofeedback devices improves clinical outcome compared to usual care in patients with unilateral TKA: a systematic review. Knee Surg Sports Traumatol Arthrosc 27(5):1611–1620
doi: 10.1007/s00167-018-5217-7
Hagino T et al (2008) Comparison of the prognosis among different age groups in elderly patients with hip fracture. Indian J Orthop 42(1):29
doi: 10.4103/0019-5413.38577
Thorngren K-G et al (2005) Influence of age, sex, fracture type and pre-fracture living on rehabilitation pattern after hip fracture in the elderly. Disabil Rehabil 27(18-19):1091–1097
doi: 10.1080/09638280500056402
Anderson DE, Madigan ML (2013) Effects of age-related differences in femoral loading and bone mineral density on strains in the proximal femur during controlled walking. J Appl Biomech 29(5):505–516
doi: 10.1123/jab.29.5.505
Loizou CL, Parker MJ (2009) Avascular necrosis after internal fixation of intracapsular hip fractures; a study of the outcome for 1023 patients. Injury 40(11):1143–1146
doi: 10.1016/j.injury.2008.11.003
Hollensteiner M et al (2019) Biomechanics of osteoporotic fracture fixation. Curr Osteoporos Rep 6:1–12
Pfeufer D et al (2019) Weight bearing in patients with femoral neck fractures compared to pertrochanteric fractures: a postoperative gait analysis. Injury 50(7):1324–1328
doi: 10.1016/j.injury.2019.05.008
Koval KJ et al (1998) Postoperative weight-bearing after a fracture of the femoral neck or an intertrochanteric fracture. JBJS 80(3):352–356
doi: 10.2106/00004623-199803000-00007
Kim J-W et al (2020) Reoperation rate, mortality and ambulatory ability after internal fixation versus hemiarthroplasty for unstable intertrochanteric fractures in elderly patients: a study on Korean Hip Fracture Registry. Arch Orthop Trauma Surg 53:1–8
Baccarani G, Battaglia L, Ceruti A (1979) Rigid fixation and early weight bearing in the treatment of pertrochanteric fractures of the femur. Ital J Orthop Traumatol 5(3):273–283
pubmed: 553914
Tian P et al (2017) Partial versus early full weight bearing after uncemented total hip arthroplasty: a meta-analysis. J Orthop Surg Res 12(1):31
doi: 10.1186/s13018-017-0527-x
Foss NB, Kehlet H (2006) Hidden blood loss after surgery for hip fracture. J Bone Joint Surg 88(8):1053–1059
doi: 10.1302/0301-620X.88B8.17534
Gdalevich M et al (2004) Morbidity and mortality after hip fracture: the impact of operative delay. Arch Orthop Trauma Surg 124(5):334–340
doi: 10.1007/s00402-004-0662-9
Roll C et al (2019) Continuous improvement process: ortho-geriatric co-management of proximal femoral fractures. Arch Orthop Trauma Surg 139(3):347–354
doi: 10.1007/s00402-018-3086-7
Warren J et al (2019) The association between weight-bearing status and early complications in hip fractures. Eur J Orthop Surg Traumatol 29(7):1419–1427
doi: 10.1007/s00590-019-02453-z
Handoll HH, Sherrington C, Mak JC (2011) Interventions for improving mobility after hip fracture surgery in adults. Cochrane Database Syst Rev 3:89
Consigliere P et al (2019) Early versus delayed weight bearing after surgical fixation of distal femur fractures: a non-randomized comparative study. Eur J Orthop Surg Traumatol 29(8):1789–1794
doi: 10.1007/s00590-019-02486-4
Siu AL et al (2006) Early ambulation after hip fracture: effects on function and mortality. Arch Internal Med 166(7):766–771
doi: 10.1001/archinte.166.7.766
Kilci O et al (2016) Postoperative mortality after hip fracture surgery: a 3 years follow up. PLoS One 11(10):16
doi: 10.1371/journal.pone.0162097
Ariza-Vega P et al (2015) Predictors of long-term mortality in older people with hip fracture. Arch Phys Med Rehabil 96(7):1215–1221
doi: 10.1016/j.apmr.2015.01.023
Atzmon R et al (2018) Cerebrovascular accidents associated with hip fractures: morbidity and mortality—5-year survival. J Orthop Surg Res 13(1345):161
doi: 10.1186/s13018-018-0867-1