Journals of Gerontology Series A: Biological Sciences and Medical Sciences, Vol 51, Issue 4 M158-M164, Copyright © 1996 by The Gerontological Society of America
The predictors of surgical procedure and the effects on functional recovery in elderly with subcapital fractures
Y Young, P German, L Brant, J Kenzora and J Magaziner
University of Maryland School of Medicine, Baltimore, USA.
BACKGROUND. It has been demonstrated that the majority of hip fracture
patients do not regain their prefracture level of functioning and usually
decline in function following fracture. Little is known about the
effectiveness of surgical procedure performed (hemiarthroplasty vs internal
fixation) on functional recovery of subcapital fracture patients. This
study examines the factors related to the type of the surgical procedure
chosen and the effect of this selection on physical activities of daily
living (PADL) and instrumental activities of daily living (IADL). METHODS.
The sample consists of 312 patients with subcapital fractures age 65 and
older admitted from the community to one of seven Baltimore area hospitals
between 1984 and 1986. Baseline information was obtained during
hospitalization through structured interviews with both patients and their
significant others (proxy). The follow-up interviews were administered to
proxies at two months, six months, and one year after discharge from
hospital. Information on disease diagnoses, fracture severity, and surgical
procedures performed was obtained from medical charts. RESULTS. Patients
with a displaced fracture were seven times more likely to receive a
hemiarthroplasty (OR = 7.0, 95% CI 3.7-13.1). During the short-term
recovery (2 months after surgery), patients who received hemiarthroplasty
were doing better in transferring, meal preparation, and shopping than
those who received internal fixation. For the long-term functional recovery
(one year), the overall PADL and IADL functions were not statistically
significantly different between the two surgical procedures performed.
CONCLUSIONS. The severity of fracture was found to be the most important
determinant of surgical procedure. Patients with a subcapital fracture who
received hemiarthroplasty tended to have a better functional recovery in
the short term. Further study of other benefits of using as
hemiarthroplasty is needed.
