FUNCTIONAL OUTCOME AFTER HIP FRACTURE

Abstract

Introduction: Life expectancy is increasing, this leads to a major number of hip fracture and its subsequent complications and costs.

Proximal femur fracture is not only a medical problem but also a social handicap.

Our objective is to see, by means of a prospective observational study, how the function varies after hip fracture and which are the most influencing factors in order to get maximum benefits of resources for this patology.

Materials and Methods: 262 patients had been hospitalized suffering hip fracture in our centre between june 2006 and December 2007.107 of them were included in the study, the others were excluded for different reasons: cognitive impairment (based on Folstein test), previous hip fracture or pathologic fractures.

86 female and 21 male. Mean age 74 years (65–93).44 suffering subcapital fracture and 63 pertrochanteric fracture. 76 patients underwent gamma nail or canulated screws and 31 hemi or total hip replacement. Mean surgery delay 3 days (1–14) At the moment of hospital registration we also determined marital status, familiar support, living at home or institution, morbidity pre- fracture (according to Charlson index), level of dependence (Barthel index), mental status (Folstein Mini Mental State Examination)quality of life perceived (short form 36 (SF-36)) and depression symptoms (Geriatric Depression Scale 15 (GDS 15)).

At three months post discharge we determined again all the test mentioned before and also recorded the functional level (Harris test), which haven’t been passed preoperatively because it includes a part of physical evaluation, not possible to do in a fractured leg.

Statistics: Analysis of Variance for repeated measures, Spearman correlation coefficient, level significance 0.05

Results: Most part of patients came from their own houses (87,6%), where only returned 23% of them at hospital discharge. In the control visit al 3 months most of them had returned at home (79%)

There were no significant differences between functional outcome al three months and delay of the surgery (p 0.76) or the type of surgery (artroplasty vs osteosintesis) (p0.308).

There was a negative correlation (rho-spearman −0.656)between depression and functional outcome, the more depressed a patient is the worse functional outcome he has (p 0.002)

There was a positive correlation (rho-spearman 0.605) between function (Harris test) and dependency (Barthel index).Patients less independent pre fracture are the ones with low function at three months. (p 0.000)

Discussion: There are a lot of patients needing nursing or social facilities at hospital discharge with the high costs that this supposes. We have seen that depressed people at hospital income are going functionally worse than non depressed and consequently are more dependent persons. Maybe early diagnosis ant treatment of depression will help to get maximum results of rehabilitation procedure.