Abstract
Fracture neck of femur (NOF) is a significant morbidity in the elderly patient and a significant burden on the healthcare system. Surgery induces a stress response resulting in hyperglycaemia, insulin resistance, and glucose intolerance (Diabetic triad). Furthermore, fasting pre operatively establishes a catabolic state. This diabetic state can last up to 3 weeks following surgery and therefore could be associated with the morbidity of diabetes.
Methods
26 patients with fracture NOF were enrolled in this preliminary study. Exclusion criteria included diabetics. Each underwent hemiarthroplasty or Dynamic Hip Screw fixation. Pre and post operative serum glucose levels were taken. 15 patients were selected to have pre and post operative serum insulin levels because of the expensive nature of the test.
Results
Normal glucose range = 4-6 mmol/l. Normal insulin range = 17.8 – 173 pmol/l. 21 of 26 patients exhibited post operative hyperglycaemia (range 5 - 16.4mmol/l). 7 of 15 patients tested for insulin remained in our pilot study where pre and post insulin levels were obtained. Insulin is a technically difficult level to take and samples are easily discarded. 6 of 7 Insulin levels showed marked elevation post operatively (range 17.5 – 595.8).
Conclusion
We are able to demonstrate that fracture NOF patients exhibit a postoperative hyperglycaemia and insulin resistance. Insulin levels were significantly elevated in 6 cases and established hyperinsulinaemia was present in 50% of cases. This pilot study determines that a post operative type 2 diabetic state is induced by surgery for fracture neck of femur, perhaps exacerbated by the catabolic state of fasting. If we are able to diminish this we may be able to mitigate morbidity associated with this diabetic state. This in turn may improve the morbidity and burden on our healthcare system.
