Abstract
At Bispebjerg University Hospital in Denmark, an Optimized Hip Fracture Program, (OHP) is the standard of care for all hip fracture patients. Part of OHP is pain treatment with a femoral nerve catheter placed at the emergency room, dosed 4 times a day with Bupivacain until 4 days after surgery, combined with systemic analgesics as needed. In 2008, a database and a bio bank were created at the ward including all hip fracture patients to make a better description of the population and as a tool for further optimisation of the OHP. One of the aims was to identify possible subgroups having specific complications, which could lead to a differentiation of the OHP by markers known at the time of admission. In this analysis, we will focus on postoperative pain that inhibits mobilization by fracture type and type of surgery.
Methods
A consecutive cohort of 898 hip fracture patients hospitalized within two years from September 2008 to July 2010 was used for this study. Patients coming from nursing homes were excluded from the study, since nearly all are discharged 1 or 2 days after surgery to rehabilitation. If the exact type of fracture was not known, or if the patient was admitted for rehabilitation after surgery at another hospital, the patient was also excluded. 508 patients were thus included in the study. Mean age 80.0 years (SD:23.7), 72.1% women and 27.9% men.
Mobilization inhibited by postoperative pain as documented in the patient files was registered in the database. Overall mobilization was inhibited by pain in 26.7% of the 508 patients included.
The following fracture types were studied: Femoral neck Garden 1–2, Femoral neck Garden 3–4, Pertrochanteric Evans 1–2, Pertrochanteric Evans 3–5, Basocervical and Subtrochanteric.
Results
Mobilization inhibited by pain was not significantly associated with type of surgery:
Cannulated Hip Screws 16/80 (20.0%), sliding hip screw 23/94 (24.5%), Intramedullary Nail 63/186 (33.9%), partial hip replacement 33/144 (22.9%), total hip replacement 1/5 (20.0%). P = 0.09 chi square.
On the other hand mobilization inhibited by pain was significantly associated with fracture type:
Femoral neck Garden 1–2: 13/64 (20.3%), Femoral neck Garden 3–4: 38/172 (22.1%), Pertrochanteric Evans 1–2: 18/69 (26.1%), Pertrochanteric Evans 3–5: 46/149 (30.9%), Basocervical: 6/28 (21.4%), Subtrochanteric 15/27(55.6%). P = 0.009 chi square.
Conclusion
The fracture types Pertrochanteric Evans 3–5 and Subtrochanteric had the biggest inhibition of mobilization caused by pain. No significant association between type of surgery and inhibition of mobilization caused by pain was found
