Purpose. Clinicians need knowledge about early and valid predictors of short-term outcome of patients with hip fracture, to adjust and plan rehabilitation. The concept of multimodal rehabilitation has proven effective. Still, some patients do not regain basic mobility independency in the acute orthopaedic setting. The aim was to examine the predictive value of age, sex, prefracture functional level, mental and health status, and fracture type of in-hospital basic mobility outcome, and discharge destination after hip fracture surgery. Subjects. A total of 213 consecutive patients (157 women and 56 men) with a median age of 82 (25–75% quartile, 75–88) years, admitted from their own home, and following a multimodal rehabilitation concept, were included. Fifty percent of patients had a high prefracture functional level, evaluated by the New Mobility Score (NMS), 77 and 62% had respectively, a high mental and health status, and the distribution of cervical versus intertrochanteric fractures were equally divided. Methods. Outcome variables were the regain of independency in basic mobility during admittance and discharge destination. The Cumulated Ambulation Score was used to evaluate basic mobility defined as, independency in getting in and out of bed, sitting down and standing up from a chair, and walking. Discharge destination was classified as own home or further inpatient rehabilitation facilities in the community. Results. A total of 50 (24%) patients did not regain their basic mobility independence during admittance, and 51 patients (24%) were not discharged to their own home. Simple regression analysis showed that age, the prefracture NMS functional level, mental status and fracture type (P<0.01), significantly influenced basic mobility outcome, while sex (P=0.06) and health status (P=0.08), did not. Multiple logistic regression analysis, revealed the prefracture NMS level, age and fracture types as the only independent predictors, when adjusted for sex, mental and health status. Thus, a patient with a low prefracture NMS and/or an intertrochanteric fracture was respectively, 6 and 4 times more likely not to regain independency in basic mobility during admittance, and 4 and 3 times more likely not being discharged to own home, compared to a patient with a high prefracture NMS level and a cervical fracture, respectively. Further, odds of not being discharged directly to own home increased with 9% per each additional year the patient got older. Conclusion. The prefracture NMS functional level, age and fracture type were strong and independent predictors of in-hospital outcome in patients with hip fracture who followed a multimodal rehabilitation concept. Clinicians using these three easily available variables, have the possibility to identify patients who may benefit from special attention

Aims

We assessed the value of the Clinical Frailty Scale (CFS) in the prediction of adverse outcome after hip fracture.

Aims

Complex fractures of the femur and tibia with associated severe soft tissue injury are often devastating for the individual. The aim of this study was to describe the two-year patient-reported outcomes of patients in a civilian population who sustained a complex fracture of the femur or tibia with a Mangled Extremity Severity Score (MESS) of ≥ 7, whereby the score ranges from 2 (lowest severity) to 11 (highest severity).

Aims

To analyse the influence of upper extremity trauma on the long-term outcome of polytraumatised patients.

Despite the increase in numbers of the extreme elderly, little data is available regarding their outcome after surgery for fracture of the hip. We performed a prospective study of 50 patients aged 95 years and over who underwent this procedure. Outcome measures included morbidity, mortality, hospital stay, residential and walking status. Comparison was made with a control group of 200 consecutive patients aged less than 95 years who had a similar operation. The mortality at 28 and 120 days was higher (p = 0.005, p = 0.001) in the patients over 95 years. However, the one-year cumulative post-operative mortality was neither significantly different between the two groups (p = 0.229) nor from the standardised mortality rate for the age-matched population (p = 0.445). Predictors of mortality included the ASA grade, the number of comorbid medical conditions and active medical problems on admission. Patients over 95 were unlikely to recover their independence and at a mean follow-up of 29.3 months (12.1 to 48) 96% required permanent institutional care.

We have evaluated the functional, clinical and radiological outcome of patients with simple and complex acetabular fractures involving the posterior wall, and identified factors associated with an adverse outcome.

We reviewed 128 patients treated operatively for a fracture involving the posterior wall of the acetabulum between 1982 and 1999. The Musculoskeletal Functional Assessment and Short-Form 36 scores, the presence of radiological arthritis and complications were assessed as a function of injury, treatment and clinical variables.

The patients had profound functional deficits compared with the normal population. Anatomical reduction alone was not sufficient to restore function. The fracture pattern, marginal impaction and residual displacement of > 2 mm were associated with the development of arthritis, which related to poor function and the need for hip replacement. It may be appropriate to consider immediate total hip replacement for patients aged > 50 years with marginal impaction and comminution of the wall, since 7 of 13 (54%) of these required early hip replacement.