The goal of this study is to investigate the relation between indicators of osteoporosis (i.e., bone mineral density (BMD), and Cortical Index (CI)) and the complexity of a fracture of the proximal humerus as a result of a low-energy trauma. A retrospective chart review of 168 patients (mean age 67.2 years, range 51 to 88.7) with a fracture of the proximal humerus between 2007 and 2011, whose BMD was assessed at the Fracture Liaison Service with Dual Energy X-ray Absorptiometry (DXA) measurements of the hip, femoral neck (FN) and/or lumbar spine (LS), and whose CI and complexity of fracture were assessed on plain anteroposterior radiographs of the proximal humerus.Objectives
Methods
Early prediction of outcome following hip fracture surgery would save valuable time towards arranging post-op rehabilitation benefiting the patient and health economics. The study aim was to develop a prognostic scoring system for elderly hip fracture patients, which on admission is able to predict rehabilitation needs at discharge based on pre-injury factors. A simple and fast prognostic scoring system was developed based on age, pre-injury level of “independence in activities of daily living” (Katz), medical co-morbidities, cognitive functioning (MMSE) and presence of a caregiver, to predict rehabilitation needs at discharge (0–8 points). Rehabilitation options were direct return to pre-injury living situation (group 1), transfer to an orthopaedic rehabilitation unit for a period shorter than 3 months (group 2), or transfer to a psychogeriatric or orthopaedic rehabilitation unit for a period longer than 3 months (group 3). Rehabilitation needs as predicted and the clinical decision by independent, blinded observers were compared. The score was validated in a prospective study on a consecutive cohort of 77 hip fractured patients. Overall positive predictive value (PPV) of the prognostic score was 0.87 (CI 0.77–0.93), a marked improvement compared to previously published scoring systems with a PPV of 0.68 (CI 0.55–0.79). PPV per group (0.80, 0.92, 0.87) was highest for the most critical groups 2 and 3. In-hospital mortality was 1.3 percent. The average length of hospital stay (LOS) was 11.4 days. Using the score fast and reliable prediction of rehabilitation needs could be made already on admission gaining maximum time for the preparation of adequate discharge destinations improving care and reducing costly LOS.
