Abstract
Background
Fragility fractures are a major health care problem worldwide. The proportion of the geriatric population and the overall life expectancy will increase. Hip fractures are the most common fragility fractures needing surgery and nowadays treatment concepts are changing. We studied the long-term functional outcome and their influencing factors in patients treated without any interdisciplinary aspects.
Design and setting
A retrospective cohort study with functional long-term follow-up examination was carried out in a level one trauma centre on hip fracture patients 80 years old and above treated without any formalized interdisciplinary aspects (“usual care”).
Patients
Of 281 consecutive patients who were treated 2005 and 2006 with usual care, 246 patients with a mean age of 86.8 years met our inclusion criteria. 69.1% died within the study period of 4.9 years. On the remaining patients, the residential status, the Barthel Index and the Parker Score were assessed.
Results
The mean Barthel Index was 49.6 and the mean Parker Score was 2.7. More than one-fourth of the survivors were found to be bedridden and 45% were not able to walk outside. 88% are bound to one floor and only 8% are able to walk unaided. Patients with more comorbidities and patients with subsequent fractures had significant higher mortality rates. Patients with trochanteric fractures had significant better functional outcome scores compared to patients with femoral neck fractures. Nursing home residents showed significant higher mortality rates and lower functional outcome scores. Patients who were transferred to a nearby acute geriatric hospital for further treatment had significantly higher functional outcome scores.
Conclusion
This paper shows the frustrating long-term outcome of geriatric hip fracture patients but it also suggests that an early geriatric intervention may lead to better function.
Similar content being viewed by others
Abbreviations
- ADL:
-
Activities of daily living
References
Cooper C, Campion G, Melton LJ (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2(6):285–289
Eurostat Yearbook (2008).230
Kanis JA, Johnell O (2005) Requirements for DXA for the management of osteoporosis in Europe. Osteoporos Int 16(3):229–238. doi:10.1007/s00198-004-1811-2
Rieder (2007) Austrian Report on Osteoporosis
Bonnaire F, Zenker H, Lill C, Weber A, Linke B (2005) Treatment strategies for proximal femur fractures in osteoporotic patients. Osteoporos Int 16(S02):S93–S102. doi:10.1007/s00198-004-1746-7
Inouye SK, Viscoli CM, Horwitz RI, Hurst LD, Tinetti ME (1993) A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Ann Intern Med 119(6):474–481
Creditor MC (1993) Hazards of hospitalization of the elderly. Ann Intern Med 118(3):219–223
Kammerlander C, Roth T, Friedman SM, Suhm N, Luger TJ, Kammerlander-Knauer U, Krappinger D et al (2010) Ortho-geriatric service—a literature review comparing different models. Osteoporos Int 21(Suppl 4):S637–S646. doi:10.1007/s00198-010-1396-x
Shyu YI, Liang J, Wu CC, Su JY, Cheng HS, Chou SW, Yang CT (2005) A pilot investigation of the short-term effects of an interdisciplinary intervention program on elderly patients with hip fracture in Taiwan. J Am Geriatr Soc 53(5):811–818. doi:10.1111/j.1532-5415.2005.53253.x
Shyu YI, Liang J, Wu CC, Su JY, Cheng HS, Chou SW, Chen MC, Yang CT (2008) Interdisciplinary intervention for hip fracture in older Taiwanese: benefits last for 1 year. J Gerontol A Biol Sci Med Sci 63(1):92–97
Vidán M, Serra JA, Moreno C, Riquelme G, Ortiz J (2005) Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial. J Am Geriatr Soc 53(9):1476–1482. doi:10.1111/j.1532-5415.2005.53466.x
Friedman SM, Mendelson DA, Bingham KW, Kates SL (2009) Impact of a comanaged Geriatric Fracture Center on short-term hip fracture outcomes. Arch Intern Med 169(18):1712–1717. doi:10.1001/archinternmed.2009.321
Friedman S, Mendelson D, Kates S, McCann R (2008) Geriatric co-management of proximal femur fractures: total quality management and protocol-driven care result in better outcomes for a frail patient population. J Am Geriatr Soc. doi:10.1111/j.1532-5415.2008.01770.x
Khasraghi FA, Christmas C, Lee EJ, Mears SC, Wenz JF (2005) Effectiveness of a multidisciplinary team approach to hip fracture management. J Surg Orthop Adv 14(1):27–31
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383
Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47(11):1245–1251
de Groot V, Beckerman H, Lankhorst GJ, Bouter LM (2003) How to measure comorbidity. a critical review of available methods. J Clin Epidemiol 56(3):221–229
Mahoney FI, Barthel DW (1965) Functional evaluation: The Barthel Index. Md State Med J 14:61–65
Parker MJ, Palmer CR (1993) A new mobility score for predicting mortality after hip fracture. J Bone Jt Surg Br Vol 75(5):797–798
Bryant DM, Sanders DW, Coles CP, Petrisor BA, Jeray KJ, Laflamme GY (2009) Selection of outcome measures for patients with hip fracture. J Orthop Trauma 23(6):434–441. doi:10.1097/BOT.0b013e318162aaf9
Shyu Y-IL, Liang J, Wu C-C, Su J-Y, Cheng H-S, Chou S-W, Chen M-C, Yang C-T (2008) Interdisciplinary intervention for hip fracture in older Taiwanese: benefits last for 1 year. J Gerontol A Biol Sci Med Sci 63(1):92–97
Shyu Y-IL, Liang J, Wu C-C, Su J-Y, Cheng H-S, Chou S-W, Yang C-T (2005) A pilot investigation of the short-term effects of an interdisciplinary intervention program on elderly patients with hip fracture in Taiwan. J Am Geriatr Soc 53(5):811–818. doi:10.1111/j.1532-5415.2005.53253.x
Khasraghi FA, Christmas C, Lee EJ, Mears SC, Wenz JF Sr (2005) Effectiveness of a multidisciplinary team approach to hip fracture management. J Surg Orthop Adv 14(1):27–31
Haentjens P, Autier P, Barette M, Venken K, Vanderschueren D, Boonen S, Group HFS (2007) Survival and functional outcome according to hip fracture type: a one-year prospective cohort study in elderly women with an intertrochanteric or femoral neck fracture. Bone 41(6):958–964. doi:10.1016/j.bone.2007.08.026
Rosell PA, Parker MJ (2003) Functional outcome after hip fracture. A 1-year prospective outcome study of 275 patients. Injury 34(7):529–532
Swanson CE, Day GA, Yelland CE, Broome JR, Massey L, Richardson HR, Dimitri K, Marsh A (1998) The management of elderly patients with femoral fractures. A randomised controlled trial of early intervention versus standard care. Med J Aust 169(10):515–518
Dennison E, Mohamed MA, Cooper C (2006) Epidemiology of osteoporosis. Rheum Dis Clin North Am 32(4):617–629
Koval KJ, Skovron ML, Aharonoff GB, Zuckerman JD (1998) Predictors of functional recovery after hip fracture in the elderly. Clin Orthop Relat Res 348:22–28
Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE (1989) Survival experience of aged hip fracture patients. Am J Public Health 79(3):274–278
Young Y, Brant L, German P, Kenzora J, Magaziner J (1997) A longitudinal examination of functional recovery among older people with subcapital hip fractures. J Am Geriatr Soc 45(3):288–294
Cooper C (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103(2):12S–17S discussion 17S–19S
Schroder HM, Petersen KK, Erlandsen M (1993) Occurrence and incidence of the second hip fracture. Clin Orthop Relat Res 289:166–169
Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jonsson B (2004) Mortality after osteoporotic fractures. Osteoporos Int 15(1):38–42. doi:10.1007/s00198-003-1490-4
Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353(9156):878–882
Roche JJ, Wenn RT, Sahota O, Moran CG (2005) Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ 331(7529):1374. doi:10.1136/bmj.38643.663843.55
Shiga T, Wajima Zi, Ohe Y (2008) Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression: [Le delai operatoire est-il associe a une mortalite accrue chez les patients atteints d’une fracture de la hanche ? Synthese systematique, meta-analyse et meta-regression]. Can J Anaesth 55(3):146–154
Rae HC, Harris IA, McEvoy L, Todorova T (2007) Delay to surgery and mortality after hip fracture. ANZ J Surg 77(10):889–891. doi:10.1111/j.1445-2197.2007.04267.x
Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301(5):513–521. doi:10.1001/jama.2009.50
Lyles KW, Colón-Emeric CS, Magaziner JS, Adachi JD, Pieper CF, Mautalen C, Hyldstrup L, Recknor C, Nordsletten L, Moore KA, Lavecchia C, Zhang J, Mesenbrink P, Hodgson PK, Abrams K, Orloff JJ, Horowitz Z, Eriksen EF, Boonen S, Trial HRF (2007) Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 357(18):1799–1809. doi:10.1056/NEJMoa074941
Beaupre LA, Morrish DW, Hanley DA, Maksymowych WP, Bell NR, Juby AG, Majumdar SR (2011) Oral bisphosphonates are associated with reduced mortality after hip fracture. Osteoporos Int 22(3):983–991. doi:10.1007/s00198-010-1411-2
Gehrig L, Lane J, O’Connor MI (2008) Osteoporosis: management and treatment strategies for orthopaedic surgeons. J Bone Joint Surg Am 90(6):1362–1374
Kates SL, Kates OS, Mendelson DA (2007) Advances in the medical management of osteoporosis. Injury 38(Suppl 3):S17–S23. doi:10.1016/j.injury.2007.08.007
Reginster JY, Seeman E, De Vernejoul MC, Adami S, Compston J, Phenekos C, Devogelaer JP, Curiel MD, Sawicki A, Goemaere S, Sorensen OH, Felsenberg D, Meunier PJ (2005) Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) study. J Clin Endocrinol Metab 90(5):2816–2822. doi:10.1210/jc.2004-1774
Karlsson MK, Gerdhem P, Ahlborg HG (2005) The prevention of osteoporotic fractures. J Bone Joint Surg Br 87(10):1320–1327. doi:10.1302/0301-620X.87B10.16578
Aharonoff GB, Koval KJ, Skovron ML, Zuckerman JD (1997) Hip fractures in the elderly: predictors of one year mortality. J Orthop Trauma 11(3):162–165
Shah MR, Aharonoff GB, Wolinsky P, Zuckerman JD, Koval KJ (2001) Outcome after hip fracture in individuals ninety years of age and older. J Orthop Trauma 15(1):34–39
Zuckerman JD, Skovron ML, Koval KJ, Aharonoff G, Frankel VH (1995) Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Jt Surg Am Vol 77(10):1551–1556
Hamerman D (1999) Toward an understanding of frailty. Ann Intern Med 130(11):945–950
Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB Jr, Walston JD (2004) Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc 52(4):625–634. doi:10.1111/j.1532-5415.2004.52174.x
Friedman SM, Mendelson DA, Kates SL, McCann RM (2008) Geriatric co-management of proximal femur fractures: total quality management and protocol-driven care result in better outcomes for a frail patient population. J Am Geriatr Soc. doi:10.1111/j.1532-5415.2008.01770.x
Luger TJ, Kammerlander C, Gosch M, Luger MF, Kammerlander-Knauer U, Roth T, Kreutziger J (2010) Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter? Osteoporos Int 21(Suppl 4):S555–S572. doi:10.1007/s00198-010-1399-7
Conflict of interest
No author has a conflict of interest regarding the topics discussed in this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kammerlander, C., Gosch, M., Kammerlander-Knauer, U. et al. Long-term functional outcome in geriatric hip fracture patients. Arch Orthop Trauma Surg 131, 1435–1444 (2011). https://doi.org/10.1007/s00402-011-1313-6
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-011-1313-6