The predictors of surgical procedure and the effects on functional recovery in elderly with subcapital fractures

Abstract

Background. It has been demonstrated that the majority of hip fracture patients do not regain their prefracture level of functioning and usually decline in function following fracture. Little is known about the effectiveness of surgical procedure performed (hemiarthroplasty vs internal fixation) on functional recovery of subcapital fracture patients. This study examines the factors related to the type of the surgical procedure chosen and the effect of this selection on physical activities of daily living (PADL) and the instrumental activities of daily living (IADL). Methods. The sample consists of 312 patients with subcapital fractures age 65 and older admitted from the community to one of seven Baltimore area hospitals between 1984 and 1986. Baseline information was obtained during hospitalization through structured interviews with both patients and their signifivcant others (proxy). The follow-up interviews were administered to proxies at two months, six months and one year after discharge from hospital. Information on disease diagnoses fracture severity and surgical procedures performed was obtained from medical charts. Results. Patients with a displaced fractre were seven times more likely to recieve a hemiarthroplasty (OR = 7.0, 95% CI 3.7-13.1). During the short-term recovery (2 months after surgery), patients who recieved hemiarthroplasty were doing better in traasferring, meal preparation, and shopping than those who recieved internal fixation. For the long-term functional recovery (one year), the overall PADL and IADL functions were not statistically significantly different between the two surgical procedures performed. Conclusions. The severity of fracture was found to be the most important determinant of surgical procedure. Patients with a subcapital fracture who recieved hemiarthroplasty tended to have a better functional recovery in the short term. Further study of other benefits of using a hemiarthroplasty is neded.