Abstract
Restoration of ambulatory status is considered a primary treatment goal for older patients with intertrochanteric fractures. Several surgical-related parameters were reported to be associated with mechanical failure without focusing on the functional outcomes. Our study examines the roles of both clinical and surgical parameters as prognostic factors on 1-year postoperative ambulatory outcomes, reaching a good functional outcome (the New Mobility Score: NMS ≥ 5) and returning to preinjury functional status at one year, of older patients with intertrochanteric fracture. Intertrochanteric fractures patients age ≥65 years who underwent surgical treatment at our institute between January 2017 and February 2020 were included. Of 209 patients included, 149 (71.3%) showed a good functional outcome at one year. The pre-injury ambulatory status (OR 52.72, 95%CI 5.19–535.77, p = 0.001), BMI <23 kg/m2 (OR 3.14, 95%CI 1.21–8.13, p = 0.018), Hb ≥10 g/dL (OR 3.26, 95%CI 1.11–9.57, p = 0.031), and NMS at discharge ≥2 (OR 8.50, 95%CI 3.33–21.70, p < 0.001) were identified as independent predictors for reaching a good postoperative functional outcome. Only aged ≤80 (OR 2.34, 95%CI 1.11–4.93, p = 0.025) and NMS at discharge ≥2 (OR 6.27, 95%CI 2.75–14.32, p < 0.001) were significantly associated with an ability to return to preinjury function. To improve postoperative ambulatory status, orthopedic surgeons should focus more on modifying factors, such as maintaining the preoperative hemoglobin ≥10 g/dL and providing adequate postoperative ambulation training to maximize the patients’ capability upon discharge. While surgical parameters were not identified as predictors, they can still be used as guidance to optimize the operation quality.
Highlights
IntroductionIntertrochanteric fracture is one of the most common fractures in the geriatric population and is associated with serious consequences [1]
Only 57 (26.5%) were able to return to preinjury functional status (50 (25%) and 4 (23.5%) in patients with good and poor preinjury ambulatory status respectively)
Other influential predictors were preoperative hemoglobin level ≥ 10 g/dL, Body mass index (BMI) < 23 kg/m2, and the ambulatory status of patients at discharge time with new mobility score (NMS) at least 2
Summary
Intertrochanteric fracture is one of the most common fractures in the geriatric population and is associated with serious consequences [1]. Even though the chance of uneventful bony healing was high, only half of the patients or less could return to their preinjury ambulatory level after operation [2]. The lack of self-ambulatory capability leads to poor quality of life after the injury and subsequently causes significant medical and socioeconomic burdens to both the patients and their families [3]. The ultimate treatment goal in treating this fracture type is to enable the patients to return to their previous functional status and social participation [2,4]. As non-operative management was proven to be
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