THE PREDICTORS OF SURGICAL-PROCEDURE AND THE EFFECTS ON FUNCTIONAL RECOVERY IN ELDERLY WITH SUBCAPITAL FRACTURES

Background. it has been demonstrated that the majority of hip fracture patients do not regain their prefracture level of functioning and usu ally decline in function following fracture. Little is known about the effectiveness of surgical procedure performed (hemiarthroplasty vs in ternal fixation) on functional recovery of subcapital fracture patient s. This study examines the factors related to the type of the surgical procedure chosen and the effect of this selection on physical activit ies of daily living (PADL) and instrumental activities of daily living (IADL). Methods. The sample consists of 312 patents with subcapital f ractures age 65 and older admitted from the community to one of seven Baltimore area hospitals between 1984 and 1986. Baseline information w as obtained during hospitalization through structured interviews with both patients and their significant others (proxy). The follow-up inte rviews 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 fro m medical charts. Results. Patients with a displaced fracture were sev en more times likely to receive a hemiarthroplasty (OR = 7.0, 95% Cl 3 .7-13.1). During the short-term recovery (2 months after surgery), pat ients who received hemiarthroplasty were doing better in transferring, meal preparation, and shopping than those who received internal fixat ion. For the long-term functional recovery (one year), the overall PAD L and IADL functions were not statistically significantly different be tween the two surgical procedures performed. Conclusions. The severity of fracture was found to be the most important determinant of surgica l procedure. Patients with a subcapital fracture who received hemiarth roplasty tended to have a better functional recovery in the short term . Further study of other benefits of using a hemiarthroplasty is neede d.