Risk assessment after hip fracture: check the "healthy" leg!

Functional deficits may increase the risk for further falls after hip fracture. The aim of this study was to elucidate function and range of movement (ROM)-related risk factors.

The consecutive, prospective study included all patients admitted to the rehabilitation unit. The geriatric assessment was performed after admission and before discharge; ROM was measured using the neutral zero method. Falls, defined as unintentionally coming to rest on the floor, were documented. Patients' functions were analyzed comparing fallers to nonfallers.

A total of 1,497 patients with a mean age of 81.1 ± 8.2 years were included. The incidence of falls during rehabilitation was 9.6 per 1,000 patient-days and was related to patients' age: patients younger than 75 years had an incidence of falls of 5.0, those between 75-84 years had an incidence of 9.5, and those >84 years had an incidence of 12.0, respectively. Fallers showed significantly more functional deficits both in the operated and on the nonoperated leg. Using logistic regression models, especially ROM measured in the frontal plane (hip adduction and abduction) of the nonoperated hip was significantly associated with an increased risk of falling (OR 0.986, 95% CI 0.973-0.999, p = 0.037).

Patients are at high risk for falls after hip fracture, with age itself being one of the most dominant risk factors. In addition to previously identified gait and mobility disorders, the physical limitations of arthritis of the "healthy" hip seem to be responsible for the functional decline. Therefore, it would be of interest to include the examination of the hips into a falls risk assessment battery.