Influence of treatment factors on the outcome after hip fractures

To investigate the influence of different treatment factors in the outcome and rehabilitation after hip fractures, a series of 282 consecutive patients with femoral neck or trochanteric fractures were followed up prospectively for two years postoperatively. The long-term results were analysed by a review of the patients' records after 10 years. The hospital stay and aftercare in the total material were shorter when the operation was not delayed. In patients from their own homes, the hospital stay was influenced by the day of operation in relation to admission, the duration of operation and the operative result (the possibility of achieving stable internal fixation). Social rehabilitation was affected by day of operation, duration of operation and postoperative complications in the femoral neck group and by postoperative complications in the trochanteric group. The walking capacity was reduced after the fracture in most patients and only about one-half of the patients became independent walkers. Reoperations led to a greatly increased length of hospital stay in patients with trochanteric fractures and to a moderate increase in those with cervical fractures. Fracture healing was influenced by treatment factors both in the femoral neck group (poor reduction and postoperative infection) and in the trochanteric group (postoperative infection and unstable internal fixation). Mortality was related to preoperative factors and was not influenced by the treatment. The frequency of the occurrence of another hip fracture up to 10 years postoperatively was 17.4%, with an equal distribution of fracture types.