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Timely Surgical Intervention for Hip Fractures is Essential to Reinstate Ambulatory Function on Discharge: Propensity
Hirotaka Kawakami1, Hiromi Sasaki2, Junichi Kamizono1
1Department of Orthopedic Surgery, Sendai Medical Association Hospital, Kagoshima, Japan.
Background:
Timely surgical intervention for hip fractures extends postoperative survival and alleviates potential complications. However, the extent to which individuals can restore their mobility after undergoing hip fracture surgery remains unclear. We aimed to investigate the effect of timely surgical management, defined as intervention within 48 hours of injury, on postoperative ambulatory function in patients with hip fractures.
Methods:
We included 320 patients who underwent bipolar hemiarthroplasty for hip fractures at our institution between April 2017 and March 2023. Patients were divided into 2 groups based on the postinjury timing of the surgical intervention: the "early group" (within 48 hours) and the "delay group" (after 48 hours). We applied propensity score matching to address confounders in this retrospective observational study.
Results:
The early and delay groups each comprised 127 patients. We assessed the Functional Independence Measure (FIM) (walking/wheelchair) score on discharge. For preinjury Functional Ambulation Category (FAC) 3, there was a notable contrast between the early (FIM: 3.44) and delay groups (FIM: 2.31) (p = 0.005). Similarly, regarding the Gross Muscle Test (GMT) (unaffected side) score on discharge, there was a significant between-group difference at FAC 3 (early group, GMT score = 3.56; delay group, GMT score = 3.18 [p = 0.01]). Except for FAC 3, there were no significant between-group differences in either FIM or GMT scores for the other categories. Multiple regression analysis revealed that the regression coefficient for the FIM (locomotion) score on the "time from injury to surgery" was -0.28 (p = 0.03).
Conclusions:
Patients who underwent surgery at >48 hours after sustaining an injury faced increased difficulties in achieving postoperative ambulatory function, especially if their mobility had been compromised before the injury, as indicated by a low preinjury FAC score. Disparities in the restoration of ambulatory function were associated with muscle weakness.
Level Of Evidence:
Level III, Case-control study. See Instructions for Authors for a complete description of levels of evidence.
