Mobility following femoral neck fracture surgery: Does surgical treatment affect outcome?

Abstract

BACKGROUND: Hip fractures are a life changing injury for many; often patients sustaining a hip fracture do not regain their pre-injury function. Early rehabilitation improves patient outcomes (e.g. Mobility, independence & function). OBJECTIVES: The aim of this study was to investigate whether patients with hip fracture progressed differently depending on their surgery type, specifically whether arthroplasty or internal fixation (IF) was employed as part of the surgical management. METHODS: A prospective audit was completed on hip fracture patients presenting to our unit between October 2019 and October 2020 who received surgical intervention for their fracture. The audit collected data on patient outcomes, specifically Timed Up and Go scores (TUG), Discharge destination and Cumulative Ambulatory Scores. The study group comprised 89 patients with femoral neck fractures (60 females, 29 males). The average age was 77 (range 50–96) years. Sixty-nine patients were managed with an arthroplasty, 20 patients were managed with IF. RESULTS: Results from this audit highlighted that at discharge, TUG scores had improved in both groups with the arthroplasty group completing their TUG in a mean of 46 seconds (median 39 seconds) and the IF group in a mean of 55.7 seconds (median 46 seconds). Eleven (55% ) of the patients treated with IF were discharged home directly, while 26 (38% ) of the patients treated with an arthroplasty were discharged home directly. Hip fracture patients treated with arthroplasty had lower functional ability on day one post-operatively based on the CAS. Patients treated with arthroplasty showed greater improvement in function and mobility at the time of discharge when compared to the IF group. A greater proportion of the IF group were discharged directly home (55% vs 38% ) and able to receive any ongoing rehabilitation as an outpatient while a greater portion of the arthroplasty group required further inpatient rehabilitation (35% vs 48% ). CONCLUSION: This audit indicated that irrespective of surgical intervention (Arthroplasty or IR) there is little difference in patient outcomes in the post-operative period.