Four or twelve months' follow-up in the evaluation of functional outcome after hip fracture surgery?

Abstract

Background and aims: As a rule, follow-up for at least one year is recommended for fracture studies. This is considered the shortest reliable interval. Still, in the case of hip fractures of the elderly, shorter follow-up might be more practical, since the life expectancy of these patients is often short. The aim of this study was to see if a short four months follow-up period would be acceptable in hip fracture surveys.

Material and methods: Information on 196 consecutive non-pathological hip fracture patients aged 50 years or over (mean 79 years) was collected using a standardised hip fracture audit concentrating on functional measurements at admission and at four and twelve months' follow-ups.

Results: 167 patients were alive at four months and 152 and at one year. The patients who died between four and twelve months had poorer functional capacity in the four- month evaluation than those who survived one year. The analysis of repeated measures, including only the patients alive at the last follow-up, showed that residential status, use of walking aids and 6 out of 10 and ADL variables (bathing, toileting, shopping, household activities, doing laundry, banking) did not change significantly. Walking ability and the rest 4 ADL variables (dressing, eating, food preparation, use of transportation) improved and pain decreased.

Conclusions: Due to high mortality and age-related deterioration of functioning, no steady state i.e. "final result" is ever reached after hip fracture in the elderly. Four-month follow-up is justified as the shortest possible period, because the socioeconomically most important variable, i.e. place of living, and most of the ADL functions do not change significantly after that.