Prognostic Factors of 1-Year Postoperative Functional Outcomes of Older Patients with Intertrochanteric Fractures in Thailand: A Retrospective Cohort Study

Abstract

Restoration of ambulatory status is considered a primary treatment goal for older patients with intertrochanteric fractures. Several surgical-related parameters were reported to be associated with mechanical failure without focusing on the functional outcomes. Our study examines the roles of both clinical and surgical parameters as prognostic factors on 1-year postoperative ambulatory outcomes, reaching a good functional outcome (the New Mobility Score: NMS ≥ 5) and returning to preinjury functional status at one year, of older patients with intertrochanteric fracture. Intertrochanteric fractures patients age ≥65 years who underwent surgical treatment at our institute between January 2017 and February 2020 were included. Of 209 patients included, 149 (71.3%) showed a good functional outcome at one year. The pre-injury ambulatory status (OR 52.72, 95%CI 5.19-535.77, p = 0.001), BMI <23 kg/m² (OR 3.14, 95%CI 1.21-8.13, p = 0.018), Hb ≥10 g/dL (OR 3.26, 95%CI 1.11-9.57, p = 0.031), and NMS at discharge ≥2 (OR 8.50, 95%CI 3.33-21.70, p < 0.001) were identified as independent predictors for reaching a good postoperative functional outcome. Only aged ≤80 (OR 2.34, 95%CI 1.11-4.93, p = 0.025) and NMS at discharge ≥2 (OR 6.27, 95%CI 2.75-14.32, p < 0.001) were significantly associated with an ability to return to preinjury function. To improve postoperative ambulatory status, orthopedic surgeons should focus more on modifying factors, such as maintaining the preoperative hemoglobin ≥10 g/dL and providing adequate postoperative ambulation training to maximize the patients' capability upon discharge. While surgical parameters were not identified as predictors, they can still be used as guidance to optimize the operation quality.

Keywords: Thai; fracture fixation; geriatric; intertrochanteric fractures; prognostic factors.

Figure 1

Study flow diagram of eligible patient with fragility intertrochanteric fracture who received reduction and internal fixation. Patient with available 1-year postoperative ambulatory status information were included from January 2017 to February 2020.

Figure 2

Coefficient plot presenting the odds ratio of each clinical parameter regarding two different endpoints (NMS ≥ 5 and the ability to return to preinjury functional status). Hb: Hemoglobin, CCI: Charlson’s Comorbidities index, BMI: Body Mass Index, NMS: The New Mobility Score.

Figure 3

Coefficient plot presenting the odds ratio of each surgical related parameter regarding two different endpoints (NMS ≥ 5 and the ability to return to preinjury functional status). AO: AO/OTA classification, CalTAD: Calcar reference Tip Apex Distance, NMS: The New Mobility Score.