To compare the postoperative outcomes and characteristic of persons with proximal femoral fractures to those with PIFF.
Participants were those admitted in an orthopaedic hospital in Japan from January 2022 to December 2023. PIFF severity was assessed using Vancouver Classification: Type A=trochanteric region, B1=well fixed, B2=loose stem but good proximal bone stock, B3=proximal bone that is poor quality or severely comminuted and C=below the stem. We compared various parameters before injury, after surgery, and before discharge in 22 persons with a proximal femoral fracture (Group A) and 12 persons with PIFF (Group B). All participants in both groups received physical therapy six days a week. The following items were examined: pre-injury Functional Independence Measure (FIM, 18-126 points), pre-discharge FIM, length of stays in the hospital, days from the acute ward to the recovery ward, the 3-day Cumulated Ambulation Score (CAS, 0-18 points, total of postoperative days 1-3), and 1-day CAS scores(0-6 points) every 7 days from postoperative day 7 to day 56 evaluated basic mobility. The difference between the two groups was examined using the T-test and Mann-Whitney's U-test, as appropriate. The significance level was set at p0.05. R-4.3.1 and EZR-1.64 were used for statistical analyses.
For the severity of PIFF, there were 3 participants in Type A, 4 in Type B1, 2 in Type B3, 3 in Type C. There were no significant between group differences in gender, age, length of hospital stays, or FIM scores before injury and at discharge. Contrary, there was a significant difference in median(25-75% quartiles) days to recovery ward transfer (Group A: 12 (11-14) days, Group B: 19 (13-26) days, p0.05). There was a significant difference in the 1-day CAS from day 7 and until day 49 in favor of group A.
We found significant longer acute care stays for persons with PIFF compared to the persons with first proximal femur fractures after surgery, in the period of transfer from acute ward to the recovery ward. We also found significantly lower degree of independence in basic mobility, evaluated by the CAS, within the first to twelfth week of hip fracture surgery, whereafter functional recovery seems comparable.
PIFF and first-ever proximal femoral fractures clearly have a different course, with PIFF requiring longer acute ward stays and significantly lower level of mobility up to 12 weeks post-surgery, indicating deleyed recovery. Physical therapists may need to set goals for patients with PIFF to take long-term changes into consideration and evaluate new approaches for faster recovery.
peri-implant
CAS
