Association of cognitive status with mobility and functioning after femoral neck fracture surgery in elderly patients : differences between hemiarthroplasty and internal fixation
Povezanost kognitivnega stanja z gibljivostjo in funkcijskim stanjem po operacijskem zdravljenju zloma vratu stegnenice pri starejših poškodovancih : razlike med uporabo delne cementne endoproteze in notranje fiksacije

english

2013

volume 82, issue 3

Activities of Daily Living   Hip fractures   Surgical procedures, operative   Walking

Slovensko zdravniško društvo
(Obvezni izvod spletne publikacije)

Background: Comparison of outcomes between two different operative treatments of femoral neck fracture hemiarthroplasty (HA) and internal fixation (IF) remains an open issue. We performed new analyses of data from a previously published study with the aim of investigating the influence of cognitive problems on mobility and functioning after such surgery and comparing it between groups treated with HA and IF. Methods: Sixty-six elderly patients were consecutively enrolled in a prospective non-randomised study. The two groups (HA and IF, each comprising 33 patients) were balanced regarding age, gender and activity before injury. Data were gathered on their walking ability (categorised, measured via walking distance, and assessed using Walking Ability Index WAI), cognitive status (assessed using Mini Mental State Examination MMSE) and independence in activities of daily living (categorised, and assessed using Functional Independence Measure FIM). Results: The association with MMSE score on admission was higher in the IF group than in the HA group for all the analysed outcome measures, i.e., walking distance at discharge, ability to walk unassisted (with walking aids) at discharge, ability to walk outdoors after three months, independence in activities of daily living after three months, improvement in motor FIM subscore after three months and WAI score at discharge. Conclusions: Presence of cognitive problems adversely affects walking ability and functioning mainly in patients operatively treated with IF after femoral neck fracture, and not (or to a much lesser extent) in patients treated with HA. It is recommended to take this into account during surgical decision-making.

02.01.2014