Geriatric and physically oriented rehabilitation improves the ability of independent living and physical rehabilitation reduces mortality: a randomised comparison of 538 patients.

OBJECTIVE: To examine effects of physical and geriatric rehabilitation on institutionalisation and mortality after hip fracture. DESIGN: Prospective randomised study. SETTING: Physically oriented (187 patients), geriatrically oriented (171 patients), and health centre hospital rehabilitation (180 patients, control group). SUBJECTS: A total of 538 consecutively, independently living patients with non-pathological hip fracture. MAIN MEASURES: Patients were evaluated on admission, at 4 and 12 months for social status, residential status, walking ability, use of walking aids, pain in the hip, activities of daily living (ADL) and mortality. RESULTS: Mortality was significantly lower at 4 and 12 months in physical rehabilitation (3.2%, 8.6%) than in geriatric rehabilitation group (9.6%, 18.7%, P=0.026, P=0.005, respectively) or control group (10.6%, 19.4%, P=0.006, P=0.004, respectively). At 4 months more patients in physical (84.4%) and geriatric rehabilitation group (78.0%) were able to live at home or sheltered housing than in control group (71.9%, P=0.0012 and P<0.001, respectively). No significant difference was found between physical rehabilitation and geriatric rehabilitation (P=0.278). Analysis of femoral neck and trochanteric fractures showed that significant difference was true only for femoral neck fractures (physical rehabilitation vs geriatric rehabilitation P=0.308, physical rehabilitation vs control group P<0,001 and geriatric rehabilitation vs control group P<0.001). Effects of intensified rehabilitations disappeared at 12 months. No impact on walking ability or ADL functions was observed. CONCLUSIONS: Physical rehabilitation reduced mortality. Physical and geriatric rehabilitation significantly improved the ability of independent living after 4 months especially among the femoral neck fracture patients but this effect could not be seen after 12 months.

Early revision after hemiarthroplasty and osteosynthesis of cervical hip fracture: short-term function mortality unchanged in 102 patients.

BACKGROUND: There is no consensus on whether osteosynthesis or hemiarthroplasty is preferable in the treatment of cervical hip fractures. Osteosynthesis is associated with more reoperations than hemiarthroplasty but there is little information available on the consequences of these reoperations. PATIENTS AND METHODS: We studied the effect on mortality, hospital stay and functional outcome of revision performed within 4 months of primary surgery with hemiarthroplasty or osteosynthesis for cervical hip fracture. 50 (6%) of 792 patients treated with uncemented Austin-Moore hemiarthroplasty and 52 (13%) of 411 patients with osteosynthesis (86 with two hook pins and 325 with three cannulated screws) had had revision surgery. Control groups matched for age, sex, residential status, walking ability at fracture, type of primary operation and fracture type consisted of patients who had not had a reoperation. RESULTS: Reoperation impaired walking ability and was associated with increased use of walking aids at 4 months in the hemiarthroplasty group and the osteosynthesis group as compared to controls, but did not have any statistically significant effect on residential status. In the hemiarthroplasty group, 4-month mortality was 12% among the reoperated patients and 18% among the controls, while mortality at 1 year was 24% in both groups. The corresponding figures in the osteosynthesis group and controls were 6% and 6% at 4 months, respectively, and 17% and 13% at 1 year. INTERPRETATION: To some extent, reoperation impairs early functional outcome after cervical hip fracture treated by either osteosynthesis or hemiarthroplasty, but does not increase mortality to any significant degree.