Introduction

Fractures of the upper end of the femur (FUEF) lead to increased mortality and dependence in the elderly. However, mechanical complications after surgery persist in up to 20% of cases, which may justify a delayed resumption of full weight bearing to protect the osteosynthesis during consolidation.

Hypothesis

Our hypothesis was that the late resumption of weight bearing in an elderly population after a FUEF would be limited by a higher frequency of medical complications.

Methods

This was a prospective monocentric study including patients aged 80 or over with an isolated FUEF requiring osteosynthesis. The operator decided on the discharge. The primary endpoint was to show a difference in a medical complication score created for this study (APRETAR), between a group with, and a group without, weight bearing delayed by 45 days.

Results

Between 2016 and 2019, 254 patients (88 ± 5.6 years, 77.6% women) were included, and of these, 70 (27.6%) had delayed weight bearing. The mean APRETAR at 45 days was greater in the delayed weight bearing group (5.9 ± 8.6 vs. 5.7 ± 11.0; p < 0.001). One-year mortality was 12.6% (32 patients), with no difference between the two groups (p = 0.51). The level of dependence was significant (IADL at 2.2 ± 1.7), with some comorbidities (Charlson at 2.9 ± 2.2 and CIRS-G at 6.5 ± 4.3) and all comparable across the two groups but with low cognitive levels, especially in the group with delayed weight bearing (MMSE 15.9 ± 10.7 vs. 21 ± 6.9; p < 0.001).

Conclusion

This prospective study shows that delaying weight bearing in the elderly population, even for mechanical problems with FUEF, statistically increases medical complications but in a clinically acceptable manner.

Level of evidence

II, Prospective cohort study.

中文翻译：

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老年股骨上端骨折手术治疗延迟负重是否会导致更多并发症？一项前瞻性研究

介绍

股骨上端骨折 (FUEF) 导致老年人死亡率和依赖性增加。然而，高达 20% 的手术后机械并发症仍然存在，这可能证明延迟恢复完全负重以保护巩固期间的接骨术是合理的。

假设

我们的假设是，老年人群在 FUEF 后较晚恢复负重将受到更高频率的医疗并发症的限制。

方法

这是一项前瞻性单中心研究，包括 80 岁或 80 岁以上的孤立性 FUEF 需要接骨术的患者。操作员决定放电。主要终点是显示为这项研究 (APRETAR) 创建的医学并发症评分在有和没有负重延迟 45 天的组之间的差异。

结果

2016 年至 2019 年间，共纳入 254 名患者（88  ±  5.6 岁，77.6% 为女性），其中 70 名 (27.6%) 患者负重延迟。延迟负重组在 45 天时的平均 APRETAR 更高（5.9  ±  8.6 对比 5.7  ±  11.0；p  <  0.001）。一年死亡率为 12.6%（32 名患者），两组间无差异 ( p  =  0.51)。依赖程度显着（IADL 为 2.2  ±  1.7），伴有一些合并症（Charlson 为 2.9  ±  2.2 和 CIRS-G 为 6.5  ±  4.3）并且两组之间的所有可比性，但认知水平较低，尤其是在有延迟负重 (MMSE 15.9  ± 10.7 对比 21  ±  6.9；p  <  0.001）。

结论

这项前瞻性研究表明，延迟老年人的负重，即使是 FUEF 的机械问题，在统计学上也会增加医疗并发症，但在临床上是可以接受的。

证据等级

II，前瞻性队列研究。