Functional Improvement in Geriatric Hip Fractures: Does Vitamin D Deficiency Affect the Functional Outcome of Patients With Surgically Treated Intertrochanteric Hip Fractures.
BACKGROUND
The "Integrated Care Pathway" for geriatric intertrochanteric (IT) fractures in Singapore's Tan Tock Seng Hospital has shown significant functional recovery in patients' activities of daily living. However, the influence of preoperative vitamin D on functional recovery remains equivocal. This retrospective study therefore aims to determine whether patients with preoperative vitamin D deficiency have poorer functional outcomes.


METHODS
A total of 171 patients who had surgical treatment for IT fractures were recruited in the study. They were categorized into group A (vitamin D deficient) and group B (normal vitamin D). Charlson Comorbidity Index (CCI) score and nutritional parameters including hemoglobin, albumin, and adjusted calcium levels on admission were recorded. The Modified Barthel Index (MBI) score was used to measure functional recovery at the following time intervals: at pre-fall, at discharge after surgery, at 6 months, and at 1-year follow-up.


RESULTS
The mean age of both the groups (A: 79.7 years, n = 45; B: 83.0 years, n = 126) was statistically different (P < .05). However, the mean CCI (A: 9.42 and B: 10.13), hemoglobin (A: 12.4 and B 11.1), adjusted calcium (A: 2.39 and B: 2.38), and mean albumin (A: 33.6 and B: 33.0) of the groups were not significantly different. Furthermore, the MBI scores were not significantly different for both groups at preinjury (A: 91.5 and B: 89.4), at discharge (A: 55.2 and B: 58.9), at 6 months (A: 70.9 and B: 75.1), and at 1 year (A: 75.8 and B: 79.4).


CONCLUSIONS
In our cohort, patients with vitamin D deficiency were younger. However, vitamin D deficiency at time of injury had no significant influence on functional recovery in patients with surgically treated hip fracture in our Integrated Care Pathway. In addition, patients who had a normal vitamin D levels had similar functional scores and improvement postoperatively and at 1 year (A: 82.8% and B: 88.9%).
Department of Orthopaedic Surgery, Tan Tock Seng Hospital Singapore, Singapore.
W R D
WR
Seng
Department of Orthopaedic Surgery, Tan Tock Seng Hospital Singapore, Singapore.
M H
MH
Belani
Geriatric Medicine Department, Tan Tock Seng Hospital Singapore, Singapore.
R
R
Ramason
Department of Orthopaedic Surgery, Tan Tock Seng Hospital Singapore, Singapore.
G
G
Naidu
Department of Orthopaedic Surgery, Tan Tock Seng Hospital Singapore, Singapore.
H K
HK
Doshi
fragility fractures; geriatric trauma; osteoporosis; systems of care; trauma surgery