title: Fixation Versus Replacement in Geriatric Hip Fractures: Does Functional Outcome and Independence in Self-Care Differ?
abstract: BACKGROUND
  Although there is evidence of improved functional outcomes with our "integrated care pathway" for geriatric hip fractures, we do not know if there is a significant difference in functional recovery of activities of daily living and attainment of independence in self-care between patients who underwent fixation and those treated with arthroplasty.
  
  
  OBJECTIVE
  To determine whether such a difference exists in surgically fixed hip fractures.
  
  
  METHODS
  Patients with hip fracture treated surgically were divided into group A (internal fixation, n = 213) and group B (arthroplasty, n = 199). Demographic data, Charlson comorbidity index (CCI) score, time to surgery, and length of stay were recorded. Inpatient complications and mortality rates were also documented. Modified Barthel Index (MBI) scores were recorded for the following intervals: prefall, discharge, 6-month, and at 1-year follow-up.
  
  
  RESULTS
  The mean age (A: 80 years and B: 81years), CCI (A: 5.41 and B: 5.43), and length of stay (A: 13.6 days and B: 15.2 days) were not significantly different. However, there was a significant difference (P < .05) in time to surgery (A: 102.2 hours and B: 86.6 hours). Complication rates were about 6% in both groups (A = 6.57%: urinary infections = 13, wound infections = 1 and B = 6.03%: urinary infections = 10, wound infections = 1, pressure ulcer = 1). The preinjury MBI scores were significantly different (P < .05; A: 91.65 and B: 88.19), however, there was no significant difference in scores measured at discharge (A: 60.79 and B: 59.39), 6 months (A: 77.65 and B: 77.47) and 1 year (A: 80.71 and B: 83.03). Patients who underwent surgery for hip fracture had overall recovered 90.9% of their preinjury function (overall MBI at 1 year: 81.83).
  
  
  CONCLUSIONS
  The MBI scores reflect the extent of attainment of independence in self-care, and actual functional recovery is gauged from the percentage of recovery of preinjury function at 1 year postsurgery. We conclude that the type of surgery may not be a significant factor in determining independence in self-care although patients who had arthroplasty had recovered more function at 1 year postsurgery than those who underwent fixation (percentage recovery of preinjury function-A: 88.1% and B: 94.1%).
authors.affiliation: Department of Orthopaedics and Traumatology, Tan Tock Seng Hospital, Singapore.
authors.forename: Arul Murugan
authors.initials: AM
authors.lastname: Palanisamy
authors.affiliation: Department of Orthopaedics and Traumatology, Tan Tock Seng Hospital, Singapore.
authors.forename: H K
authors.initials: HK
authors.lastname: Doshi
authors.affiliation: Department of Orthopaedics and Traumatology, Tan Tock Seng Hospital, Singapore.
authors.forename: Dahshaini
authors.initials: D
authors.lastname: Selvaraj
authors.affiliation: Department of Rehabilitation medicine, Tan Tock Seng Hospital, Singapore.
authors.forename: William
authors.initials: W
authors.lastname: Chan
authors.affiliation: Department of Orthopaedics and Traumatology, Tan Tock Seng Hospital, Singapore.
authors.forename: G
authors.initials: G
authors.lastname: Naidu
authors.affiliation: Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.
authors.forename: R
authors.initials: R
authors.lastname: Ramason
keywords: arthroplasty; fixation; functional outcome; hip fracture