Does delayed weight bearing in the surgical management of fractures of the upper end of the femur in the elderly lead to more complications? A prospective study - 05/08/22

Doi : 10.1016/j.otsr.2022.103381

Pierre-Alban Bouché ^a,^c,⁎ , Simon Corsia ^a, David Biau ^a,^c, Philippe Anract ^a,^c, Karine Briot ^b,^c, Philippe Leclerc ^d, Guillaume Auberger ^d, Pierre-Emmanuel Cailleaux ^e,^f
^a Service de chirurgie orthopédique et traumatologique, hôpital Cochin, Assistance Publique – hôpitaux de Paris, Paris, France
^b Service de rhumatologie, hôpital Cochin, Assistance Publique – Hôpitaux de Paris, Paris, France
^c Université de Paris, faculté de médecine Paris-Centre, 75006 Paris, France
^d Service de chirurgie orthopédique et traumatologique, hôpital de La Croix Saint-Simon, GH Diaconnesses Croix Saint-Simon, Paris, France
^e Université de Paris, faculté de médecine Paris-Nord & Inserm UMR-S 1132, 75006 Paris, France
^f Service de gériatrie aiguë, hôpital Louis-Mourier, assistance Publique - Hôpitaux de Paris, 92700 Colombes, France

^⁎Corresponding author. Service de chirurgie orthopédique et traumatologique, hôpital Cochin, Assistance Publique – hôpitaux de Paris, Paris, France.Service de chirurgie orthopédique et traumatologique, hôpital Cochin, Assistance Publique – hôpitaux de ParisParisFrance

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Abstract

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.