Factors influencing period from surgery to discharge in patients with femoral trochanteric fractures.
Soichiro Shinoda, Hirotaka Mutsuzaki, Arata Watanabe and 2 others
PMID 29200639WHAT IT FOUND
In 60 patients after trochanteric fracture fixation, lesser trochanteric displacement and higher age were associated with longer surgery-to-discharge time.
Among 19 with weekly X-rays, 57.9% had displacement immediately, and 26.3% had confirmed displacement from start of physical therapy to 3 weeks postoperatively.
Key findings
01After logistic regression, lesser trochanteric displacement and age were selected as factors influencing the period from surgery to discharge (p<0.001).
02Lesser trochanteric fracture was observed in 24 (40.0%) of 60 patients, and displacement was observed in 21 (87.5%) of those 24 lesser trochanteric fractures.
03Among 19 patients with weekly X-ray information, 11 (57.9%) had lesser trochanteric displacement immediately after surgery, and 5 (26.3%) had confirmed displacement from the start of physical therapy to 3 weeks postoperatively.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study included only 60 patients and was retrospective, so it cannot prove that lesser trochanteric displacement caused a longer stay. The patients were divided into under-85-day and over-85-day groups using the mean period from surgery to discharge of 85.6 days. Walking ability was assessed only with the Mobility score, and quantitative tests such as 10-m walking speed or timed Up & Go were not performed. The Mobility score evaluates indoor walking, outdoor walking, and shopping, but it does not replace the quantitative walking measures the authors say were absent. All participants had to be able to walk indoors independently or live at home before injury, and the study excluded pathological fractures, trauma from traffic accident or fall from height, death or systemic complications, pre-injury wheelchair use, moderate or high cognitive dysfunction, stroke effects, missing records, or refusal. The authors state that larger prospective studies are needed to clarify the influence of lesser trochanteric displacement on walking ability and performance of ADL.
The easy way to misread this
Do not conclude that preventing lesser trochanteric displacement will shorten hospital stay. This was a retrospective association study of 60 patients, not a trial, and it did not test a treatment that changed displacement or discharge timing.