Title:
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Prognostic factors for outcome in hip fracture patients
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The aims of the Edinburgh Hip Fracture Study were to determine the distribution of outcomes over a one year period following a hip fracture; to establish between measures of outcome and the patients' pre-fracture status; and to derive prognostic indices. An unselected consecutive series of osteoporotic hip fracture patients was recruited over a six month period and followed up at 1, 6 and 12 months post-fracture. 270 patients were recruited into the study. Normative data on a wide range of baseline characteristics of hip fracture patients and their outcome were obtained. Patients were mainly elderly, physically and mentally frail, and dependent. The cumulative mortality was 29%. A general pattern of recovery emerged. At 1 month post-fracture there was a profound loss of functioning, partial improvement at 6 months and then a plateauing out over the final 6 months of follow-up to a point below the baseline level. There was a substantial decline in mobility over the year following the fracture. An unexpected finding was that 12% had a significant degree of femoral shortening. Despite the pattern of increased dependency in the survivors the overall burden at the community level was noted to decline by one year post-fracture due to the frailer individuals dying during the course of follow-up. Prognostic indices were derived for mortality, placement, depression and dependency at 1 and 12 months post-fracture using multivariate statistical methods. Hip pain and function were also assessed at 12 months post-fracture. The derived indices reflected the importance of age, pre-fracture health, dependency and fracture type on outcome. Depression and social variables were not found to be useful predictors of outcome.
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