Extracapsular fractures

Background Benefits of post-operative partial weight bearing (PWB) in extracapsular hip fractures (ECFs) have not been proved. We have assessed influence of PWB on long-term survival and the final mobility achieved, dependence and mortality-related factors. Methods Retrospective cohort study of osteoporotic ECFs in ≥ 65-year-old patients who underwent surgery with trochanteric Gamma3 nails in 2014 (n=218), followed in the long term (consolidation or stabilisation). According to Baumgaertner-Fogagnolo classification (138 good, 71 acceptable and 9 poor) a postoperative protocol was applied. 116 cases bore weight before discharge (Immediate Partial Weight Bearing, IPWB=116; Not-IPWB=102), and 118 did it after a month (Early PWB, EPWB=118; Not-EPWB=100). Variables were collected from medical records and complementary studies. We used FMS (Fracture Mobility Score) and the National Mortality Database from the Spanish Ministry of Health at >5 years. EPWB and Not-EPWB were comparable, except for hospital stay and dependence. We used the Cox method for mortality. <0.05 P-values were significant. Results Survival improved in IPWB earlier than in EPWB, although there was no statistical significance. The final FMS was significantly favourable only in EPWB. Not-EPWB showed greater dependence. Age (per year of increment), moderate Charlson comorbidity index (not age-modified) and greater immediate postoperative anaemia rates were independent factors for mortality, but no radiological factors. Conclusions Postoperative PWB in ECF may increase mid-term and long-term survival rates, but considerably delayed in EPWB. Only EPWB improved final mobility. Not-EPWB presented with greater dependence. Only clinical factors were independently related to mortality, but no radiological factors were.