The effectiveness of immediate weight bearing as tolerated versus delayed weight bearing following intramedullary fixation for geriatric intertrochanteric fractures: a post-hoc analysis

The effectiveness of immediate weight bearing as tolerated versus delayed weight bearing following intramedullary fixation for geriatric intertrochanteric fractures: a post-hoc analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The effectiveness of immediate weight bearing as tolerated versus delayed weight bearing following intramedullary fixation for geriatric intertrochanteric fractures: a post-hoc analysis Ning Li, Kai-Yuan Cheng, Jing Zhang, Gang Liu, Li Zhou, Shi-Wen Zhu, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4215688/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Early weight bearing is an essential variable for fracture healing after osteosynthesis for Intertrochanteric fractures (ITF), which may impact morbidity and mortality. The optimal period to start weight bearing after surgery is still under debate, despite the recommendation of guidelines. The objective of this study was to evaluate the effectiveness of both a delayed and an immediate weight-bearing regimen following intramedullary fixation for elderly ITF. Methods This study is a post-hoc analysis of the multicenter prospective non-randomized controlled study (NCT03184896) listed on Clinicaltrials.gov. Eligible patients were aged ≥ 65 years with X-ray confirmed ITF, admitted within 21 days after injury and received intramedullary fixation surgery. Patients would be excluded if they were diagnosed with pathologic fractures, unable to comply with the rehabilitation program due to physical or psychological problems or received conservative treatment or other types of surgery. Patients bearing weight as tolerated during hospitalization were identified as the immediate weight bearing (IWB) group and patients bearing weight after discharge were identified as the delayed weight bearing (DWB) group in this study. The primary outcome was EQ5D score of patients at 120 days post-surgery. Secondary outcomes include EQ5D score of patients at 30 days and 365 days post-surgery, complication rate and mortality. Results 410 eligible patients enrolled (190 patients with IWB and 220 patients with DWB). Compared to the DWB group, the IWB group had a higher EQ5D score at 30 days and 120 days after surgery (30d, P < 0.001; 120d, P = 0.002). The DWB group had a higher EQ5D score at 365 days after surgery (P = 0.012) than the IWB group. There were no statistical differences in the incidence of any complication, reoperation rate, or cumulative complication rate between the two groups. The one-year mortality was 5.79% in the IWB group and 4.55% in the DWB group (P = 0.542). Conclusions Immediate weight bearing as tolerated following intramedullary fixation for intertrochanteric fractures in elderly patients improves functional outcomes in the early stage (within 120 days after surgery) without increasing the incidence of complications, reoperation, or mortality compared with delayed weight bearing. intertrochanteric fracture weight bearing EQ5D complication mortality Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Intramedullary fixation is a commonly employed surgical procedure for the treatment of intertrochanteric fractures. According to the reported data, the incidence of clinical failures varies from 0.5–56%, depending on the type of fracture, the patient’s condition, and the effectiveness of the surgery and consequential rehabilitation[ 1 – 3 ]. The strategy to improve the patient’s quality of life and mitigate the occurrence of complications and surgical failures is still under investigation. Notably, early weight bearing following intramedullary fixation for intertrochanteric fractures is a crucially adjustable element for fracture healing and may prevent further complications, reducing morbidity and mortality. The guidelines from the American Academy of Orthopaedic Surgeons strongly recommend initiating early weight bearing rehabilitation after surgery, but there is still ongoing debate over the optimal timing for commencing weight bearing [ 4 , 5 ]. Although research has suggested that delayed mobilization after the surgical treatment of intertrochanteric fractures is a risk factor for complications such as pneumonia, deep venous thrombosis, urinary tract infection and delirium[ 6 – 8 ], limitations are often advised to preserve surgical restoration and account for underlying bone quality[ 9 , 10 ]. Early loading of a fresh fracture may lead to a substantial increase in strain at the fracture site, causing a significant delay in fracture healing and a decrease in the quality of the newly formed tissue compared to fractures subjected to restricted loading conditions[ 11 ]. In consideration of the lifestyle of the Chinese elderly and their physical condition, some scholars recommend that only muscle strength and joint mobility training should be carried out in the early stage after osteosynthesis, and weight-bearing training should be initiated until there is callus growth at the fracture site in order to prevent internal fixation failure[ 12 ]. On the other hand, Dr. He reported a study of 45 cases that early weight bearing within 48h after proximal femoral nail anti-rotation (PFNA) fixation for Evans-Jensen type II intertrochanteric fractures and reduction with positive medical cortex support could shorten the length of stay, fracture healing time and promote early recovery of hip function[ 13 ]. The order of “immediate weight bearing” has not been issued consistently postoperatively in China. The aim of the study was to compare the effectiveness of immediate weight bearing as tolerated regimen with delayed weight bearing regimen after intramedullary fixation for geriatric intertrochanteric fractures. The current study acts as a post-hoc analysis of the multicenter prospective non-randomized controlled study (Clinicaltrials.gov NCT03184896)[ 14 ]. Patients bearing weight as tolerated during hospitalization were identified as the immediate weight bearing (IWB) group and patients bearing weight after discharge were identified as the delayed weight bearing (DWB) group in our study. We hypothesized that patients with immediate weight bearing as tolerated (during hospitalization) would have better outcomes compared to those with delayed weight bearing (after discharge). Materials and Methods Participants and study design The original study conducted in Beijing (China) is a multicenter prospective non-randomized controlled study (Clinicaltrials.gov NCT03184896)[ 14 ], aimed at evaluating a co-management care model of elderly patients with hip fractures in China on the quality standards guided by the UK “Blue Book”[ 15 ], compared with routine care, in order to establish a standardized protocol for precision care in elderly patients with hip fractures in China. This post-hoc analysis included patients at Beijing Jishuitan Hospital from November 26th, 2018 to November 30th, 2019. Qualified nurses collected baseline characteristics and in-hospital conditions through a face-to-face interview. The follow-up was made by phone call at 30 days, 120 days, and 365 days after discharge. Each patient signed informed consent to participate in the study. The Biomedical Ethics Committee at Beijing Jishuitan Hospital (201807-11) and the Institutional Review Board at Peking University Health Science Centre (IRB00001052-17021) both granted ethics approvals. Eligibility Patients will be enrolled in the study if they meet the criteria: 1) aged 65 and older; 2) admitted into our hospital within 21 days of the fractures and treated under orthogeriatric co-management care; 3) the intertrochanteric fracture was confirmed with X-ray; 4) receiving intramedullary fixation surgery. Exclusion criteria are: 1) the patient was diagnosed with pathologic fracture; 2) multiple fractures or other type of fractures; 3) patients unable to comply with the regular rehabilitation program because of cognitive disorders and other barriers, such as a language barrier, immobility prior to surgery or severe medical illness; 4) patients receiving conservative treatments or other types of surgery. Anticoagulation protocol Subcutaneous injection of low molecular weight heparin (LWMH) was administered during the hospitalization period. After discharge, the sequential subcutaneous LMWH was followed by oral rivaroxaban at a dose of 20mg once daily for 5 weeks postoperatively. In cases where deep vein thrombosis (DVT) occurred during the perioperative period, rivaroxaban was extended for an additional 3 months postoperatively. Outcome measurements Trained orthopaedic nurses were responsible for patients’ screening, enrollments, and data collection at baseline and follow-ups. The baseline data depicted patient demographic information (e.g., age and gender), peri-operative information (e.g., side of fracture, BMD, ASA grade, type of anaesthesia and type of fracture) and post-operative information (e.g., hospital length of stay and discharge destination). Mobility, complications and mortality data were included in the follow-up data. A table-based Research Electronic Data Capture system was used to collect data. The primary outcome was the EQ-5D score at 120 days after surgery. Secondary outcomes included the EQ-5D score at 30 and 365 days after surgery, the incidence of complications and reoperations at 30, 120 and 365 days after surgery, and cumulative mortality within one year. Statistical Analysis Continuous variables were expressed as mean ± standard deviation (SD), while categorical variables were described as the frequencies and proportions. Student t-test was applied for variables with a normal distribution, or a non-parametric test (Mann-Whitney) was used. The categorical variables were analyzed by chi-square test. Two-sided P < 0.05 was statistical significance in this study. The one-year cumulative mortality was referred to the death occurring within one-year from the ward admission (370 days as the upper limit of follow-up) in both groups. A log-rank test was performed using the Kaplan-Meier survivorship analysis to determine the difference between the IWB and DWB groups in terms of survival status. For each risk factor, a Cox proportional hazards model was employed. To evaluate risk factors, a multivariate analysis was run on variables with P values < 0.05 in the univariate study. We conducted the analysis procedure by SPSS, version 23.0 and SAS, version 9.4. Source of Funding This study received support from the Beijing Municipal Science & Technology Commission (Z211100002921056), the National Key Research and Development Program of China (2021YFC2501706), and Capital’s Funds for Health Improvement and Research (2018-1-2071, 2022-1-2071). Results Patients and Injury Characteristics A total of 410 patients who underwent intramedullary fixation for an intertrochanteric fracture in the original study and met the inclusion criteria were collected (Fig. 1). Out of these patients, 190 (46.3%) patients capable of performing weight bearing as tolerated during hospitalization were identified as the immediate weight bearing (IWB) group. On the other hand, 220 (53.7%) patients disabled from performing weight bearing before discharge were identified as the delayed weight bearing (DWB) group. The demographics of the patients in each of these categories are shown in Table 1 . Table 1 Patient demographics. BMI body mass index, BMD bone mineral density, SD standard deviation, ASA American Society of Anesthesiologists. Immediate Weight-Bearing (IWB) Delayed Weight-Bearing (DWB) P Number of patients 190 220 Sex (male/female) 59/131 58/162 0.324 Age, yrs ± SD 80.97 ± 7.56 80.91 ± 7.28 0.692‡ BMI, kg/m 2 ± SD † 23.04 ± 3.89 23.25 ± 4.27 0.601‡ Living by himself/herself(yes/no) † 0.338 Yes 17 27 No 171 193 Smoking 0.253 Once 24 17 Now 13 15 Never 153 188 Frequency of drinking per month 0.688 Never 179 202 Less than 1 4 7 2–4 2 1 5–16 1 1 More than 16 4 9 Side of fracture (left/right/bilateral) 99/91/0 107/107/6 0.062 T-score of BMD ± SD (greater trochanter) † -3.05 ± 1.12 -3.21 ± 1.06 0.578 T-score of BMD ± SD (overall) † -3.18 ± 1.09 -3.07 ± 1.09 0.938‡ ASA grade, score ± SD 2.29 ± 0.67 2.20 ± 0.74 0.116‡ ASA grade distribution 0.157 ASA I 20 33 ASA II 98 119 ASA III 69 60 ASA IV 3 7 ASA V 0 1 Type of anaesthesia 0.778 General anaesthesia 5 7 Spinal anaesthesia 185 213 Type of fracture 0.998 31A1 55 63 31A2 117 136 31A3 18 21 Discharge destination 0.364 Home 172 190 Nursing home (without 24-hour care) 1 5 Nursing home (with 24-hour care) 1 1 Rehabilitation Department 1 4 Another department (except orthogeriatric and rehabilitation) 3 8 Other hospital 12 12 Hospital length of stay, days ± SD 6.32 ± 3.55 5.82 ± 6.46 0.034‡ † Patients’ data was missing in part. ‡ The data is not normally distributed. Mann-Whitney U test was used. Among the 410 patients, the mean age was 80.93 ± 7.40 years, and 293 of them(71.5%) were female. Variables in the two groups consisted of age, gender, body mass index (BMI, calculated as weight in kilograms divided by height in meters squared), living status (living alone or requiring care), smoking, drinking, side of the fracture, T-score of bone mineral density, ASA grade, type of anaesthesia, type of fracture and discharge destination. There were no significant differences between the two groups regarding these elements. The hospital length of stay was 6.32 ± 3.55 days in IWB group and 5.82 ± 6.46 days in DWB group, and the difference was significant (P = 0.034). Outcomes Figure 2 exhibits the EQ5D score in two groups. For the primary outcome, at 120 days post-surgery, the EQ5D score of the IWB group was 73.51 ± 12.62, whereas the DWB group had a score of 70.55 ± 11.36, P = 0.002 (Fig. 2b). For the secondary outcomes, at 30 days post-surgery, the EQ5D score of the IWB group was 74.01 ± 14.87, whereas the DWB group had a score of 66.23 ± 13.14, P < 0.001 (Fig. 1\2a). At 365 days post-surgery, the EQ5D score of the IWB group was 73.89 ± 16.88, whereas the EQ5D score of the DWB group was 78.33 ± 15.24, P = 0.012 (Fig. 2c). There was no improvement in the EQ5D score of the IWB group after 30 days following surgery (IWB 30d vs. 120d, P = 0.898; IWB 30d vs. 365d, P = 0.676; IWB 120d vs. 365d, P = 0.927) (Fig. 2f). However, the EQ5D score of the DWB group showed substantial improvement at 120 days and 365 days following surgery (DWB 30d vs. 120d, P < 0.001; DWB 30d vs. 365d, P < 0.001; DWB 120d vs. 365d, P < 0.001) (Fig. 2g). The EQ5D score of each patient in both groups is illustrated in Figs. 2d and 2e. The hue corresponds to the range of the EQ5D score spectrum. No disparities were seen in the incidence of any complication between the two groups, as indicated in Table 2 . At follow-up 30 days after surgery, 8 patients had complications and 2 patients died in the IWB group. Similarly, the DWB group had 11 patients with complications and 1 patient died. At follow-up 120 days after surgery, 7 patients had complications and 5 patients died in the IWB group, whereas 6 patients had complications and 2 patients died in the DWB group. At follow-up 365 days after surgery, 10 patients had complications and 4 patients died in the IWB group. In comparison, the DWB group had 4 patients with complications and 7 patients died. The cumulative complication rate is shown in Fig. 2. The cumulative complication rate was 4.21% in the IWB group and 5.00% in the DWB group at 30 days after surgery (P = 0.816), 5.79% in the IWB group and 6.36% in the DWB group at 120 days after surgery (P = 0.839), 8.42% in the IWB group and 6.81% in the DWB group at 365 days after surgery (P = 0.578). There was no statistical difference in the cumulative complication rate between the IWB and DWB groups (Fig. 3). Furthermore, there was no statistical difference in the incidence of each category of reoperation between the two groups, as shown in Table 3 . Overall survival Kaplan-Meier curve was depicted in Fig. 4. The one-year mortality was 5.79% in the IWB group and 4.55% in the DWB group (Log-rank test, P = 0.542). Table 2 Incidence of complications in 410 patients with intertrochanteric fractures in one year after surgery. Patients were consulted about their complications at 30 days, 120 days and 365 days after surgery. Complication IWB-d30 (n = 190) DWB-d30 (n = 220) P IWB-d120 (n = 188) DWB-d120 (n = 219) P IWB-d365 (n = 183) DWB-d365 (n = 217) P Deep venous thrombosis 3 (1.6) 7 (3.2) 0.351 4 (2.1) 4 (1.8) 1.000 5 (2.7) 2 (0.9) 0.254 Pulmonary embolism 0 0 / 0 1 (0.4) 1.000 1 (0.5) 2 (0.9) 1.000 Pneumonia 1 (0.5) 1 (0.4) 1.000 1 (0.5) 1 (0.4) 1.000 2 (1.1) 0 0.209 Urinary tract infection 2 (1.0) 1 (0.4) 0.599 1 (0.5) 0 0.462 0 0 / Delirium 0 1 (0.4) 1.000 0 0 / 0 0 / Neurological complications 1 (0.5) 1 (0.4) 1.000 1 (0.5) 0 0.462 1 (0.5) 0 0.457 Cardiovascular complications 2 (1.0) 0 0.214 1 (0.5) 0 0.462 1 (0.5) 0 0.457 Other 0 1 (0.4) a 1.000 0 0 / 1 (0.5) b 0 0.457 Total number of patients with complications 8 (4.2) 11 (5.0) 0.816 7 (3.7) 6 (2.7) 0.586 10 (5.5) 4 (1.8) 0.059 Data are given as n (%) . Note that one patient could experience more than one complication. No significant difference between groups in the complication rate. a. genital infection. b. hyperparathyroidism. Table 3 Incidence of reoperations in 410 patients with intertrochanteric fractures in one year after surgery. Patients were consulted about their reoperations at 30 days, 120 days and 365 days after surgery. Type of reoperation IWB-d30 (n = 190) DWB-d30 (n = 220) P IWB-d120 (n = 188) DWB-d120 (n = 219) P IWB-d365 (n = 183) DWB-d365 (n = 217) P Removal of internal fixation 0 0 / 0 0 / 1 (0.5) 0 0.458 Transfer to hip arthroplasty 0 0 / 1 (0.5) 0 0.463 1 (0.5) 0 0.458 Secondary fracture after internal fixation 0 1 (0.4) 1.000 0 1 (0.4) 1.000 0 0 0 Overall reoperations 0 1 (0.4) 1.000 1 (0.5) 1(0.4) 1.000 2 (1.1) 0 0.209 Data are given as n (%) . Note that one patient could experience more than one reoperation. No significant difference between groups in the reoperation rate. Discussion Intramedullary fixation is an established treatment approach for intertrochanteric fractures, and the weight-bearing status following surgery plays a crucial role in determining the prognosis and functional outcomes of patients. Jia reported that comparison of functional outcomes and complications between immediate weight bearing and restricted weight bearing in elderly patients with intertrochanteric fractures treated with proximal femoral nail anti-rotation II [ 16 ]. No previous study investigated the effectiveness comparison between immediate weight bearing and delayed weight bearing in patients with intertrochanteric fractures after surgery. The objective of this study was to evaluate and compare the functional outcomes, complications, reoperation rate and mortality to define the optimal weight-bearing protocol following intertrochanteric fracture surgery in elderly patients. Only patients in Beijing Jishuitan Hospital were enrolled in this study, because the other 5 hospitals of the original multicentre study provided usual care for hip fracture patients, which may add potential selection bias to our results. This post-hoc analysis focusing on elderly patients with intramedullary fixation for intertrochanteric fractures found that the receipt of immediate weight bearing as tolerated, compared with delayed weight bearing, resulted in better postoperative functional outcomes during the early stage after surgery and did not increase the risks of postoperative implant failure (screw cutout, stress failure, and nonunion) or complications. The two groups exhibited identical demographics, which enhanced the internal validity of this study. However, the hospital length of stay was shorter in the DWB group. The possible reason for this may come from the pain of early mobilization in IWB group and insufficient analgesia, while Chinese patients tend to take fewer painkillers around the world[ 17 ]. The weight bearing status seems to have an impact on the patient's health, but the nature of this impact may differ between the short-term and long-term periods in our study. At one-year follow-up, the patients with delayed weight bearing appeared to have a higher EQ5D score than patients with immediate weight bearing. However, in the early stage, at 30 days and 120 days after surgery, patients with immediate weight bearing had a higher EQ5D score compared to patients with delayed weight bearing. Based on our clinical observations and literature reviews[ 18 ], patients with worse outcomes in the early stage could lower their expectation of health status, and the EQ5D score is a subjective assessment questionnaire, in which the patient’s psychological condition plays a crucial role. Therefore, patients in the DWB group with lower EQ5D scores in the early stage may have reduced expectations for the outcomes and rate higher clinical scores in long-term follow-up in comparison with patients in the IWB group, which might explain the tricky phenomenon in our study. Additionally, it is worth noting that the EQ5D score of the IWB group did not show any statistical difference after 30 days post-surgery. In contrast, the DWB group exhibited substantial improvement in their EQ5D score at 120 days and 365 days post-surgery. In other words, patients who engage in immediate weight bearing as tolerated after surgery may have swift progress in their functional recovery and sustain it consistently, whereas patients with delayed weight bearing may undergo a rather “typical” functional recovery. Regarding the complications, noteworthy comparisons were the incidences of deep venous thrombosis (DVT) and overall complications at 30 days and 365 days post-surgery. The incidences of DVT and overall complications were lower at 30 days after surgery in the IWB group than in the DWB group; however, this relationship was overturned at 365 days after surgery, despite no statistical difference. The occurrence of reoperation was infrequent among these patients, and there was no difference in reoperation rates between the two groups. The one-year mortality was higher in the IWB group compared to the DWB group, with no statistically significant difference. Our study explored the pros and cons of different timings of weight bearing and pinpointed that immediate weight bearing as tolerated following intramedullary fixation for geriatric intertrochanteric fractures compared with delayed weight bearing improved the functional outcome in the early stage without increasing the incidence of complications, reoperation, or mortality. A twelve-week study concluded that elderly patients who were allowed to bear as much weight as tolerated appeared to voluntarily limit loading on the injured limb after operative treatment for intertrochanteric fractures[ 19 ]. Biomechanical tests and finite element analyses indicated that an early weight-bearing load of 900N (1.45 times body weight) could be recommended for postoperative rehabilitation of geriatric intertrochanteric fractures[ 20 ]. In terms of complications, reoperation, and mortality, there are diverse factors influencing them. Fracture patterns, type of surgery, and age play a crucial role in the complications and mortality of intertrochanteric fractures[ 21 – 23 ]. Weight bearing may not be an independent risk factor for complications, reoperation, or mortality. In the meantime, long-term functional outcomes following surgery for intertrochanteric fractures may not be limited to weight bearing. The anxiety state was observed to have an impact on functional outcomes following surgery for intertrochanteric fractures, according to a prospective observational cohort study[ 24 ]. In addition, Adulkasem et al. evaluated both clinical and surgical parameters to determine prognostic factors for one-year postoperative functional outcomes. The author discovered that haemoglobin levels before surgery, pre-injury ambulatory status, BMI, and the New Mobility Score (NMS) were all independent factors for achieving a favourable postoperative functional outcome. Age and NMS were significantly associated with the ability to restore pre-injury function[ 25 ]. Therefore, based on the findings in our study and the interpretation of previous research, immediate weight bearing as tolerated is beneficial in the early stage and should be encouraged after operative treatment of intertrochanteric fractures. There are several limitations to be considered in our study. Firstly, the evaluation of the primary outcome and secondary outcomes was conducted via telephone, so the assessment might not be as reliable as face-to-face follow-up and could introduce recall bias, social desirability bias, and response bias as patients might not remember or report their experiences truthfully or consistently. Secondly, the current study is a post-hoc analysis, involving a smaller subset of participants compared to the main trial, which may result in reduced statistical power. This may present a challenge in identifying significant differences, especially for outcomes with low prevalence, such as complications and reoperations in this study. In the meantime, the study design is prospective but non-randomized, and RCT could enhance the robustness of the study. However, the nature of our investigation, involving post-hoc analysis, limited our ability to implement randomization. Moreover, a meticulous assessment of actual weight bearing and the exact time of weight bearing outside the hospital in the DWB group was absent from this study, which plays an essential role in the results. The patient in the DWB group could undergo weight bearing at any time after discharge. However, due to recalling bias, it is difficult to obtain objective and accurate information about the duration of the delay. Furthermore, the type of weight bearing in our study was classified into IWB and DWB, while we failed to quantify the weight. A constant amount of weight would improve the quality of the study. However, in the clinical scenario, the ambulation ability of the elderly was attenuated, and some may walk with crutches before the fracture. An altered level of consciousness also contributes to the deterioration of ambulation in geriatric patients with fractures. At present, weight bearing as tolerated is recommended for the balance recovery of elderly patients to decrease the risk of falling again. A constant amount of weight bearing is difficult to implement in the real world. Therefore, smart wearable medical devices with mobile force sensors are necessary for accurately detecting the real-time weight bearing status of patients in future research. In addition, the current study was a single-centre design, which may limit the generalizability of these results. It is imperative to carry out large-scale, randomized, and multicenter investigations to enhance the credibility and generalizability of the study. Finally, the surgical techniques and operational details varied among the surgeons, which may affect the treatment of intertrochanteric fractures. In conclusion, for elderly patients with intra journal of orthopaedic surgery research medullary fixation for intertrochanteric fractures, immediate weight bearing as tolerated improved the functional outcomes in the early stage and did not increase the incidence of complications, reoperation, or mortality compared with delayed weight bearing. These findings affirm the viability of allowing immediate weight bearing as tolerated post-surgery for elderly patients with intertrochanteric fractures. This will empower surgeons to provide more confident recommendations regarding the optimal weight-bearing protocol following surgery for geriatric intertrochanteric fractures. Declarations Funding Beijing Municipal Science & Technology Commission (Z211100002921056), Recipient: Xie-Yuan Jiang National Key Research and Development Program of China (2021YFC2501706) Recipient: Xie-Yuan Jiang Capital’s Funds for Health Improvement and Research (2018-1-2071, 2022-1-2071) Recipient: Ming-Hui Yang Conflict of Interest The authors declare that they have no conflict of interest. Author contributions Ning Li: Writing - Review & Editing, Supervision, Project administration Kai-Yuan Cheng: Formal analysis, Writing - Original Draft, Software Jing Zhang: Writing - Review & Editing, Methodology Gang Liu: Validation, Investigation Li Zhou: Data Curation, Validation Shi-Wen Zhu: Visualization, Investigation Ming-Hui Yang: Conceptualization, Writing - Review & Editing, Supervision, Funding acquisition Xin-Bao Wu: Resources, Supervision Xie-Yuan Jiang: Funding acquisition, Project administration References Lin JC-F, Liang W-M. 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Geriatric orthopaedic surgery & rehabilitation.2023;14:21514593231193234. Adulkasem N, Phinyo P, Khorana J, Pruksakorn D, Apivatthakakul T. Prognostic factors of 1-year postoperative functional outcomes of older patients with intertrochanteric fractures in Thailand: a retrospective cohort study. International Journal of Environmental Research and Public Health. 2021;18:6896. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4215688","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":289988613,"identity":"427b08fe-6a6e-4892-bdde-dcb47a35b2cf","order_by":0,"name":"Ning Li","email":"","orcid":"","institution":"Beijing Jishuitan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ning","middleName":"","lastName":"Li","suffix":""},{"id":289988614,"identity":"b53f0e5f-e3ba-420c-bdcb-78647224153e","order_by":1,"name":"Kai-Yuan Cheng","email":"","orcid":"","institution":"Beijing Jishuitan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kai-Yuan","middleName":"","lastName":"Cheng","suffix":""},{"id":289988615,"identity":"e47535b9-ce3e-4c14-af7f-56280c9cbe8a","order_by":2,"name":"Jing Zhang","email":"","orcid":"","institution":"Beijing Jishuitan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Zhang","suffix":""},{"id":289988616,"identity":"c68540f9-f3af-4541-8fef-111ba53f0d42","order_by":3,"name":"Gang Liu","email":"","orcid":"","institution":"Beijing Jishuitan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Gang","middleName":"","lastName":"Liu","suffix":""},{"id":289988617,"identity":"2f037d22-484d-4c63-8ce6-652c4ba1172b","order_by":4,"name":"Li Zhou","email":"","orcid":"","institution":"Beijing Jishuitan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Zhou","suffix":""},{"id":289988618,"identity":"a7204cc5-306b-4ffe-b260-36f211024c54","order_by":5,"name":"Shi-Wen Zhu","email":"","orcid":"","institution":"Beijing Jishuitan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shi-Wen","middleName":"","lastName":"Zhu","suffix":""},{"id":289988619,"identity":"b231abba-55aa-4a8d-9672-0d4e5c8ecd41","order_by":6,"name":"Ming-Hui Yang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYDCCA1CajZn5+IcPBjZyxGhhbADR/OxsaYwzCtKMidci2c9jxszz4XAiQR18x5ufP+apuWO34TCD2WMbA+YEBvbDRzfg0yJ55phhM8+xZ8lALenGOQZseQw8aWk38GkxuJHD2MzDdjjZ4DDDAekcA55iBgkeMyK0/ANpYWyQtjCQSGwgSgtv22E7yWZmNmkGAwPCWkB+mTm373ACPzMbs2GPQYIxGyG/AEPswYc33w7bs/Gf//jgx5//cvzsh4/h1QICTDwMDIkNMB4bIeUgwPiDgcGeGIWjYBSMglEwQgEAMp5ONFB0FGoAAAAASUVORK5CYII=","orcid":"","institution":"Beijing 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05:02:58","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4215688/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4215688/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54993661,"identity":"0323fab0-7579-4a6b-a82b-f7f2ce893db2","added_by":"auto","created_at":"2024-04-19 17:39:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":45048,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"OnlineFigure13.png","url":"https://assets-eu.researchsquare.com/files/rs-4215688/v1/10ff559e62650ca7ec737e57.png"},{"id":54993419,"identity":"f27b1c81-19ac-4f8e-9bf0-2512ffb7bba1","added_by":"auto","created_at":"2024-04-19 17:31:02","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":165951,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"OnlineFigure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4215688/v1/47f3ba0259ab8efe29c1d427.png"},{"id":54993417,"identity":"d8dba94c-e389-4167-a48b-2e8085db15c1","added_by":"auto","created_at":"2024-04-19 17:31:01","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":41928,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"OnlineFigure3.png","url":"https://assets-eu.researchsquare.com/files/rs-4215688/v1/5c804f748b7e2d8cd9b0bbf9.png"},{"id":54993418,"identity":"cc5a9721-a44f-40fb-952a-7dae9d3eee7f","added_by":"auto","created_at":"2024-04-19 17:31:01","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":20108,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"OnlineFigure4.png","url":"https://assets-eu.researchsquare.com/files/rs-4215688/v1/c32daf4df7efd8ff5206935b.png"},{"id":54995777,"identity":"baa70bdc-68b1-4228-936e-9abe04bbfeec","added_by":"auto","created_at":"2024-04-19 17:55:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":989465,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4215688/v1/50b6c4a0-3cd4-4995-bb99-4f7f789d1894.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The effectiveness of immediate weight bearing as tolerated versus delayed weight bearing following intramedullary fixation for geriatric intertrochanteric fractures: a post-hoc analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIntramedullary fixation is a commonly employed surgical procedure for the treatment of intertrochanteric fractures. According to the reported data, the incidence of clinical failures varies from 0.5\u0026ndash;56%, depending on the type of fracture, the patient\u0026rsquo;s condition, and the effectiveness of the surgery and consequential rehabilitation[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The strategy to improve the patient\u0026rsquo;s quality of life and mitigate the occurrence of complications and surgical failures is still under investigation. Notably, early weight bearing following intramedullary fixation for intertrochanteric fractures is a crucially adjustable element for fracture healing and may prevent further complications, reducing morbidity and mortality. The guidelines from the American Academy of Orthopaedic Surgeons strongly recommend initiating early weight bearing rehabilitation after surgery, but there is still ongoing debate over the optimal timing for commencing weight bearing [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Although research has suggested that delayed mobilization after the surgical treatment of intertrochanteric fractures is a risk factor for complications such as pneumonia, deep venous thrombosis, urinary tract infection and delirium[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], limitations are often advised to preserve surgical restoration and account for underlying bone quality[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Early loading of a fresh fracture may lead to a substantial increase in strain at the fracture site, causing a significant delay in fracture healing and a decrease in the quality of the newly formed tissue compared to fractures subjected to restricted loading conditions[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn consideration of the lifestyle of the Chinese elderly and their physical condition, some scholars recommend that only muscle strength and joint mobility training should be carried out in the early stage after osteosynthesis, and weight-bearing training should be initiated until there is callus growth at the fracture site in order to prevent internal fixation failure[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. On the other hand, Dr. He reported a study of 45 cases that early weight bearing within 48h after proximal femoral nail anti-rotation (PFNA) fixation for Evans-Jensen type II intertrochanteric fractures and reduction with positive medical cortex support could shorten the length of stay, fracture healing time and promote early recovery of hip function[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The order of \u0026ldquo;immediate weight bearing\u0026rdquo; has not been issued consistently postoperatively in China. The aim of the study was to compare the effectiveness of immediate weight bearing as tolerated regimen with delayed weight bearing regimen after intramedullary fixation for geriatric intertrochanteric fractures. The current study acts as a post-hoc analysis of the multicenter prospective non-randomized controlled study (Clinicaltrials.gov NCT03184896)[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Patients bearing weight as tolerated during hospitalization were identified as the immediate weight bearing (IWB) group and patients bearing weight after discharge were identified as the delayed weight bearing (DWB) group in our study. We hypothesized that patients with immediate weight bearing as tolerated (during hospitalization) would have better outcomes compared to those with delayed weight bearing (after discharge).\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants and study design\u003c/h2\u003e \u003cp\u003eThe original study conducted in Beijing (China) is a multicenter prospective non-randomized controlled study (Clinicaltrials.gov NCT03184896)[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], aimed at evaluating a co-management care model of elderly patients with hip fractures in China on the quality standards guided by the UK \u0026ldquo;Blue Book\u0026rdquo;[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], compared with routine care, in order to establish a standardized protocol for precision care in elderly patients with hip fractures in China. This post-hoc analysis included patients at Beijing Jishuitan Hospital from November 26th, 2018 to November 30th, 2019. Qualified nurses collected baseline characteristics and in-hospital conditions through a face-to-face interview. The follow-up was made by phone call at 30 days, 120 days, and 365 days after discharge.\u003c/p\u003e \u003cp\u003e Each patient signed informed consent to participate in the study. The Biomedical Ethics Committee at Beijing Jishuitan Hospital (201807-11) and the Institutional Review Board at Peking University Health Science Centre (IRB00001052-17021) both granted ethics approvals.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eEligibility\u003c/h2\u003e \u003cp\u003ePatients will be enrolled in the study if they meet the criteria: 1) aged 65 and older; 2) admitted into our hospital within 21 days of the fractures and treated under orthogeriatric co-management care; 3) the intertrochanteric fracture was confirmed with X-ray; 4) receiving intramedullary fixation surgery. Exclusion criteria are: 1) the patient was diagnosed with pathologic fracture; 2) multiple fractures or other type of fractures; 3) patients unable to comply with the regular rehabilitation program because of cognitive disorders and other barriers, such as a language barrier, immobility prior to surgery or severe medical illness; 4) patients receiving conservative treatments or other types of surgery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eAnticoagulation protocol\u003c/h2\u003e \u003cp\u003eSubcutaneous injection of low molecular weight heparin (LWMH) was administered during the hospitalization period. After discharge, the sequential subcutaneous LMWH was followed by oral rivaroxaban at a dose of 20mg once daily for 5 weeks postoperatively. In cases where deep vein thrombosis (DVT) occurred during the perioperative period, rivaroxaban was extended for an additional 3 months postoperatively.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eOutcome measurements\u003c/h2\u003e \u003cp\u003eTrained orthopaedic nurses were responsible for patients\u0026rsquo; screening, enrollments, and data collection at baseline and follow-ups. The baseline data depicted patient demographic information (e.g., age and gender), peri-operative information (e.g., side of fracture, BMD, ASA grade, type of anaesthesia and type of fracture) and post-operative information (e.g., hospital length of stay and discharge destination). Mobility, complications and mortality data were included in the follow-up data. A table-based Research Electronic Data Capture system was used to collect data. The primary outcome was the EQ-5D score at 120 days after surgery. Secondary outcomes included the EQ-5D score at 30 and 365 days after surgery, the incidence of complications and reoperations at 30, 120 and 365 days after surgery, and cumulative mortality within one year.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eContinuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), while categorical variables were described as the frequencies and proportions. Student t-test was applied for variables with a normal distribution, or a non-parametric test (Mann-Whitney) was used. The categorical variables were analyzed by chi-square test. Two-sided P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was statistical significance in this study. The one-year cumulative mortality was referred to the death occurring within one-year from the ward admission (370 days as the upper limit of follow-up) in both groups. A log-rank test was performed using the Kaplan-Meier survivorship analysis to determine the difference between the IWB and DWB groups in terms of survival status. For each risk factor, a Cox proportional hazards model was employed. To evaluate risk factors, a multivariate analysis was run on variables with P values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in the univariate study. We conducted the analysis procedure by SPSS, version 23.0 and SAS, version 9.4.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSource of Funding\u003c/h2\u003e \u003cp\u003eThis study received support from the Beijing Municipal Science \u0026amp; Technology Commission (Z211100002921056), the National Key Research and Development Program of China (2021YFC2501706), and Capital\u0026rsquo;s Funds for Health Improvement and Research (2018-1-2071, 2022-1-2071).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003ePatients and Injury Characteristics\u003c/h2\u003e \u003cp\u003eA total of 410 patients who underwent intramedullary fixation for an intertrochanteric fracture in the original study and met the inclusion criteria were collected (Fig.\u0026nbsp;1). Out of these patients, 190 (46.3%) patients capable of performing weight bearing as tolerated during hospitalization were identified as the immediate weight bearing (IWB) group. On the other hand, 220 (53.7%) patients disabled from performing weight bearing before discharge were identified as the delayed weight bearing (DWB) group. The demographics of the patients in each of these categories are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient demographics. \u003cem\u003eBMI\u003c/em\u003e body mass index, \u003cem\u003eBMD\u003c/em\u003e bone mineral density, \u003cem\u003eSD\u003c/em\u003e standard deviation, \u003cem\u003eASA\u003c/em\u003e American Society of Anesthesiologists.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImmediate Weight-Bearing (IWB)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDelayed Weight-Bearing (DWB)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of patients\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex (male/female)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59/131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58/162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.324\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge, yrs\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80.97\u0026thinsp;\u0026plusmn;\u0026thinsp;7.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80.91\u0026thinsp;\u0026plusmn;\u0026thinsp;7.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.692\u0026Dagger;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI, kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;\u003cb\u003e\u0026plusmn;\u0026thinsp;SD \u0026dagger;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.04\u0026thinsp;\u0026plusmn;\u0026thinsp;3.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.25\u0026thinsp;\u0026plusmn;\u0026thinsp;4.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.601\u0026Dagger;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLiving by himself/herself(yes/no) \u0026dagger;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.338\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e193\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.253\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e188\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFrequency of drinking per month\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.688\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSide of fracture (left/right/bilateral)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99/91/0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107/107/6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eT-score of BMD\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (greater trochanter) \u0026dagger;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-3.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-3.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.578\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eT-score of BMD\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u0026nbsp;(overall) \u0026dagger;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-3.18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-3.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.938\u0026Dagger;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eASA grade, score\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.116\u0026Dagger;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eASA grade distribution\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA V\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of anaesthesia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.778\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral anaesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpinal anaesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of fracture\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31A1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31A2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31A3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDischarge destination\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.364\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNursing home (without 24-hour care)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNursing home (with 24-hour care)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRehabilitation Department\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnother department (except\u003c/p\u003e \u003cp\u003eorthogeriatric and rehabilitation)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHospital length of stay, days\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.32\u0026thinsp;\u0026plusmn;\u0026thinsp;3.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.82\u0026thinsp;\u0026plusmn;\u0026thinsp;6.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.034\u0026Dagger;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u0026dagger; Patients\u0026rsquo; data was missing in part.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u0026Dagger; The data is not normally distributed. Mann-Whitney U test was used.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAmong the 410 patients, the mean age was 80.93\u0026thinsp;\u0026plusmn;\u0026thinsp;7.40 years, and 293 of them(71.5%) were female. Variables in the two groups consisted of age, gender, body mass index (BMI, calculated as weight in kilograms divided by height in meters squared), living status (living alone or requiring care), smoking, drinking, side of the fracture, T-score of bone mineral density, ASA grade, type of anaesthesia, type of fracture and discharge destination. There were no significant differences between the two groups regarding these elements. The hospital length of stay was 6.32\u0026thinsp;\u0026plusmn;\u0026thinsp;3.55 days in IWB group and 5.82\u0026thinsp;\u0026plusmn;\u0026thinsp;6.46 days in DWB group, and the difference was significant (P\u0026thinsp;=\u0026thinsp;0.034).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eOutcomes\u003c/h2\u003e \u003cp\u003eFigure 2 exhibits the EQ5D score in two groups. For the primary outcome, at 120 days post-surgery, the EQ5D score of the IWB group was 73.51\u0026thinsp;\u0026plusmn;\u0026thinsp;12.62, whereas the DWB group had a score of 70.55\u0026thinsp;\u0026plusmn;\u0026thinsp;11.36, P\u0026thinsp;=\u0026thinsp;0.002 (Fig.\u0026nbsp;2b). For the secondary outcomes, at 30 days post-surgery, the EQ5D score of the IWB group was 74.01\u0026thinsp;\u0026plusmn;\u0026thinsp;14.87, whereas the DWB group had a score of 66.23\u0026thinsp;\u0026plusmn;\u0026thinsp;13.14, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001 (Fig.\u0026nbsp;1\\2a). At 365 days post-surgery, the EQ5D score of the IWB group was 73.89\u0026thinsp;\u0026plusmn;\u0026thinsp;16.88, whereas the EQ5D score of the DWB group was 78.33\u0026thinsp;\u0026plusmn;\u0026thinsp;15.24, P\u0026thinsp;=\u0026thinsp;0.012 (Fig.\u0026nbsp;2c). There was no improvement in the EQ5D score of the IWB group after 30 days following surgery (IWB 30d vs. 120d, P\u0026thinsp;=\u0026thinsp;0.898; IWB 30d vs. 365d, P\u0026thinsp;=\u0026thinsp;0.676; IWB 120d vs. 365d, P\u0026thinsp;=\u0026thinsp;0.927) (Fig.\u0026nbsp;2f). However, the EQ5D score of the DWB group showed substantial improvement at 120 days and 365 days following surgery (DWB 30d vs. 120d, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; DWB 30d vs. 365d, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; DWB 120d vs. 365d, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;2g). The EQ5D score of each patient in both groups is illustrated in Figs.\u0026nbsp;2d and 2e. The hue corresponds to the range of the EQ5D score spectrum.\u003c/p\u003e \u003cp\u003eNo disparities were seen in the incidence of any complication between the two groups, as indicated in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. At follow-up 30 days after surgery, 8 patients had complications and 2 patients died in the IWB group. Similarly, the DWB group had 11 patients with complications and 1 patient died. At follow-up 120 days after surgery, 7 patients had complications and 5 patients died in the IWB group, whereas 6 patients had complications and 2 patients died in the DWB group. At follow-up 365 days after surgery, 10 patients had complications and 4 patients died in the IWB group. In comparison, the DWB group had 4 patients with complications and 7 patients died. The cumulative complication rate is shown in Fig.\u0026nbsp;2. The cumulative complication rate was 4.21% in the IWB group and 5.00% in the DWB group at 30 days after surgery (P\u0026thinsp;=\u0026thinsp;0.816), 5.79% in the IWB group and 6.36% in the DWB group at 120 days after surgery (P\u0026thinsp;=\u0026thinsp;0.839), 8.42% in the IWB group and 6.81% in the DWB group at 365 days after surgery (P\u0026thinsp;=\u0026thinsp;0.578). There was no statistical difference in the cumulative complication rate between the IWB and DWB groups (Fig.\u0026nbsp;3). Furthermore, there was no statistical difference in the incidence of each category of reoperation between the two groups, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Overall survival Kaplan-Meier curve was depicted in Fig.\u0026nbsp;4. The one-year mortality was 5.79% in the IWB group and 4.55% in the DWB group (Log-rank test, P\u0026thinsp;=\u0026thinsp;0.542).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIncidence of complications in 410 patients with intertrochanteric fractures in one year after surgery. Patients were consulted about their complications at 30 days, 120 days and 365 days after surgery.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIWB-d30 (n\u0026thinsp;=\u0026thinsp;190)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDWB-d30 (n\u0026thinsp;=\u0026thinsp;220)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIWB-d120 (n\u0026thinsp;=\u0026thinsp;188)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDWB-d120 (n\u0026thinsp;=\u0026thinsp;219)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIWB-d365 (n\u0026thinsp;=\u0026thinsp;183)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDWB-d365 (n\u0026thinsp;=\u0026thinsp;217)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeep venous thrombosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.254\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary embolism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.209\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrinary tract infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.599\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.462\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelirium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurological complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.462\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiovascular complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.462\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.4)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (0.5)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal number of patients with complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.816\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.586\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10 (5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eData are given as \u003cem\u003en (%)\u003c/em\u003e. Note that one patient could experience more than one complication. No significant difference between groups in the complication rate.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003ea. genital infection.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eb. hyperparathyroidism.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIncidence of reoperations in 410 patients with intertrochanteric fractures in one year after surgery. Patients were consulted about their reoperations at 30 days, 120 days and 365 days after surgery.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of reoperation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIWB-d30 (n\u0026thinsp;=\u0026thinsp;190)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDWB-d30 (n\u0026thinsp;=\u0026thinsp;220)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIWB-d120 (n\u0026thinsp;=\u0026thinsp;188)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDWB-d120 (n\u0026thinsp;=\u0026thinsp;219)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIWB-d365 (n\u0026thinsp;=\u0026thinsp;183)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDWB-d365 (n\u0026thinsp;=\u0026thinsp;217)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRemoval of internal fixation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.458\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransfer to hip arthroplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.463\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.458\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary fracture after internal fixation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall reoperations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.209\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eData are given as \u003cem\u003en (%)\u003c/em\u003e. Note that one patient could experience more than one reoperation. No significant difference between groups in the reoperation rate.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIntramedullary fixation is an established treatment approach for intertrochanteric fractures, and the weight-bearing status following surgery plays a crucial role in determining the prognosis and functional outcomes of patients. Jia reported that comparison of functional outcomes and complications between immediate weight bearing and restricted weight bearing in elderly patients with intertrochanteric fractures treated with proximal femoral nail anti-rotation II [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. No previous study investigated the effectiveness comparison between immediate weight bearing and delayed weight bearing in patients with intertrochanteric fractures after surgery. The objective of this study was to evaluate and compare the functional outcomes, complications, reoperation rate and mortality to define the optimal weight-bearing protocol following intertrochanteric fracture surgery in elderly patients. Only patients in Beijing Jishuitan Hospital were enrolled in this study, because the other 5 hospitals of the original multicentre study provided usual care for hip fracture patients, which may add potential selection bias to our results.\u003c/p\u003e \u003cp\u003eThis post-hoc analysis focusing on elderly patients with intramedullary fixation for intertrochanteric fractures found that the receipt of immediate weight bearing as tolerated, compared with delayed weight bearing, resulted in better postoperative functional outcomes during the early stage after surgery and did not increase the risks of postoperative implant failure (screw cutout, stress failure, and nonunion) or complications. The two groups exhibited identical demographics, which enhanced the internal validity of this study. However, the hospital length of stay was shorter in the DWB group. The possible reason for this may come from the pain of early mobilization in IWB group and insufficient analgesia, while Chinese patients tend to take fewer painkillers around the world[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe weight bearing status seems to have an impact on the patient's health, but the nature of this impact may differ between the short-term and long-term periods in our study. At one-year follow-up, the patients with delayed weight bearing appeared to have a higher EQ5D score than patients with immediate weight bearing. However, in the early stage, at 30 days and 120 days after surgery, patients with immediate weight bearing had a higher EQ5D score compared to patients with delayed weight bearing. Based on our clinical observations and literature reviews[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], patients with worse outcomes in the early stage could lower their expectation of health status, and the EQ5D score is a subjective assessment questionnaire, in which the patient\u0026rsquo;s psychological condition plays a crucial role. Therefore, patients in the DWB group with lower EQ5D scores in the early stage may have reduced expectations for the outcomes and rate higher clinical scores in long-term follow-up in comparison with patients in the IWB group, which might explain the tricky phenomenon in our study. Additionally, it is worth noting that the EQ5D score of the IWB group did not show any statistical difference after 30 days post-surgery. In contrast, the DWB group exhibited substantial improvement in their EQ5D score at 120 days and 365 days post-surgery. In other words, patients who engage in immediate weight bearing as tolerated after surgery may have swift progress in their functional recovery and sustain it consistently, whereas patients with delayed weight bearing may undergo a rather \u0026ldquo;typical\u0026rdquo; functional recovery.\u003c/p\u003e \u003cp\u003eRegarding the complications, noteworthy comparisons were the incidences of deep venous thrombosis (DVT) and overall complications at 30 days and 365 days post-surgery. The incidences of DVT and overall complications were lower at 30 days after surgery in the IWB group than in the DWB group; however, this relationship was overturned at 365 days after surgery, despite no statistical difference. The occurrence of reoperation was infrequent among these patients, and there was no difference in reoperation rates between the two groups. The one-year mortality was higher in the IWB group compared to the DWB group, with no statistically significant difference.\u003c/p\u003e \u003cp\u003eOur study explored the pros and cons of different timings of weight bearing and pinpointed that immediate weight bearing as tolerated following intramedullary fixation for geriatric intertrochanteric fractures compared with delayed weight bearing improved the functional outcome in the early stage without increasing the incidence of complications, reoperation, or mortality. A twelve-week study concluded that elderly patients who were allowed to bear as much weight as tolerated appeared to voluntarily limit loading on the injured limb after operative treatment for intertrochanteric fractures[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Biomechanical tests and finite element analyses indicated that an early weight-bearing load of 900N (1.45 times body weight) could be recommended for postoperative rehabilitation of geriatric intertrochanteric fractures[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In terms of complications, reoperation, and mortality, there are diverse factors influencing them. Fracture patterns, type of surgery, and age play a crucial role in the complications and mortality of intertrochanteric fractures[\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Weight bearing may not be an independent risk factor for complications, reoperation, or mortality. In the meantime, long-term functional outcomes following surgery for intertrochanteric fractures may not be limited to weight bearing. The anxiety state was observed to have an impact on functional outcomes following surgery for intertrochanteric fractures, according to a prospective observational cohort study[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In addition, Adulkasem et al. evaluated both clinical and surgical parameters to determine prognostic factors for one-year postoperative functional outcomes. The author discovered that haemoglobin levels before surgery, pre-injury ambulatory status, BMI, and the New Mobility Score (NMS) were all independent factors for achieving a favourable postoperative functional outcome. Age and NMS were significantly associated with the ability to restore pre-injury function[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Therefore, based on the findings in our study and the interpretation of previous research, immediate weight bearing as tolerated is beneficial in the early stage and should be encouraged after operative treatment of intertrochanteric fractures.\u003c/p\u003e \u003cp\u003eThere are several limitations to be considered in our study. Firstly, the evaluation of the primary outcome and secondary outcomes was conducted via telephone, so the assessment might not be as reliable as face-to-face follow-up and could introduce recall bias, social desirability bias, and response bias as patients might not remember or report their experiences truthfully or consistently. Secondly, the current study is a post-hoc analysis, involving a smaller subset of participants compared to the main trial, which may result in reduced statistical power. This may present a challenge in identifying significant differences, especially for outcomes with low prevalence, such as complications and reoperations in this study. In the meantime, the study design is prospective but non-randomized, and RCT could enhance the robustness of the study. However, the nature of our investigation, involving post-hoc analysis, limited our ability to implement randomization. Moreover, a meticulous assessment of actual weight bearing and the exact time of weight bearing outside the hospital in the DWB group was absent from this study, which plays an essential role in the results. The patient in the DWB group could undergo weight bearing at any time after discharge. However, due to recalling bias, it is difficult to obtain objective and accurate information about the duration of the delay. Furthermore, the type of weight bearing in our study was classified into IWB and DWB, while we failed to quantify the weight. A constant amount of weight would improve the quality of the study. However, in the clinical scenario, the ambulation ability of the elderly was attenuated, and some may walk with crutches before the fracture. An altered level of consciousness also contributes to the deterioration of ambulation in geriatric patients with fractures. At present, weight bearing as tolerated is recommended for the balance recovery of elderly patients to decrease the risk of falling again. A constant amount of weight bearing is difficult to implement in the real world. Therefore, smart wearable medical devices with mobile force sensors are necessary for accurately detecting the real-time weight bearing status of patients in future research. In addition, the current study was a single-centre design, which may limit the generalizability of these results. It is imperative to carry out large-scale, randomized, and multicenter investigations to enhance the credibility and generalizability of the study. Finally, the surgical techniques and operational details varied among the surgeons, which may affect the treatment of intertrochanteric fractures.\u003c/p\u003e \u003cp\u003eIn conclusion, for elderly patients with intra journal of orthopaedic surgery research medullary fixation for intertrochanteric fractures, immediate weight bearing as tolerated improved the functional outcomes in the early stage and did not increase the incidence of complications, reoperation, or mortality compared with delayed weight bearing. These findings affirm the viability of allowing immediate weight bearing as tolerated post-surgery for elderly patients with intertrochanteric fractures. This will empower surgeons to provide more confident recommendations regarding the optimal weight-bearing protocol following surgery for geriatric intertrochanteric fractures.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBeijing Municipal Science \u0026amp; Technology Commission (Z211100002921056), Recipient: Xie-Yuan Jiang\u003c/p\u003e\n\u003cp\u003eNational Key Research and Development Program of China (2021YFC2501706)\u003c/p\u003e\n\u003cp\u003eRecipient: Xie-Yuan Jiang\u003c/p\u003e\n\u003cp\u003eCapital\u0026rsquo;s Funds for Health Improvement and Research (2018-1-2071, 2022-1-2071)\u003c/p\u003e\n\u003cp\u003eRecipient: Ming-Hui Yang\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNing Li: Writing - Review \u0026amp; Editing, Supervision, Project administration\u003c/p\u003e\n\u003cp\u003eKai-Yuan Cheng: Formal analysis, Writing - Original Draft, Software\u003c/p\u003e\n\u003cp\u003eJing Zhang: Writing - Review \u0026amp; Editing, Methodology\u003c/p\u003e\n\u003cp\u003eGang Liu: Validation, Investigation\u003c/p\u003e\n\u003cp\u003eLi Zhou: Data Curation, Validation\u003c/p\u003e\n\u003cp\u003eShi-Wen Zhu: Visualization, Investigation\u003c/p\u003e\n\u003cp\u003eMing-Hui Yang: Conceptualization, Writing - Review \u0026amp; Editing, Supervision, Funding acquisition\u003c/p\u003e\n\u003cp\u003eXin-Bao Wu: Resources, Supervision\u003c/p\u003e\n\u003cp\u003eXie-Yuan Jiang: Funding acquisition, Project administration\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLin JC-F, Liang W-M. 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Orthopaedics \u0026amp; Traumatology: Surgery \u0026amp; Research; 2022. p. 103381.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim JH, Lee YS, Kim YH, Cho KJ, Jung YH, Choi S-H, et al. Early ambulation to prevent delirium after long-time head and neck cancer surgery. Front Surg. 2022;9:880092.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarlin L, Sibley K, Jenkinson R, Kontos P, McGlasson R, Kreder HJ, et al. Exploring Canadian surgeons' decisions about postoperative weight bearing for their hip fracture patients. J Eval Clin Pract. 2018;24:42\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKubiak EN, Beebe MJ, North K, Hitchcock R, Potter MQ. Early weight bearing after lower extremity fractures in adults. JAAOS-Journal Am Acad Orthop Surg. 2013;21:727\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAugat P, Merk J, Ignatius A, Margevicius K, Bauer G, Rosenbaum D et al. Early, full weightbearing with flexible fixation delays fracture healing. Clin Orthop Relat Res. 1996:194\u0026ndash;202.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang DZJL. [Chinese]The timing and influence factors of early postoperative weight-bearing in elderly hip fracture. Chin J Geriatr Orthop Rehabil (Electronic Edition). 2017;3:257\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHE Y-q RUANJ, FENG, G-d et al. LIN X-y, WU Y-p, WAN W-x,. Effect of Early Weight-bearing on Appropriate Population with Intertrochanteric Fracture after Surgery. Chinese Journal of Rehabilitation Theory and Practice. 2020:955-9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBritish Orthopaedic Association: The care of patients with fragility fracture(Blue Book) 2007.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJia X, Qiang M, Zhang K, Han Q, Wu Y, Chen Y. 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Postoperative weight-bearing after a fracture of the femoral neck or an intertrochanteric fracture. Journal of Bone and Joint Surgery-American Volume. 1998;80A:352-6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi S, Sun GX, Chang SM, Yang CS, Li Y, Niu WX, et al. Simulated postoperative weight-bearing after fixation of a severe osteoporotic intertrochanteric fracture.International Journal of Clinical and Experimental Medicine. 2017;10:8438-48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLu XC, Gou WL, Wu SY, Wang Y, Wang ZM, Xiong Y. Complication Rates and Survival of Nonagenarians after Hip Hemiarthroplasty versus Proximal Femoral Nail Antirotation for Intertrochanteric Fractures: A 15-Year Retrospective Cohort Study of 113 Cases.Orthopaedic Surgery. 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStenquist DS, Albertson S, Bailey D, Paladino L, Flanagan CD, Stang T, et al.High- Versus Low-Energy Intertrochanteric Hip Fractures in Young Patients: Injury Characteristics and Factors Associated With Complications. Journal of Orthopaedic Trauma. 2023;37:222-9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeKeyser GJ, Wilson JM, Kellam PJ, Spencer C, Haller JM, Rothberg DL, et al. Young Intertrochanteric Femur Fractures Are Associated With Fewer Complications than Young Femoral Neck Fractures. Journal of Orthopaedic Trauma. 2021;35:356\u0026thinsp;\u0026ndash;\u0026thinsp;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKalem M, Kocaoğlu H, Duman B, Şahin E, Yoğun Y, Ovali SA. Prospective associations between fear of falling, anxiety, depression, and pain and functional outcomes following surgery for intertrochanteric hip fracture. Geriatric orthopaedic surgery \u0026amp; rehabilitation.2023;14:21514593231193234.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdulkasem N, Phinyo P, Khorana J, Pruksakorn D, Apivatthakakul T. Prognostic factors of 1-year postoperative functional outcomes of older patients with intertrochanteric fractures in Thailand: a retrospective cohort study. International Journal of Environmental Research and Public Health. 2021;18:6896.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"intertrochanteric fracture, weight bearing, EQ5D, complication, mortality","lastPublishedDoi":"10.21203/rs.3.rs-4215688/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4215688/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEarly weight bearing is an essential variable for fracture healing after osteosynthesis for Intertrochanteric fractures (ITF), which may impact morbidity and mortality. The optimal period to start weight bearing after surgery is still under debate, despite the recommendation of guidelines. The objective of this study was to evaluate the effectiveness of both a delayed and an immediate weight-bearing regimen following intramedullary fixation for elderly ITF.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study is a post-hoc analysis of the multicenter prospective non-randomized controlled study (NCT03184896) listed on Clinicaltrials.gov. Eligible patients were aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years with X-ray confirmed ITF, admitted within 21 days after injury and received intramedullary fixation surgery. Patients would be excluded if they were diagnosed with pathologic fractures, unable to comply with the rehabilitation program due to physical or psychological problems or received conservative treatment or other types of surgery. Patients bearing weight as tolerated during hospitalization were identified as the immediate weight bearing (IWB) group and patients bearing weight after discharge were identified as the delayed weight bearing (DWB) group in this study. The primary outcome was EQ5D score of patients at 120 days post-surgery. Secondary outcomes include EQ5D score of patients at 30 days and 365 days post-surgery, complication rate and mortality.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e410 eligible patients enrolled (190 patients with IWB and 220 patients with DWB). Compared to the DWB group, the IWB group had a higher EQ5D score at 30 days and 120 days after surgery (30d, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; 120d, P\u0026thinsp;=\u0026thinsp;0.002). The DWB group had a higher EQ5D score at 365 days after surgery (P\u0026thinsp;=\u0026thinsp;0.012) than the IWB group. There were no statistical differences in the incidence of any complication, reoperation rate, or cumulative complication rate between the two groups. The one-year mortality was 5.79% in the IWB group and 4.55% in the DWB group (P\u0026thinsp;=\u0026thinsp;0.542).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eImmediate weight bearing as tolerated following intramedullary fixation for intertrochanteric fractures in elderly patients improves functional outcomes in the early stage (within 120 days after surgery) without increasing the incidence of complications, reoperation, or mortality compared with delayed weight bearing.\u003c/p\u003e","manuscriptTitle":"The effectiveness of immediate weight bearing as tolerated versus delayed weight bearing following intramedullary fixation for geriatric intertrochanteric fractures: a post-hoc analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-19 17:30:57","doi":"10.21203/rs.3.rs-4215688/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5fe8123d-0a39-4aa7-b330-a9d7b008f114","owner":[],"postedDate":"April 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-19T17:30:59+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-19 17:30:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4215688","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4215688","identity":"rs-4215688","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}