Faculty Bibliography

OBJECTIVE: To assess predictive and discriminant validity and responsiveness of the Functional Recovery Score, a disease-specific health assessment tool. STUDY DESIGN: Prospective, consecutive. METHODS: Six hundred eighty-two elderly patients who sustained a hip fracture were prospectively followed and evaluated by using the Functional Recovery Score at three, six, and twelve months after surgery RESULTS: The Functional Recovery Score (FRS) was found to be responsive to change: scores after hip fracture were significantly lower at three months than prefracture, increased significantly from three to six months, and increased slightly between six and twelve months after fracture, consistent with expectation. The FRS had predictive validity: prefracture scores were predictive of death, skilled nursing facility transfer, and rehospitalization within one year of fracture. In addition, the FRS had discriminant validity. Mean scores for the following groups were significantly different from each other at three and six months: (a) patients who were alive, living in the community, and did not require rehospitalization; (b) those who were admitted to a skilled nursing facility; and (c) those who were rehospitalized. Comparison of the FRS with a sex- and age-matched non-hip-fracture population indicated that hip fracture resulted in a 20 percent loss of function within the first year. Reliability testing of telephone interviews of patients as a means of obtaining information indicated very high reliability. CONCLUSION: The Functional Recovery Score is a reliable method of assessing functional outcome for elderly hip fracture patients

OBJECTIVE: To develop a Functional Recovery Score for ambulatory elderly hip fracture patients related to independent functioning to assess restoration of function to prefracture status. STUDY DESIGN/METHODS: The phases of this effort consisted of: (a) identification of five relevant components represented by sixteen specific functional capacities; (b) assessment of the importance independent community-dwelling elderly gave to the sixteen functional capacities; (c) pilot testing of a sixteen-item preliminary questionnaire in recovering elderly hip fracture patients; and (d) modification of the questionnaire to an eleven-item score. RESULTS: The resulting eleven-item Functional Recovery Score is comprised of three main components: basic activities of daily living (BADL) assessed by four items, instrumental activities of daily living (IADL) assessed by six items, and mobility assessed by one item. Basic activities of daily living comprise 44 percent of the score; instrumental activities of daily living comprise 23 percent, and mobility comprises 33 percent. Complete independence in basic and instrumental activities of daily living and mobility results in a score of 100 percent

The effects of the anterior and posterior sternoclavicular joint (SCJ) soft tissue structures on joint dislocation strength by sequential sectioning the ligaments and capsule of twenty-eight SCJs were evaluated. The medial clavicle of each specimen was initially loaded in the anterior and posterior directions to provide control values for joint laxity. The anterior or posterior ligaments and capsular structures of the SCJs were then selectively cut and the specimens retested for laxity and then loaded to failure simulating either anterior or posterior dislocation. Testing of intact specimens showed that the posterior ligaments were stiffer than other structures in that it was significantly more difficult to posteriorly displace the SCJ than in any other direction and that the capsule was the important anterior structure affecting joint laxity. Load-to-failure testing showed that it required 50% more force to create a failure by posterior dislocation than by anterior dislocation. The results of this study explain the clinical rarity of posterior sternoclavicular joint dislocations

Recent studies have suggested that patients with a history of diabetes undergoing hip fracture stabilization have higher rates of morbidity and mortality as well as poorer functional results than control groups of non-diabetics. This study was performed to evaluate the effect of diabetes on patient outcome after hip fracture. Between July 1987 and December 1996, 849 community dwelling elderly who sustained an operatively treated hip fracture were prospectively followed to determine the effect of diabetes on patient outcome. The predictor variable was the presence or absence of diabetes mellitus. Ninety-three patients (11%) had a history of diabetes. Diabetic patients were more dependent in activities of daily living and ambulation prior to hip fracture. The presence of diabetes mellitus also increased the likelihood of a patient dying during hospitalization, but had no effect on recovery of ambulatory ability or activities of daily living. Although diabetic patients have increased in-hospital mortality when compared to non-diabetic patients, patients with diabetes are just as likely to recover pre-fracture functional status as non-diabetic patients

Variations in the shape and orientation of the anterior acromion have been implicated as predisposing factors for the development of rotator cuff problems. We determined and analyzed by computer digitization the anterior and posterior acromial slopes for 141 cadaver shoulders (whose rotator cuff status had been previously assessed). No significant differences in either the anterior or posterior angle were found between the intact and rotator cuff tear groups. Frequency histograms of both angles demonstrated continuous, normal distributions. The individual acromions were consistently asymmetric in that the anterior slope was larger than the posterior slope. However, the anterior slope distribution did not reveal groupings indicative of the specific acromial types previously reported. These results suggest that acromial classification into flat, curved, and hooked types does not accurately describe the actual anatomical findings