Evaluation of fetuin-A as a predictor of outcome after surgery for osteoporotic fracture of the proximal femur
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ORTHOPAEDIC SURGERY
Evaluation of fetuin‑A as a predictor of outcome after surgery for osteoporotic fracture of the proximal femur Claas Jasper Steffen1,3 · Philipp K. E. Herlyn1 · Norina Cornelius1,4 · Thomas Mittlmeier1 · Dagmar‑C. Fischer2 Received: 11 October 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Background In the elderly, osteoporotic fractures of the femur are associated with high morbidity and mortality. At the time of hospitalization and during pre-operative care identification of patients at risk for poor outcome despite an otherwise good clinical condition is challenging. We hypothesized that the serum concentration of fetuin-A during post-operative recovery might serve as a biomarker. Methods During a 15 months period patients admitted to our hospital for treatment of a femur fracture were registered on a voluntary basis and irrespective of age, underlying diseases and therapy. For all patients enrolled in this registry, blood was sampled for additional laboratory analysis. Patients with osteoporotic fractures were invited for follow-up examination about 2 years later. At this time, the functional outcome and clinical performance together with the handgrip strength as a surrogate measure of overall strength were assessed and the occurrence of additional fractures was recorded. Results from these assessments and the absence or presence of subsequent fractures were combined as summary score of outcome (SSO) and overall physical performance (oPP), a score derived by principal component analysis and relying on normally distributed data, only. Results 39 of 96 eligible patients were deceased during the follow-up period, while 45 consented to participate in the study. Patients with a SSO ≥ 17 pts were younger and had higher fetuin-A serum concentrations (each p 10– 10 s Unable TST ≥ 10 s 30 kg > 15–≤ 30 kg ≤ 15 kg
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3 2 1 0 3 2 1 0 6 0
3 2 1 0 2 1 0 2 1 0 2 1 0
HHS, Harris hip score; MAPS, Merle d’Aubigné and Postel Score; 2nd fracture during the follow-up period; TUG, Timed “Up & Go” test; CRT, chairrising-test; TST, tandem-standtest; HGS, hand-grip strength
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Scoring was according to current guidelines [28]
Archives of Orthopaedic and Trauma Surgery
determination of the mobility and range of movement of the hip. However, the HHS is more detailed in that the walking distance, the ability to climb stairs, to sit on a chair, limping and activities of daily life (ability to use public transportation, ability to put on shoes and socks without help) are considered. Apart from the overall results of HHS and MAPS, walking ability and walking distance were considered as individual variables. Mobility, strength of the lower extremities, overall balance and handgrip strength (HGS) was judged by means of the timed “Up & Go”-test (TUG), chair-rising-test (CRT), tandem-stand-test (TST) and a Jamar hand dynamometer (Saehan Corporation, Masan, Korea) [24–27]. In addition, the walking distance and the use of walking aids were recorded. Handgrip strength (H
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