Quality of Life Research

, Volume 11, Issue 5, pp 473–481 | Cite as

Femoral neck fractures in the elderly: Functional outcome and quality of life according to EuroQol

  • Jan Tidermark
  • Niklas Zethraeus
  • Olle Svensson
  • Hans Törnkvist
  • Sari Ponzer


The main purpose of this prospective study was to investigate the functional outcome and health-related quality of life according to EuroQol (EQ-5D) after a femoral neck fracture treated with internal fixation in relatively healthy elderly patients. We also aimed to validate the use of the EQ-5D in routine clinical follow-ups of this group of patients. The inclusion criteria were more than 65 years of age, absence of severe cognitive dysfunction, living independently, and unhindered walking ability preoperatively. The mean follow-up period was 17 months. The rated prefracture EQ-5Dindex scores showed good correspondence with the scores of an age-matched Swedish reference population. The EQ-5Dindex scores decreased from 0.78 before the fracture (based on recall) to 0.59 at 4 months and 0.51 at 17 months after surgery. The decrease was significantly larger among patients with fracture healing complications. There was a good correlation between the EQ-5Dindex scores and other outcome measures such as pain, mobility, independence in ADL and independent living status. The questionnaire response rate (EQ-5D) was 89–100% on different follow-up occasions. The EQ-5D appears to be an easy-to-use instrument even for elderly patients with femoral neck fractures. Changes in the quality of life may be useful to identify patients who might benefit from reoperation, i.e. arthroplasty. The EQ-5D also appears to be a relevant clinical end-point in outcome studies.

Femoral neck fractures Functional outcome Internal fixation Quality of life 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Jarnlo GB, Jakobsson B, Ceder L, et al. Hip fracture incidence in Lund, Sweden, 1966-1986. Acta Orthop Scand 1989; 60: 278-282.Google Scholar
  2. 2.
    Strömberg L, Lindgren U, Nordin C, et al. The appearance and disappearance of cognitive impairment in elderly patients during treatment for hip fracture. Scand J Caring Sci 1997; 11: 167-175.Google Scholar
  3. 3.
    Garden RS. Low-angle Fixation in Fractures of the Femoral Neck. J Bone Joint Surg 1961; 43B: 647.Google Scholar
  4. 4.
    Holmberg S, Mattsson P, Dahlborn Mt, et al. Fixation of 220 femoral neck fractures. A prospective comparison of the Rydell nail and the LIH hook pins. Acta Orthop Scand 1990; 61: 154-157.Google Scholar
  5. 5.
    Strömqvist B, Hansson LI, Nilsson LT, et al. Hook-pin fixation in femoral neck fractures. A two-year follow-up study of 300 cases. Clin Orthop 1987: 58-62.Google Scholar
  6. 6.
    Strömqvist B, Nilsson LT, Thorngren KG. Femoral neck fracture fixation with hook-pins. 2-year results and learning curve in 626 prospective cases. Acta Orthop Scand 1992; 63: 282-287.Google Scholar
  7. 7.
    Lu-Yao GL, Keller RB, Littenberg B, et al. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Joint Surg Am 1994; 76: 15-25.Google Scholar
  8. 8.
    Williams A. The Role of the Euroqol Instrument in QUALY Calculations. York: The University of York, Centre for Health Economics, 1995.Google Scholar
  9. 9.
    Pfeiffer E. A short portable mental status questionnaire for the assessment of organicbrain deficit in elderly patients. J Am Geriatr Soc 1975; 23: 433-441.Google Scholar
  10. 10.
    Garden R. Stability and union in subcapital fractures of the femur. J Bone Joint Surg Br 1964; 46B: 630-647.Google Scholar
  11. 11.
    Katz S, Ford A, Moskowitz R, et al. Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychological function. JAMA 1963; 185: 94-99.Google Scholar
  12. 12.
    Ceder L, Thorngren KG, Wallden B. Prognosticindic ators and early home rehabilitation in elderly patients with hip fractures. Clin Orthop 1980: 173-184.Google Scholar
  13. 13.
    Brooks R. EuroQol: The current state of play. Health Policy 1996; 37: 53-72.Google Scholar
  14. 14.
    Burström K, Johannesson M, Diderichsen F. Swedish population health-related quality of life results using the EQ-5D. Qual Life Res 2001; 10: 621-635.Google Scholar
  15. 15.
    Dolan P, Gudex C, Kind P, et al. The time trade-off method: Results from a general population study. Health Econ 1996; 5: 141-154.Google Scholar
  16. 16.
    Maxwell C. Sensitivity and accuracy of the visual analogue scale: A psycho-physical classroom experiment. Br J Clin Pharmacol 1978; 6: 15-24.Google Scholar
  17. 17.
    Hillner BE, Hollenberg JP, Pauker SG. Postmenopausal estrogens in prevention of osteoporosis. Benefit virtually without risk if cardiovascular effects are considered. Am J Med 1986; 80: 1115-1127.Google Scholar
  18. 18.
    Jönsson B, Christiansen C, Johnell O, et al. Cost-effectiveness of fracture prevention in established osteoporosis. Osteoporos Int 1995; 5: 136-142.Google Scholar
  19. 19.
    Zethraeus N, Johannesson M, Jönsson B. A computer model to analyse the cost-effectivness of hormone replacement therapy. Int J Technol Assess 1999; 15(2): 352-365.Google Scholar
  20. 20.
    MacKenzie EJ, Cushing BM, Jurkovich GJ, et al. Physical impairment and functional outcomes six months after severe lower extremity fractures. J Trauma 1993; 34: 528-538; discussion 38-39.Google Scholar
  21. 21.
    Borgquist L, Nilsson LT, Lindelöw G, et al. Perceived health in hip-fracture patients: A prospective follow-up of 100 patients. Age Ageing 1992; 21: 109-116.Google Scholar
  22. 22.
    Coast J, Peters TJ, Richards SH, et al. Use of the EuroQoL among elderly acute care patients. Qual Life Res 1998; 7: 1-10.Google Scholar
  23. 23.
    Dorman P, Slattery J, Farrell B, et al. Qualitative comparison of the reliability of health status assessments with the EuroQol and SF-36 questionnaires after stroke. United Kingdom Collaborators in the International Stroke Trial. Stroke 1998; 29: 63-68.Google Scholar
  24. 24.
    Harper R, Brazier JE, Waterhouse JC, et al. Comparison of outcome measures for patients with chronic obstructive pulmonary disease (COPD) in an outpatient setting. Thorax 1997; 52: 879-887.Google Scholar
  25. 25.
    Hurst NP, Kind P, Ruta D, et al. Measuring health-related quality of life in rheumatoid arthritis: Validity, responsiveness and reliability of EuroQol (EQ-5D). Br J Rheumatol 1997; 36: 551-559.Google Scholar
  26. 26.
    Brazier JE, Walters SJ, Nicholl JP, et al. Using the SF-36 and Euroqol on an elderly population. Qual Life Res 1996; 5: 195-204.Google Scholar
  27. 27.
    Brazier J, Jones N, Kind P. Testing the validity of the Euroqol and comparing it with the SF-36 health survey questionnaire [see comments]. Qual Life Res 1993; 2: 169-180.Google Scholar
  28. 28.
    Sernbo I, Johnell O, Bååth L, et al. Internal fixation of 410 cervical hip fractures. A randomized comparison of a single nail versus two hook-pins. Acta Orthop Scand 1990; 61: 411-414.Google Scholar
  29. 29.
    Nilsson LT, Strömqvist B, Thorngren KG. Function after hook-pin fixation of femoral neck fractures. Prospective 2-year follow-up of 191 cases. Acta Orthop Scand 1989; 60: 573-578.Google Scholar
  30. 30.
    Svensson O, Strömberg L, Öhlen G, et al. Prediction of the outcome after hip fracture in elderly patients. J Bone Joint Surg Br 1996; 78: 115-118.Google Scholar

Copyright information

© Kluwer Academic Publishers 2002

Authors and Affiliations

  • Jan Tidermark
    • 1
  • Niklas Zethraeus
    • 2
  • Olle Svensson
    • 3
  • Hans Törnkvist
    • 1
  • Sari Ponzer
    • 1
  1. 1.Department of OrthopaedicsKarolinska Institute at Stockholm Söder HospitalStockholmSweden
  2. 2.Stockholm School of EconomicsStockholmSweden
  3. 3.Department of Orthopedics at Norrlands University HospitalUmeåSweden

Personalised recommendations