The Association Between Traumatic Brain Injury and Accelerated Fracture Healing: A Study on the Effects of Growth Factors and Cytokines.

Evidence suggests that some systemic and local factors, including cytokines and growth factors in patients with traumatic brain injury (TBI), can play an essential role in accelerating fracture healing. The purpose of this study was to evaluate serum levels of some inflammatory cytokines and growth factors in patients with fracture and TBI as well as healthy subjects. In this study, a total number of 30 patients with a femoral fracture, 30 cases with TBI, 30 patients with TBI and a femoral fracture (fracture + TBI group), and 30 healthy subjects were recruited. The Glasgow Coma Scale (GCS) scores were also determined upon their admission. Then, the serum levels of fibroblast growth factor 2 (FGF-2), transforming growth factor-beta (TGF-ß), platelet-derived growth factor (PDGF), bone morphogenetic protein 2 (BMP-2), insulin-like growth factor 1 (IGF-1), interleukin-1 beta (IL-1ß), and interleukin-6 (IL-6) were measured via enzyme-linked immunosorbent assay (ELISA) technique, 12 h and 4 weeks after injury and hospital admission. The study results demonstrated that the serum levels of BMP-2, FGF-2, IL-1ß, and PDGF in the femoral fracture + TBI group increased significantly over 12 h and after 4 weeks compared with other groups, but the serum levels of IGF-I, IL-6, and TGF-ß in this group increased in a significant manner at 12 h compared with other studied groups. The findings also showed that the time to union of a femoral fracture was shorter in the fracture + TBI group than in cases with a femoral fracture alone (p = 0.03). Accordingly, it seems that elevated serum levels of BMP-2, PDGF, FGF-2, and IL-1ß may be associated with healing acceleration in fracture + TBI patients. However, further studies are needed to confirm this claim.

Prevention of bone infection after open fracture using a chitosan with ciprofloxacin implant in animal model

Abstract Purpose To evaluate different concentrations of ciprofloxacin to prevent infection after open fracture contaminated with S. aureus in rats using absorbable local delivery system. Methods Fifty-two Wistar rats were assigned to six groups. After 4 weeks, all animals underwent 99mTc-ceftizoxima scintigraphy evaluation, callus formation measurement and histological analysis. ANOVA, t-Student and Kruskal Wallis were used for quantitative variables statistical analysis, whereas qui square and exact Fisher were used for qualitative variables. Results Treatment using 25% and 50% of ciprofloxacin incorporated at the fracture fixation device were effective in preventing bone infection compared to control group (p<0.05). Chitosan were not effective in preventing bone infection when used alone compared to control group (p>0.05). Histological findings demonstrated bone-healing delay with 50% of ciprofloxacin. No difference in callus formation were observed (p>0.05). Conclusion Local delivery treatment for contaminated open fracture using chitosan with ciprofloxacin is effective above 25%.

Effect of hyperbaric oxygen therapy (HBO) on implant-associated osteitis in a femur fracture model in mice.

Hyperbaric oxygen therapy (HBO) is applied very successfully in treatment of various diseases such as chronic wounds. It has been already suggested as adjunctive treatment option for osteitis by immune- and fracture modulating effects. This study evaluates the importance of HBO in an early implant-associated localized osteitis caused by Staphylococcus aureus (SA) compared to the standard therapy. In a standardized murine model the left femur of 120 BALB/c mice were osteotomized and fixed by a titanium locking plate. Osteitis has been induced with a defined amount of SA into the fracture gap. Debridément and lavages were progressed on day 7, 14, 28 and 56 to determine the local bacterial growth and the immune reaction. Hyperbaric oxygen (2 ATA, 90%) was applied for 90 minutes on day 7 to 21 for those mice allocated to HBO therapy. To evaluate the effect of HBO therapy the following groups were analyzed: Two sham-groups (12 mice / group) with and without HBO therapy, two osteotomy groups (24 mice / group) with plate osteosynthesis of the femur with and without HBO therapy, and two osteotomy SA infection groups (24 mice / group) with and without HBO therapy. Fracture healing was also quantified on day 7, 14, 28 and 56 by a.p. x-ray and bone healing markers from blood samples. Progression of infection was assessed by estimation of colony-forming units (CFU) and immune response was analyzed by determination of polymorphonuclear neutrophils (PMN), Interleukin (IL) - 6, and the circulating free DNA (cfDNA) in lavage samples. Osteitis induced significantly higher IL-6, cfDNA- and PMN-levels in the lavage samples (on day 7 and 14, each p < 0.05). HBO-therapy did not have a significant influence on the CFU and immune response compared to the standard therapy (each p > 0.05). At the same time HBO-therapy was associated with a delayed bone healing assessed by x-ray radiography and a higher rate of non-union until day 28. In conclusion, osteitis led to significantly higher bacterial count and infection parameters. HBO-therapy neither had a beneficial influence on local infection nor on immune response or fracture healing compared to the standard therapy in an osteitis mouse model.

Magnesium Sulfate as Adjuvant in Prehospital Femoral Nerve Block for a Patient with Diaphysial Femoral Fracture: A Randomized Controlled Trial.

Introduction: Prehospital management of traumatic pain is commonly based on morphine while locoregional analgesia techniques, especially the femoral nerve block (FNB), can be safely and efficiently used. Adjuvants uses can reduce local anesthetic doses and decrease their related risk. The aim of the study was to assess the analgesic effect of magnesium sulfate when used as an adjuvant in prehospital FNB. Methods: This is a randomized double-blinded trial conducted in a prehospital medical department of an academic hospital. Patients with isolated diaphysial femoral fracture and eligible to participate were randomized into 2 groups. Group C had a FNB with 15 ml of lidocaine with epinephrine (300 mg) and 3 ml of normal saline solution. Group I had a FNB with 15 ml of lidocaine with epinephrine (300 mg) and 3 ml of MgS 15% (450 mg). The FNB was performed according to the WINNIE technique. Primary endpoints were morphine consumption and pain intensity during the first 6 hours. Secondary endpoints were the duration of the sensory block, time to the first analgesic request, and side effects occurrence. Results: Twenty-four patients were enrolled in each group. Both groups were comparable according to demographic characteristics, initial pain scores, and vital constants. In group I, morphine requirements were significantly lower (2 ± 2 mg versus 5 ± 3 mg, p < 10-3), analgesic onset was significantly faster, and the average time to the first analgesic request was longer (276 ± 139 min versus 160 ± 79 min, p < 10-3). The average duration of sensory block was longer in group I (226 ± 64 min versus 116 ± 70 min p < 10-3). No side effects were recorded. Conclusion: Magnesium sulfate should be considered as an efficient and safe adjuvant to lidocaine in prehospital FNB. This trial is registered with (NCT03597945).

Teriparatide treatment of femoral fracture nonunion that autogenous bone grafting failed to heal: a case report.

PURPOSE: Management of fracture nonunion is challenging as another surgical intervention for the patient is often a necessity, which has a huge impact on both quality of life and economic burden of the patient. Thus, a less aggressive and better accepted treatment for nonunion is required. METHODS: We gave teriparatide to a 45-year-old man with femoral fracture nonunion 1 year after he underwent surgery with autogenous bone grafting that failed to heal his initial nonunion. Successful union was obtained after once-daily administration of teriparatide for 9 months. RESULTS: Our case showed teriparatide could successfully treat a femoral fracture nonunion that autogenous bone grafting failed to heal. CONCLUSIONS: Teriparatide may provide an alternative treatment for fracture nonunion.

Effects of local vanadium delivery on diabetic fracture healing.

This study evaluated the effect of local vanadyl acetylacetonate (VAC), an insulin mimetic agent, upon the early and late parameters of fracture healing in rats using a standard femur fracture model. Mechanical testing, and radiographic scoring were performed, as well as histomorphometry, including percent bone, percent cartilage, and osteoclast numbers. Fractures treated with local 1.5 mg/kg VAC possessed significantly increased mechanical properties compared to controls at 6 weeks post-fracture, including increased torque to failure (15%; p = 0.046), shear modulus (89%; p = 0.043), and shear stress (81%; p = 0.009). The radiographic scoring analysis showed increased cortical bridging at 4 weeks and 6 weeks (119%; p = 0.036 and 209%; p = 0.002) in 1.5 mg/kg VAC treated groups. Histomorphometry of the fracture callus at days 10 and 14 showed increased percent cartilage (121%; p = 0.009 and 45%; p = 0.035) and percent mineralized tissue (66%; p = 0.035 and 58%; p = 0.006) with local VAC treated groups compared to control. Additionally, fewer osteoclasts were observed in the local VAC treated animals as compared to controls at day 14 (0.45% ± 0.29% vs. 0.83% ± 0.36% of callus area; p = 0.032). The results suggest local administration of VAC acts to modulate osteoclast activity and increase percentage of early callus cartilage, ultimately enhancing mechanical properties comparably to non-diabetic animals treated with local VAC. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2174-2180, 2017.

Hypochlorhydria-induced calcium malabsorption does not affect fracture healing but increases post-traumatic bone loss in the intact skeleton.

Efficient calcium absorption is essential for skeletal health. Patients with impaired gastric acidification display low bone mass and increased fracture risk because calcium absorption is dependent on gastric pH. We investigated fracture healing and post-traumatic bone turnover in mice deficient in Cckbr, encoding a gastrin receptor that affects acid secretion by parietal cells. Cckbr-/- mice display hypochlorhydria, calcium malabsorption, and osteopenia. Cckbr-/- and wildtype (WT) mice received a femur osteotomy and were fed either a standard or calcium-enriched diet. Healed and intact bones were assessed by biomechanical testing, histomorphometry, micro-computed tomography, and quantitative backscattering. Parathyroid hormone (PTH) serum levels were determined by enzyme-linked immunosorbent assay. Fracture healing was unaffected in Cckbr-/- mice. However, Cckbr-/- mice displayed increased calcium mobilization from the intact skeleton during bone healing, confirmed by significantly elevated PTH levels and osteoclast numbers compared to WT mice. Calcium supplementation significantly reduced secondary hyperparathyroidism and bone resorption in the intact skeleton in both genotypes, but more efficiently in WT mice. Furthermore, calcium administration improved bone healing in WT mice, indicated by significantly increased mechanical properties and bone mineral density of the fracture callus, whereas it had no significant effect in Cckbr-/- mice. Therefore, under conditions of hypochlorhydria-induced calcium malabsorption, calcium, which is essential for callus mineralization, appears to be increasingly mobilized from the intact skeleton in favor of fracture healing. Calcium supplementation during fracture healing prevented systemic calcium mobilization, thereby maintaining bone mass and improving fracture healing in healthy individuals whereas the effect was limited by gastric hypochlorhydria. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1914-1921, 2016.

High-dose rosuvastatin treatment for multifocal stroke in trauma-induced cerebral fat embolism syndrome: a case report.

BACKGROUND: Fat embolism syndrome is a life-threatening condition with treatment centering on the provision of excellent supportive care and early fracture fixation. No pharmacologic intervention has yet shown any clear benefit. We used high-dose rosuvastatin specifically for its anti-inflammatory effects to treat a patient with severe fat embolism syndrome. We also suggest that magnetic resonance imaging and transcranial Doppler studies are helpful in establishing the diagnosis and for monitoring the patient's course. PATIENT: A 17-year-old boy developed severe cerebral fat embolism syndrome with multifocal strokes after sustaining bilateral femur fractures. RESULTS: In spite of profound and prolonged neurological impairment, our patient experienced dramatic recovery by the time he was discharged from inpatient rehabilitation several weeks after his initial injury. Magnetic resonance imaging revealed the classic "starfield" pattern of infarcts on diffusion-weighted sequences early in the illness. Additionally, serial transcranial Doppler studies demonstrated dramatically elevated microembolic events that resolved completely during the course of treatment. CONCLUSION: We feel that the acute administration of high-dose rosuvastatin early in the development of our patient's illness may have contributed to his ultimate recovery. Therapeutic guidelines cannot be extrapolated from a single patient, but our experience suggests that statin therapy could be potentially beneficial for individuals with severe fat embolism syndrome, and this approach deserves further clinical evaluation. Additionally, the diagnosis and monitoring of cerebral involvement in fat embolism syndrome is facilitated by both magnetic resonance imaging and transcranial Doppler studies.

Dehydroepiandrosterone modulates the inflammatory response in a bilateral femoral shaft fracture model.

BACKGROUND: Dehydroepiandrosterone (DHEA) has been shown to have immunomodulatory effects after hemorrhage and sepsis. The present study analyzes whether DHEA is also involved in the mediation of inflammatory stimuli induced by bilateral femoral shaft fracture. METHODS: Male C57/BL6 mice (6 per group) were subjected to closed bilateral femoral shaft fracture with intramedullary nailing followed by administration of either 25 mg/kg/24 h DHEA diluted in saline with 0.1% ethanol or saline with 0.1% ethanol. The sham group was treated by isolated intramedullary nailing without fracture. Animals were sacrificed after 6, 24, or 72 h. Serum TNFα, IL-1ß, IL-6, IL-10, MCP-1, and KC concentrations were measured by Bio-Plex ProTm analysis. Acute pulmonary inflammation was assessed by histology, pulmonary myeloperoxidase (MPO) activity, and pulmonary IL-6 concentration. RESULTS: DHEA was associated with a decrease in the systemic inflammatory response induced by bilateral femoral fracture, especially systemic IL-6 (322.2 vs. 62.5 pg/mL; P = 0.01), IL-1ß (1,422.6 vs. 754.1 pg/mL; P = 0.05), and MCP-1 (219.4 vs. 44.1 pg/mL; P >0.01) levels. No changes in pulmonary inflammation were measured. CONCLUSION: We conclude that DHEA may be a treatment option to reduce systemic inflammation following musculoskeletal injuries although the pulmonary inflammatory reaction was not affected.

Custom-made antibiotic cement nails: a comparative study of different fabrication techniques.

INTRODUCTION: The management of intramedullary long bone infections remains a challenge. Placement of antibiotic cement nails is a useful adjuvant to the antibiotic treatment of osteomyelitis. However, fabrication of antibiotic cement nails can be arduous. The purpose of this article is to introduce an easy and reproducible technique for the fabrication of antibiotics cement nails. MATERIALS AND METHODS: We compared the time required to peel the chest tube off the 6 antibiotic cement nail using 2 different cement-cooling techniques and the addition of mineral oil in the chest tube. Additionally, we evaluated the optimal time to cut the chest tube (before and after cement hardening), consistency of nail's diameter, and the roughness of its surface. Cooling and peeling times were measured and failure was defined as a working time (from cement mixing to have a usable antibiotic cement nail) that exceeded 1 h. RESULTS: When the antibiotic cement nail was left to cool by convection (i.e. air-cooling), we failed to peel the plastic off the cement nail. When the chest tube was cut after conductive cooling (i.e. cold water-cooled), the cooling time was 10 min and the peeling time was 30 min without the use of mineral oil; the addition of mineral oil reduced peeling time to 7.5 min. Following peeling, residual adherent plastic pieces were found along the entire surface of the nail when no mineral oil was used. This was rarely seen when mineral oil was utilized to coat the inner layer of the chest tube. CONCLUSION: Conductively cooling of the cement nail (in cold water) and pre-lubricating the chest tube with mineral oil are 2 tricks that render fabrication of antibiotic nail more efficient, reliable, and practical.

Thalidomide prolongs survival after experimental musculoskeletal injury, through an effect on mononuclear apoptosis.

BACKGROUND: This study was conducted to investigate the effects of intravenous thalidomide administration in an experimental model of musculoskeletal trauma. We hypothesized that because thalidomide inhibits secretion of tumor necrosis factor alpha (TNF-α), survival of animals that received thalidomide would be significantly prolonged. MATERIAL AND METHODS: After an open fracture of the right femur, 24 rabbits were randomly assigned to control and thalidomide groups. Intravenous therapy with thalidomide was started 30 min after fracture. Hemodynamic monitoring of all animals was performed for 4 h. Survival was recorded and bacterial growth in blood and organs was measured after animal death or sacrifice. Blood was sampled for TNF-α measurement and for isolation of peripheral blood mononuclear cells (PBMCs). Apoptosis of PBMCs was measured by flow cytometry. RESULTS: Survival was significantly prolonged in the thalidomide group. Apoptosis of PBMCs was increased in the control group compared with the thalidomide group at 24 h. There were no differences in vital signs, blood and tissue cultures, and serum TNF-α concentration between the two groups. CONCLUSIONS: Intravenous thalidomide prolonged survival in an experimental model of severe musculoskeletal injury in rabbits. Its mechanism of action did not involve TNF-α suppression but prevention of mononuclear apoptosis. In view of these promising results, further research is needed to clarify the immunomodulatory mechanism of action of thalidomide and its potential use for the management of severe trauma.

Incidence of atypical nontraumatic diaphyseal fractures of the femur.

Bisphosphonates reduce the rate of osteoporotic fractures in clinical trials and community practice. "Atypical" nontraumatic fractures of the diaphyseal (subtrochanteric or shaft) part of the femur have been observed in patients taking bisphosphonates. We calculated the incidence of these fractures within a defined population and examined the incidence rates according to duration of bisphosphonate use. We identified all femur fractures from January 1, 2007 until December 31, 2011 in 1,835,116 patients older than 45 years who were enrolled in the Healthy Bones Program at Kaiser Southern California, an integrated health care provider. Potential atypical fractures were identified by diagnostic or procedure codes and adjudicated by examination of radiographs. Bisphosphonate exposure was derived from internal pharmacy records. The results showed that 142 patients had atypical fractures; of these, 128 had bisphosphonate exposure. There was no significant correlation between duration of use (5.5 ± 3.4 years) and age (69.3 ± 8.6 years) or bone density (T-score -2.1 ± 1.0). There were 188,814 patients who had used bisphosphonates. The age-adjusted incidence rates for an atypical fracture were 1.78/100,000/year (95% confidence interval [CI], 1.5-2.0) with exposure from 0.1 to 1.9 years, and increased to 113.1/100,000/year (95% CI, 69.3-156.8) with exposure from 8 to 9.9 years. We conclude that the incidence of atypical fractures of the femur increases with longer duration of bisphosphonate use. The rate is much lower than the expected rate of devastating hip fractures in elderly osteoporotic patients. Patients at risk for osteoporotic fractures should not be discouraged from initiating bisphosphonates, because clinical trials have documented that these medicines can substantially reduce the incidence of typical hip fractures. The increased risk of atypical fractures should be taken into consideration when continuing bisphosphonates beyond 5 years.

Soporte nutricional en el anciano con fractura de fémur / Nutritional support in the elderly patient with femur fracture

La desnutrición en los ancianos es frecuentemente insidiosa y multifactorial, y de gran prevalencia en aquellos pacientes hospitalizados. La baja ingesta, la mala elección de alimentos, la pluripatología y polimedicación hacen a este grupo de población más predispuesto al déficit de ciertas vitaminas y minerales. Ello ha llevado a que las guías actuales de las principales sociedades de nutrición recomienden la administración de suplementos de micronutrientes para alcanzar los requerimientos diarios en caso de riesgo de desnutrición, pluripatología o cirugía ortopédica, especialmente fractura de cadera. Sobre ésta última hay que recalcar que de todas las fracturas osteoporóticas, es la que provoca la mayor repercusión sanitaria. La nutrición tiene una importancia capital en el devenir del anciano con fractura de cadera, así como sobre su pronóstico a corto y medio, y largo plazo. En este sentido, los suplementos nutricionales hiperproteícos se recomiendan en la actualidad en el anciano hospitalizado con fractura de cadera. Estudios recientes han demostrado que su uso es eficaz incluso en pacientes normonutridos o con desnutrición leve durante el período perioperatorio (AU)

Malnutrition in the elderly population is frequently an insidious and multifactorial problem, showing a large prevalence among inpatients. Low intake, poor food selection, multiple pathology and multiple medication make this population group more prone to a deficit of certain vitamins and minerals. This has led main nutritional institutions to recommend the administration of supplements and micronutrients to achieving daily needs in case of malnutrition, multiple pathology or orthopedic surgery, particularly hip fracture. Among osteoporotic fractures, hip fracture is the one with the greatest impact on the health system. Nutrition plays a crucial role in the medical progress of the elderly individuals with a broken hip, as well as on their short, medium and long term prognosis. Hyperproteic nutritional supplements are therefore currently recommended for the inpatient care of the elderly with hip fracture. Recent studies have shown the effectiveness of these supplements even in patients with normonutrition or mild malnutrition during the perisurgical period (AU)

Effects of calcium supplements on fracture healing in a rat osteoporotic model.

Fracture healing is a complex process, which is further complicated if the bone is osteoporotic. Calcium is one of the important minerals in bone and has been found to prevent osteoporosis but its role in fracture healing of osteoporotic bone is still unclear. We carried out a study on the effects of calcium supplementation on the late phase healing of fractured osteoporotic bone using an ovariectomized rat model. Twenty-four female Sprague-Dawley rats were divided into three groups: sham-operated (SO), ovariectomized-control (OVXC), and ovariectomized + calcium supplements (Ca). The right femurs of all the rats were fractured at mid-epiphysis and a K-wire was inserted for internal fixation. After 2 months of treatment, the rats were sacrificed and the femora were dissected out for radiological and biomechanical assessment. As expected, osteoporosis resulted in impaired healing as shown by the poor radiological and biomechanical properties of the OVXC group. CT scans showed significantly lower callus volumes in the SO and Ca groups compared to the OVXC group. Radiological scoring of fracture healing and callus staging of the SO and Ca groups were better than the OVXC group. However, the biomechanical parameters of the Ca group were significantly lower than the SO group and similar to the OVXC group. Therefore, calcium supplements may appear to improve fracture healing of osteoporotic bone but failed to improve strength.

[Polyspecialistic treatment of a polytrauma. Case report]. / Politrauma complesso: gestione poli-specialistica. Caso clinico.

The Authors report the clinical course of M.L., a 22 years old man. He came to our observation after a road accident, in third care. In the former hospital admissions hemodynamic stabilization, surgical haemostasis of multiple hepatic lacerations with hemoperitoneum and right leg amputation were performed. He arrived to our department in a critical condition owing to mild respiratory insufficiency due to many rib fractures with sero-haematic spillage into the pleural cavity, in dialytic treatment for acute renal insufficiency consequent to right renal artery damage, soft tissues necrosis of the amputation stump with sepsis and persistent fever until 40 degrees C. The treatment and care of this patient required a team-work with the collaboration of many specialists, namely surgeons, nephrologists, anaesthetists, interventionist radiologists and hyperbaric oxygen therapy experts. Thanks to such collaboration we achieved an excellent quoad vitam result. The aim of this paper is to confirm and emphasize the central role of a Trauma Team, fed in a Trauma Center and in a Trauma System, in the management of complex traumas.

Lateral femoral condyle osteochondral fracture combined to patellar dislocation: a case report.

The authors report the case of an osteochondral fracture involving the weight-bearing portion of the lateral femoral condyle in a 23-year-old sportsman. The defect was concomitant to a lateral patellar dislocation involving a rare injury mechanism. Fixation of the osteochondral fragment was performed with bioabsorbable pins and healing was achieved within an acceptable time. Clinical and radiographic outcome at one year is highly satisfactory and bioabsorbable implant fixation reveals to be a worthwhile option in such a case. This rare lesion is diagnostically challenging and requires an adapted and prompt treatment.

Evolução funcional nas fraturas da extremidade proximal do fêmur / Functional evolution of proximal femoral end fractures

OBJETIVOS: analisar a evolução da capacidade funcional e do escore fisiológico em pacientes com fraturas da extremidade proximal do fêmur, assim como comparar os resultados finais do tratamento instituído com as diversas variáveis pré-fratura. MATERIAIS E MÉTODOS: estudo prospectivo com pacientes acima de 40 anos e diagnóstico de fratura do fêmur proximal. Os pacientes foram submetidos à aplicação de um protocolo pré-estabelecido e acompanhados ambulatorialmente por um período de um ano. RESULTADOS: foram acompanhados 68 pacientes (27 homens e 41 mulheres) com idade média de 75,84 anos. O tratamento cirúrgico foi instituído em 83,82 por cento dos casos. O escore fisiológico inicial médio foi de 17,16 pontos, sendo o valor de 17,58 pontos nos pacientes operados e 9,27 pontos naqueles submetidos a tratamento conservador. A mortalidade verificada em um ano após a fratura foi de 36,76 por cento. A capacidade deambulatória sem auxílio foi readquirida em 32,56 por cento dos pacientes. 25,58 por cento dos casos, cujo escore fisiológico inicial médio foi inferior à média geral, não deambularam após o seguimento de um ano. 27,90 por cento dos pacientes previamente independentes passaram a necessitar de cuidados de familiares e/ou do serviço social. CONCLUSÃO: o fator de maior influência no resultado final foi o escore fisiológico inicial.

OBJECTIVES: To assess the functional capacity evolution and the physiologic score in patients with proximal femoral end fractures, as well as to compare the final results of the treatment provided to the several pre-fracture variables. MATERIALS AND METHODS: A prospective study with patients over 40 years old diagnosed with proximal femoral fracture. The patients were submitted to a pre-established protocol and followed up on an outpatient basis for a period of one year. RESULTS: 68 patients were assessed (27 men and 41 women), with a mean age of 75,84 years. 83,82 percent were submitted to surgical treatment. The early mean physiologic score was 17,16 points (17,58 points for patients submitted to surgical treatment and 9,27 points for those not submitted to surgical treatment). The mortality rate found after one year of fracture was 36,76 percent. The free ambulation ability was achieved by 32,56 percent. 25,58 percent of the cases whose mean early physiologic score was lower compared to the overall mean score couldn't ambulate after one year of follow up. 27,90 percent of the patients who were previously independent, required family care and/or social service. CONCLUSION: the initial physiologic score was the most important influencing factor in the final result.