# Impact of handgrip strength on postoperative recovery and prognosis in elderly patients with intertrochanteric fractures

## TL;DR

This study shows that lower handgrip strength in elderly patients with hip fractures is linked to worse recovery, more complications, and higher mortality after surgery.

## Contribution

The study identifies preoperative grip strength as a novel predictor of postoperative outcomes in elderly intertrochanteric fracture patients.

## Key findings

- Low grip strength correlates with worse postoperative hemoglobin levels, longer hospital stays, and delayed ambulation.
- Patients with low grip strength had higher complication rates and worse quality of life scores at 6 and 12 months.
- Lower grip strength is associated with increased 1-year mortality in these patients.

## Abstract

To investigate the impact of preoperative grip strength on early postoperative recovery, functional outcomes, and prognosis in elderly patients with intertrochanteric fractures.

A retrospective cohort study was conducted on 195 elderly patients who underwent closed reduction and intramedullary nailing for intertrochanteric fractures between January 2018 and December 2022. Based on EWGSOP2 cut-off values (men < 27 kg, women < 16 kg), patients were classified into a high grip strength group (n = 110) and a low grip strength group (n = 85). Data on baseline characteristics, perioperative indicators (postoperative hemoglobin, transfusion volume, time to ambulation, length of hospital stay), postoperative follow-up outcomes (Harris Hip Score, SF-36 quality of life score), as well as postoperative complications and 1-year all-cause mortality were collected and compared between the two groups.

The baseline characteristics were comparable between the two groups (P > 0.05). Compared to the high grip strength group, the low grip strength group had significantly lower postoperative hemoglobin levels (7.7 ± 3.4 vs. 9.2 ± 4.1 g/dL, P = 0.014), greater postoperative transfusion volume (78.9 ± 44.2 vs. 45.1 ± 26.8 ml, P = 0.025), longer time to ambulation (4.2 ± 2.5 vs. 2.5 ± 1.8 days, P = 0.034), and extended hospital stay (14.2 ± 3.5 vs. 10.4 ± 4.6 days, P = 0.041). At the 6- and 12-month follow-ups, the low grip strength group showed significantly worse Harris Hip Scores and SF-36 scores across all domains (all P < 0.05). Furthermore, the incidence of postoperative complications—including pneumonia (9 vs. 4, P = 0.033), deep vein thrombosis (6 vs. 4, P = 0.010), pressure ulcers (3 vs. 1, P = 0.018), urinary tract infections (4 vs. 2, P = 0.029), and internal fixation loosening (3 vs. 1, P = 0.005)—was significantly higher in the low grip strength group. The 1-year all-cause mortality was also significantly higher in the low grip strength group (4 vs. 2, P = 0.040).

Preoperative grip strength is an effective predictor of postoperative prognosis in elderly patients with intertrochanteric fractures. Low grip strength is significantly associated with greater hidden blood loss, a higher incidence of complications, poorer functional recovery, and increased mortality. Incorporating grip strength assessment into the preoperative evaluation and developing targeted rehabilitation strategies may help improve patient outcomes.