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

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