A retrospective analysis of bilateral fractures over sixteen years: localisation and variation in treatment of second hip fractures

Abstract

The aim of this study was the evaluation of contralateral hip fractures after a previous hip fracture. For this retrospective analysis patients were selected from the database of the LUMC, a teaching hospital in the south-west of the Netherlands. We analyzed all patients with a second fracture of a hip between 1992 and 2007. The exclusion criteria were high impact trauma and patients with diseases or medication known to have a negative effect on bone metabolism. A total of 1,604 hip fractures were identified. The possible predictive factors for the second fracture and descriptive statistics related to surgery (Hb and HT before and after the operation, total amount of intra- and postoperative blood loss, type of osteosynthesis, complications, time of death after the last fracture, time between arrival in the hospital and operation and hospital stay for both fractures) were recorded. A total of 32 second hip fractures were identified (2%) at a mean of 27.5 (SD 28.9) months after the initial hip fracture. The mean age at the first fracture was 77.2 years (SD 11.7), and 27 of 32 patients were female. Of these 32 patients (64 bilateral hip fractures), 32 fractures were intracapsular (1 femoral neck, 31 subcapital) and 32 were extracapsular fractures (6 subtrochanteric, 26 transtrochanteric). Although 24 of the 32 patients had identical first and second hip fractures, only eight out of 32 hips were treated with the same implants. There was a significant difference in Singh index between both hips at the time of the first fracture. There was also a significant difference in Singh index between the hip which was not fractured compared with its subsequent index when it was broken. All other studied patient and fracture characteristics were not significantly different. In this population the percentage of second hip fractures was relatively low compared to other studies. The choice of implants in this study shows that implants were chosen randomly. Because there is a significant difference in the Singh index during first and second hip fracture, osteoporosis medication might help reduce the incidence of second hip fractures.

Risk of second hip fracture persists for years after initial trauma

“…We found that the risk of another fracture among survivors increased steadily with time, reaching 34% by 10 years, and did not differ between women and men after adjustment for age, fracture type, period, and hospital length of stay. Our findings on the rate and cumulative incidence of events are in agreement with previous reports [5,17,[25][26][27][28][29][30][31][32][33][34][35][36][37][38]. In particular, we confirm that women have higher rates of second hip fracture during the early post-injury periods and lower death rates overall, when compared to men.…”

Cumulative incidence and treatment of non-simultaneous bilateral femoral neck fractures in a cohort of one thousand two hundred and fifty patients

“…This is in line with literature data, where intervals from 2 to 5 years between the first and second hip fracture are reported (2,4,6). Given this short period, substantial changes in patient characteristics were not very likely.…”

“…A first hip fracture is a risk factor for sustaining a second hip fracture at the contralateral side. Other reported predictors for a second hip fracture include age, female gender, living alone, alcoholism, any prior fracture, functional status, dementia, and osteoporosis (2)(3)(4)(5)(6).…”

“…The reported interval between both fractures is 2-5 years (2-4, 6, 13, 15, 18, 21, 22). In 60-81% of the patients with bilateral hip fractures the second fracture is of the same type as the first hip fracture (i.e., trochanteric or femoral neck) (3,4,13,14,18,21,23). Most reports on characteristics of bilateral hip fractures involved patients with both trochanteric and femoral neck fractures.…”

Risk factors for contralateral hip fractures following femoral neck fractures in elderly: analysis of the Hungarian nationwide health insurance database

“…Among the risk factors; the role of accompanying diseases, bone status, body mass index, residence, Singh index, localization of the fracture, physical functioning, and complications are often studied. [2][3][4]7,8] On the other hand, little is known about the effect of different settlement types (location of residence) and operation techniques of primary fractures as risk factors of second hip fractures.…”