Epidemiology and Management of Proximal Femoral Fractures in Italy between 2001 and 2016 in Older Adults: Analysis of the National Discharge Registry

Longo, Umile Giuseppe; Viganò, Marco; Girolamo, Laura de; Banfi, Giuseppe; Salvatore, Giuseppe; Denaro, Vincenzo

doi:10.3390/ijerph192416985

Cited by 11 publications

(8 citation statements)

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“…We observed a downward trend in hip fracture events irrespective how fractures were ascertained, nding it with a naïve analysis, with o cial Swedish statistics as well as with our more accurate algorithm-based approach. The same downward trend has also been seen in other European settings (31)(32)(33)(34), while trends have plateaued in North America (35). In contrast, hip fracture rates are increasing in Asia (36-39).…”

Section: Discussionsupporting

confidence: 60%

Declining hip fracture burden in Sweden 1998-2019 and consequences for projections through 2050

Michaëlsson

Baron

Byberg

et al. 2023

Preprint

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Although it may seem trivial to use national diagnosis databases to identify the number of patients, analyze time trends, and make projections, here we use hip fracture to illustrate the complexity and difficulty of estimating the reliable number of injury events. Readmissions after the index hip fracture are common, and register identification of a real second fracture is crucial for data accuracy. Therefore, we aimed to estimate the absolute and age-standardized number of hip fractures in Sweden during the past two decades to produce time trends and future projections. We also illustrate how the naïve use of register data leads to invalid estimates. We used nationwide Swedish register data from 1998 to 2019 and a validated algorithm to calculate the annual absolute and age-standardized number of incident hip fractures over time. According to our algorithm, the total hip fracture burden was 335,399 incident events over the 22-year period, with a change from 16,180 in 1998 to 13,929 in 2019, a 14% decrease. One decade after the index hip fracture event, 80% of the patients had died and 11% had a new hip fracture. After considering the steady growth of the older population, the decline in the age-standardized number of hip fractures was 30%. With a continued similar reduction in hip fracture incidence, we can predict that 14,800 hip fractures will occur in 2034 and 12,000 in 2050 despite a doubling of the oldest old (≥80 years). Without an algorithm, a naïve estimate of the total number of hip fractures over the study period was 539,947, with a second 10-year hip fracture risk of 35%. Accordingly, the naïve use of register data can dramatically inflate estimates of the number of fractures. We note an ongoing decline in absolute and age-standardized actual number of hip fractures in Sweden, with consequences for future projections.

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Section: Discussionsupporting

confidence: 60%

Declining hip fracture burden in Sweden 1998-2019 and consequences for projections through 2050

Michaëlsson

Baron

Byberg

et al. 2023

Preprint

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“…Most of the international literature, guidelines [ 18 ] and Italian data on the epidemiology and management of proximal femur fractures were confirmed by data from the Region of Lombardy: the higher frequency of females and patients older than 80 years, the higher prevalence of pertrochanteric fractures over transcervical ones, internal fixation more common to treat pertrochanteric fractures and arthroplasty (both total and partial) more common to treat transcervical fractures [ 8 ]. For example, the adoption of THA to fix transcervical fractures is consistent with reports from other countries like Australia, Canada, Finland, South Korea and United States [ 19 – 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…These fractures are expected to reach up to 21.3 million globally by 2050 as a consequence of aging [ 6 ], bone mass decrease and higher chances of accidental falls [ 7 ]. The incidence of proximal femoral fractures among people aged 65 or older varies in different countries depending on age itself, sex, comorbidities and lifestyle, reaching a peak among patients 85–89 years old, affecting more women than men and being exacerbated by cognitive disfunction and institutionalisation [ 8 – 10 ]. The direct costs of hip fracture treatment have a major economic impact on the healthcare system worldwide [ 7 , 11 , 12 ], not to mention the indirect impact on caregivers and society more in general which is under investigated.…”

Section: Introductionmentioning

confidence: 99%

“…While in Italy the absolute number of these events increases, the incidence adjusted per age seems to decrease [ 8 ], possibly as a consequence of beneficial prevention policies adopted by those regions where aging is specifically addressed. Examples are preventive osteoporosis treatment, fall prevention policies inside healthcare facilities and promotion of a more active lifestyle to improve general health and frailty [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Proximal hip fractures in 71,920 elderly patients: incidence, epidemiology, mortality and costs from a retrospective observational study

Viganò,

Pennestrì,

Listorti

et al. 2023

BMC Public Health

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Background The risk of proximal femoral fractures increases with aging, causing significant morbidity, disability, mortality and socioeconomic pressure. The aims of the present work are (1) to investigate the epidemiology and incidence of these fractures among the elderly in the Region of Lombardy; (2) to identify the factors influencing survival; (3) to identify the factors influencing hospitalization and post-operative costs. Methods The Region of Lombardy provided anonymized datasets on hospitalized patients with a femoral neck fracture between 2011 and 2016, and anonymized datasets on extra-hospital treatments to track the patient history between 2008 and 2019. Statistical evaluations included descriptive statistics, survival analysis, Cox regression and multiple linear models. Results 71,920 older adults suffered a femoral fracture in Lombardy between 2011 and 2016. 76.3% of patients were females and the median age was 84. The raw incidence of fractures was stable from year 2011 to year 2016, while the age-adjusted incidence diminished. Pertrochanteric fractures were more spread than transcervical fractures. In patients treated with surgery, receiving treatment within 48 h reduced the hazard of death within the next 24 months. Combined surgical procedures led to increased hazard in comparison with arthroplasty alone, while no differences were observed between different arthroplasties and reduction or fixation. In patients treated conservatively, age and male gender were associated with higher hazard of death. All patients considered, the type of surgery was the main factor determining primary hospitalization costs. A higher number of surgeries performed by the index hospital in the previous year was associated with financial savings. The early intervention significantly correlated with minor costs. Conclusions The number of proximal femoral fractures is increasing even if the age-adjusted incidence is decreasing. This is possibly due to prevention policies focused on the oldest cohort of the population. Two policies proved to be significantly beneficial in clinical and financial terms: the centralization of patients in high-volume hospitals and a time limit of 48 h from fracture to surgery. Trial registration Non applicable.

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“…Proximal femur fracture or 'hip fracture' management continues to be an area of global interest even as recent evidence has suggested stabilizing or decreasing incidence. [14][15][16][17][18] Optimization of surgical technique to maximize functional recovery remains the cornerstone of multidisciplinary approaches developed to decrease morbidity and mortality after hip fractures. 16 Selecting the correct entry point is the most technically challenging and critical aspect of placing an medullary implant after reduction is obtained.…”

Section: Discussionmentioning

confidence: 99%

Optimizing the Entry Point for Medullary Hip Screws

Huang,

Rockov,

Foster

et al. 2024

J Am Acad Orthop Surg

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Introduction: Medullary hip screws (MHSs) are the most common treatment of intertrochanteric hip fractures because they can be used for varied fracture patterns and resist shortening. Identifying the appropriate MHS entry point can be intellectually and technically challenging. We aimed to quantify the variability in the ideal entry point (IEP) for MHSs. Methods: Standing alignment radiographs of 50 patients were evaluated using TraumaCad (Brainlab). The femoral neck shaft angle and the offset from the tip of the greater trochanter (GT) to the femur's longitudinal axis (‘greater trochanter offset’) were measured. Five MHS system templates were superimposed on the femur's longitudinal axis, and the distance from the GT tip to MHS's top center was measured. Five independent reviewers each templated 20 images such that all images were measured at least twice. A random sample of five images was selected for all five raters to measure and to calculate an intraclass coefficient Mean IEPs were compared with an independent sample Student t-test. Results: The mean GT offset was 13.5 ± 5.6 mm (range 12.9 to 26.7 mm). The mean neck shaft angle was 129.5 ± 4.0 (range 120 to 139). The mean IEP for nail systems ranged from 5.7 to 7.1 mm medial to the GT tip; there was no notable difference in pairwise comparison of nail systems or in aggregate. Intraclass coefficient for all ratings, measurements, and nail types ranged from moderate to good. Both intra-rater and inter-rater reliability were excellent. Discussion and Conclusion: In a sample with broad variation in femoral anatomy, there is a specific, roughly 1.5 mm wide interval that is 6.4 mm medial to the GT tip that serves as the IEP for the most common MHS systems. No notable difference seems to exist in the IEP among these MHS systems.

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Epidemiology and Management of Proximal Femoral Fractures in Italy between 2001 and 2016 in Older Adults: Analysis of the National Discharge Registry

Cited by 11 publications

References 50 publications

Declining hip fracture burden in Sweden 1998-2019 and consequences for projections through 2050

Declining hip fracture burden in Sweden 1998-2019 and consequences for projections through 2050

Proximal hip fractures in 71,920 elderly patients: incidence, epidemiology, mortality and costs from a retrospective observational study

Optimizing the Entry Point for Medullary Hip Screws

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