Geriatric trauma hip fractures: is there a difference in outcomes based on fracture patterns?

Abstract

BackgroundAnnually in the US, there are over 300,000 hospital admissions due to hip fractures in geriatric patients. Consequently, there have been several large observational studies, which continue to provide new insights into differences in outcomes among hip fracture patients. However, few hip fracture studies have specifically examined the relationship between hip fracture patterns, sex, and short-term outcomes including hospital length of stay and discharge disposition in geriatric trauma patients.MethodsWe performed a retrospective study of hip fractures in geriatric trauma patients. Hip fracture patterns were based on ICD -9 CM diagnostic codes for hip fractures (820.00-820.9). Patient variables were patient demographics, mechanism of injury, injury severity score, hospital and ICU length of stay, co-morbidities, injury location, discharge disposition, and in-patient mortality.ResultsA total of 325 patient records met the inclusion criteria. The mean age of the patients was 82.2 years, and the majority of the patients were white (94%) and female (70%). Hip fractures patterns were categorized as two fracture classes and three fracture types. We observed a difference in the proportion of males to females within each fracture class (Femoral neck fractures Z-score = -8.86, p < 0.001, trochanteric fractures Z-score = -5.63, p < 0.001). Hip fractures were fixed based on fracture pattern and patient characteristics. Hip fracture class or fracture type did not predict short-term outcomes such as in-hospital or ICU length of stay, death, or patient discharge disposition. The majority of patients (73%) were injured at home. However, 84% of the patients were discharged to skilled nursing facility, rehabilitation, or long-term care while only 16% were discharged home. There was no evidence of significant association between fracture pattern, injury severity score, diabetes mellitus, hypertension or dementia.ConclusionsHip fracture patterns differ between geriatric male and female trauma patients. However, there was no significant association between fracture patterns and short-term patient outcomes. Further studies are planned to investigate the effect of fracture pattern and long-term outcomes including 90-day mortality, return to previous levels of activity, and other quality of life measures.

Epidemiology, treatment and mortality of trochanteric and subtrochanteric hip fractures: data from the Swedish fracture register

“…Our finding of a higher number of fractures among females is in line with most of the previous studies and has an association with osteoporosis [ 4 , 17 – 21 ]. The high age of the patients reflects that there is an increased risk to fall with advanced age, and as these patients often are frail with poor bone-quality there is an increased risk for suffering from a hip fracture even after a low energy fall.…”

“…The high age of the patients reflects that there is an increased risk to fall with advanced age, and as these patients often are frail with poor bone-quality there is an increased risk for suffering from a hip fracture even after a low energy fall. Mangram et al 2014 [ 17 ] described that 73% of their trochanteric fracture patients fell at home. Similarly, Haginoa et al 2017 [ 6 ] reported that an indoors simple fall was the trauma mechanism in 80% of their hip fracture patients, and 85% of them were ≥ 90 years old.…”

Age-specific 1-year mortality rates after hip fracture based on the populations in mainland China between the years 2000 and 2018: a systematic analysis

“…We also found that the 1-year mortality rate was higher after femoral intertrochanteric fracture than femoral neck fracture in every 5-year age group when the age was over 60 years old. The relationship between fracture type and mortality remains controversial, with some investigators [ 25 ] reporting that the fracture type did not affect the mortality while some survival studies [ 26 , 27 ] revealed the mortality rates of intertrochanteric fracture patients were higher than femoral neck fracture patients. However, patients with intertrochanteric fractures were older than those with a femoral neck fracture in the previous studies.…”

30-day mortality for fractured neck of femur patients with concurrent COVID-19 infection

“…The COVID-19 pandemic has had a dramatic impact on the United Kingdom's National Health Service (NHS) in recent months. However, despite unprecedented social restrictions during the pandemic, we have continued to see fragility hip fracture admissions, and we assume due to the majority of these injuries occurring in the patients' normal place of residence [1,2]. In the UK in 2018, there were over 66,000 hip fractures registered with the National Hip Fracture Database (NHFD) with a 30-day and 1-year mortality rate of 6.1% and 33%, respectively [3].…”