Hip fractures in young adults: a retrospective cross-sectional study of characteristics, injury mechanism, risk factors, complications and follow-up

Wang, Michael T.; Yao, Sarah Hui Wen; Wong, Phillip; Trinh, Anne; Ebeling, Peter R.; Tran, Ton; Milat, Frances; Mutalima, Nora

doi:10.1007/s11657-017-0339-y

Cited by 23 publications

(23 citation statements)

References 20 publications

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“…Our results are also in agreement with clinical observations that younger subjects have a greater FE‐estimated femoral strength and a lower prevalence of hip fracture compared to the elderly 37 . Some clinical data also show that young adults aged between 15 and 49 years account for only 2.5% of hip fractures 38 …”

Section: Discussionsupporting

confidence: 91%

In Vivo Assessment of Age‐ and Loading Configuration‐Related Changes in Multiscale Mechanical Behavior of the Human Proximal Femur Using MRI‐Based Finite Element Analysis

Zhang

Wang

et al. 2020

Magnetic Resonance Imaging

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Background MRI‐based finite element analysis (MRI‐FEA) is the only method able to assess microstructural and whole‐bone mechanical properties of the hip in vivo. Purpose To examine whether MRI‐FEA is capable of discriminating age‐related changes in whole‐bone mechanical performance and micromechanical behavior of the proximal femur, particularly considering the most common hip fracture‐related sideways fall loading. Study Type Retrospective. Subjects A total of nine younger (27 ± 3.2 years) and nine elderly (61 ± 3.9 years) healthy volunteers. Field Strength/Sequence 3T; 3D fast field echo sequence. Assessment The left proximal femurs were scanned and FE models created. FEA was performed to simulate sideways fall and stance loading for each femoral model. Apparent stiffness and high‐risk (90th percentile) tensile and compressive strains of the proximal femur as well as the average strains within cubic regions of the femoral neck and greater trochanter were assessed. Statistical Tests Paired and unpaired t‐tests. Results Compared to the young group, the femoral stiffness of the elderly decreased by 39% and 40% (both P < 0.05) under the sideways fall and stance conditions, respectively. Accordingly, the high‐risk tensile and compressive stains were elevated with aging (40% and 23% for sideways fall, 23% and 11% for stance conditions; all P < 0.05). However, the loading configuration‐induced difference was only observed in the elderly group for the high‐risk strains (22% for tension and 12% for compression; both P < 0.05). Additionally, compared to the stance condition, the sideways fall increased the average tensile (young: 108%, elderly: 123%; both P < 0.05) and compressive strains (young: 631%, elderly: 617%, both P < 0.05) within the greater trochanter rather than the femoral neck region. Data Conclusion In vivo MRI‐FEA is capable of capturing age‐related changes in both apparent‐level stiffness and tissue‐level micromechanical behavior of the proximal femur. However, the effect of sideways fall loading might be better reflected by tissue‐level micromechanics rather than apparent stiffness. Level of Evidence 3 Technical Efficacy Stage 1

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Section: Discussionsupporting

confidence: 91%

In Vivo Assessment of Age‐ and Loading Configuration‐Related Changes in Multiscale Mechanical Behavior of the Human Proximal Femur Using MRI‐Based Finite Element Analysis

Zhang

Wang

et al. 2020

Magnetic Resonance Imaging

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“…2-11% of hip fractures occur among non-elderly [3][4][5][6][7]. In contrast to the geriatric population, some studies find men more prone to fracture their hip than women.…”

Section: Demographicsmentioning

confidence: 99%

“…The higher mortality of younger hip fracture patients, compared to the general population, may to a certain extent be explained by alcoholism [21]. Smoking is noted for 25% to as many as 67% [3,4,16,17,19,22]. Tobacco use may reflect an adverse lifestyle-related behaviour in general and is also associated with low peak bone mass and increased risk of hip and spine fractures [23,24].…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…An old Swedish study found high and low energy trauma to be equally common and identified two separate groups of patients: the healthy ones struck by significant trauma versus those with predisposing diseases only sustaining low-energy trauma [20]. More recent papers have found patients to have one or several risk factors for osteoporosis regardless of the trauma mechanism, as well as lower BMD than controls [3,4,9,16,19,27]. Overall, sociocultural factors, such as types of leisure activities, traffic behaviour, and alcohol consumption differ between countries and will influence these analyses.…”

Section: Trauma Mechanismmentioning

confidence: 99%

“…As in the elderly, the distribution between intra-and extracapsular fractures appears even. Two studies found intracapsular fractures to be associated with somewhat less comorbidity and higher trauma energy [3,8]. Also, Karantana et al [4] found women under 65 years to have fewer extracapsular fractures than their older counterparts.…”

Section: Accepted Manuscript Fracture Typesmentioning

confidence: 99%

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Hip fractures in the non-elderly—Who, why and whither?

Rogmark

Kristensen

Viberg

et al. 2018

Injury

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Nonelderly hip fracture patients have gathered little scientific attention, and our understanding of the group may be biased by patient case-mix and lack of follow-up. Preconceptions may thwart adequate investigation of bone health and other comorbidities. This literature review focusses on who these patients between 20 and 60 years are, how to treat them and how to evaluate the outcome. 2-11% of the hip fractures occur in non-elderly, equally common in men and women. Every second to forth patient smoke, have chronic diseases, and abuse alcohol. Poor self-rated health, sleep disturbances, low cognitive function and education are associated with increased hip fracture risk in young adults. Bone health is poorly investigated, but literature suggest young patients to have lower bone mineral density regardless of trauma mechanism. Studies contradict on whether surgery within 8-12 h reduce the risk of avascular necrosis in femoral neck fractures (FNF). Based on rationality, surgery ought to be performed promptly, in order to reduce pain and permit rehabilitation. There is no convincing support from the existing literature to use open reduction. Good reduction is mandatory, preferably using a closed reduction technique. The failure rate following internal fixation of displaced FNF in younger patients can be as high as 59%. In some cases a displaced FNF is better treated with a primary arthroplasty; in case of rheumatoid arthritis or osteoarthritis for example. Complications after extracapsular fractures vary from 6 to 23%. The relatively few studies looking at functional outcome in non-elderly use a multitude of outcome measures, precluding comparisons. Many non-elderly patients seem not to fully recover. While some non-elderly hip fracture patients are healthy individuals sustaining high energy trauma, others have low-energy fractures and comorbidities including reduced bone strength (either as a primary or secondary condition). i.e. non-delaying medical optimization, proper surgical technique, bone health investigation and secondary fracture prevention is necessary. Younger hip fracture patients are at risk of permanent loss of function, and negative socioeconomic and psychological consequences. High-energy trauma does not exclude the presence of osteopenia. A hip fracture in adulthood and middle-age is very seldom caused by bad luck only!

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Dilemmas in the Management of Osteoporosis in Younger Adults

et al. 2022

Self Cite

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Osteoporosis in premenopausal women and men younger than 50 years is challenging to diagnose and treat. There are many barriers to optimal management of osteoporosis in younger adults, further enhanced by a limited research focus on this cohort. Herein we describe dilemmas commonly encountered in diagnosis, investigation, and management of osteoporosis in younger adults. We also provide a suggested framework, based on the limited available evidence and supported by clinical experience, for the diagnosis, assessment, and management of osteoporosis in this cohort.

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Hip fractures in young adults: a retrospective cross-sectional study of characteristics, injury mechanism, risk factors, complications and follow-up

Abstract: Young adults with MTF of the hip have more severe systemic disease and are at risk of post-operative complications and subsequent fractures. Referral of patients to endocrine care is recommended to manage osteoporosis and comorbid diseases.

Cited by 23 publications

References 20 publications

In Vivo Assessment of Age‐ and Loading Configuration‐Related Changes in Multiscale Mechanical Behavior of the Human Proximal Femur Using MRI‐Based Finite Element Analysis

In Vivo Assessment of Age‐ and Loading Configuration‐Related Changes in Multiscale Mechanical Behavior of the Human Proximal Femur Using MRI‐Based Finite Element Analysis

Hip fractures in the non-elderly—Who, why and whither?

Dilemmas in the Management of Osteoporosis in Younger Adults

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