Location of Femoral Fractures in Patients with Different Weight Classes in Fall and Motorcycle Accidents: A Retrospective Cross-Sectional Analysis

Abstract

Background: This study aimed to determine the incidence of femoral fracture location in trauma patients with different weight classes in fall and motorcycle accidents. Methods: A total of 2647 hospitalized adult patients with 2760 femoral fractures from 1 January 2009 to 31 December 2014 were included in this study. Femoral fracture sites were categorized based on their location: proximal femur (type A, trochanteric; type B, neck; and type C, head), femoral shaft, and distal femur. The patients were further classified as obese (body mass index [BMI] of ≥30 kg/m2), overweight (BMI of <30 but ≥25 kg/m2), normal weight (BMI of <25 but ≥18.5 kg/m2), and underweight (BMI of <18.5 kg/m2). Odds ratios and 95% confidence intervals of the incidences of femoral fracture location were calculated in patients with different weight classes in fall or motorcycle accidents, and they were then compared with those in patients with normal weight. p values of <0.05 were considered statistically significant. Results: Most of the fractures sustained in fall accidents presented in the proximal type A (41.8%) and type B (45.3%) femur, whereas those sustained in motorcycle accidents involved the femoral shaft (37.1%), followed by the distal femur (22.4%) and proximal type A femur (21.2%). In fall accidents, compared with normal-weight patients, obese and overweight patients sustained lower odds of risk for proximal type B fractures but higher odds of risk for femoral shaft and distal femoral fractures. In motorcycle accidents, compared with normal-weight patients, obese patients sustained lower odds of risk for proximal type B fractures but no difference in odds of risk for femoral shaft and distal femoral fractures. Overweight and underweight patients who sustained fractures in a motorcycle accident did not have different fracture location patterns compared with normal-weight patients. Conclusions: This study revealed that femoral fracture locations differ between fall and motorcycle accidents. Moreover, greater soft tissue padding may reduce impact forces to the greater trochanteric region in obese patients during fall accidents, and during motorcycle accidents, the energy transmitted and the point of impact may dominantly determine the location of femoral fractures.

The influence of ageing on the incidence and site of trauma femoral fractures: a cross-sectional analysis

“…In obese patients, increased soft tissue padding around the hip attenuates the greater impact forces that result from falls and reduces the force transmitted to the bone [15, 16]. In contrast, obese patients had a higher odds risk for shaft and distal femoral fractures in fall accidents [4]. In this type of scenario, the body weight associated with obesity would increase the impact force but provide less protection in the shaft and distal region of the femur.…”

“…The factors influencing femoral fracture site are interrelated and are not independent. For example, increasing age is associated with osteoporotic bone changes, which are believed to increase the rate of femoral fracture; falls occur more frequently in the elderly [3, 4] but traffic-related fractures caused by motorcycle or bicycle accidents occur more often in younger adults and the rate of its occurrence differs between genders [4, 5]. In a fall accident, the force directly impacts the posterolateral aspect of the greater trochanter, but the impact point is not limited to only this site in a non-fall accident.…”

“…In a fall accident, the force directly impacts the posterolateral aspect of the greater trochanter, but the impact point is not limited to only this site in a non-fall accident. Therefore, proximal type A and B fractures are predominant in falls, but in motorcycle accidents, femoral shaft fracture comprises the most common fracture site, followed by distal femoral fractures [4]. In addition, The distribution of impact force through the hip that is associated with falls from a standing height is greater than the average energy required to fracture an elderly hip but not that of a younger adult [6].…”

Geriatric Nutritional Risk Index as a Screening Tool to Identify Patients with Malnutrition at a High Risk of In-Hospital Mortality among Elderly Patients with Femoral Fractures—A Retrospective Study in a Level I Trauma Center

“…Elderly individuals are at the greatest risk of a fall accidents [1,2] and their consequences, such as fractures, immobility, and sometimes even death [3][4][5][6][7]. In addition to pain, a femoral fracture results in a curtailment of physical activity, increased dependence, and rapid worsening of the health status.…”

Descriptive Analysis Of Femur Fracture Patterns, Management And Outcome: Descriptive Observational Study From A Level 1 Trauma Center

“…There is an evidence that femoral shaft fractures have frequent assosciation with skeletal injuries (46.4%) and one-fourth of cases had occult assocaited injuries [8]. Notably, many studies have reported the presence of assosciated injuries such as hemothorax, bowel and head injuries concomitant with femur shaft fracture which dictates the severity of injury [8][9][10]. Of note, there are certain factors such as age, gender, mechanism of injury and magnitude of traumatic impact which might in uence the site of femoral fracture [11,12].…”