Majority of Hip Fractures Occur as a Result of a Fall and Impact on the Greater Trochanter of the Femur: A Prospective Controlled Hip Fracture Study with 206 Consecutive Patients

Abstract

The objectives of this study were to learn how hip fracture patients fall, and to compare the mechanics of their falls with those falls that did not result in hip fracture. In this way we sought to obtain reliable insight into the etiology and pathogenesis of hip fracture and fracture prevention. A total of 206 consecutive patients with fresh hip fracture and 100 controls were interviewed and examined between October 1994 and May 1996. The only inclusion criterion was that the fracture had occurred within 24 hours of hospital admittance. The control subjects were admitted from the same community after an accidental fall that did not result in hip fracture. The characteristics of the accident were determined by personal interview and examination of the patients within 24 hours of the event. In 98% of the hip fracture patients, the fracture was a result of a fall. The majority of the patients (76%) reported that they had fallen directly to the side. Forty-eight fracture cases had one or more eyewitnesses and their reports supported this observation. In 56% of the hip fracture patients, a fresh subcutaneous hematoma was seen on the greater trochanter of the proximal femur; such a hematoma was rare in the controls (6%) (P < 0. 001), and this gave evidence for the direct impact of the greater trochanter during the fall of the hip fracture subjects. Most of the elderly fallers who fractured a hip did not manage to break the fall, e.g., with an outstretched arm. In conclusion, our results suggest that a typical hip fracture is the result of a fall and a subsequent impact on the greater trochanter of the proximal femur. The clinical implication of this finding is that effective prevention of hip fractures could be achieved by the diminution of the number and severity of falls of the elderly. We suggest that the severity of the falls (impacts on the greater trochanter) could be decreased by an external hip protector.

The impact of decreasing U.S. hip fracture rates on future hip fracture estimates

“…The fastest-growing segment of the population is people aged 80 and over, and this group has the highest hip fracture rate. Over 95 % of hip fractures are caused by falling [16], usually by falling sideways onto the hip [17] from a standing height. While it is possible that current rates will level off or even increase, it is also possible that rates will decline faster due to broad implementation of fall prevention strategies and/or improved screening and treatment of osteoporosis.…”

Effects of a Multicomponent Home-Based Physical Rehabilitation Program on Mobility Recovery After Hip Fracture: A Randomized Controlled Trial

“…The average age of Finnish hip fracture patients is 81.6 years for women and 76.0 years for men (Korhonen et al 2013). In Finland, the incidence of hip fractures increased up to the end of the 1990s (Kannus et al 1999) and declined thereafter (Kannus et al 2006, Korhonen et al 2013, especially among women and persons over age 65 (Korhonen et al 2013). The reasons for the decline are unclear, but better overall health and physical function, fall prevention programs, increased body weight and better osteoporosis prevention, interventions for polypharmacy, modifications of environmental hazards and increased D-vitamin intake among older people might partly explain the decline.…”

Exercise loading history and femoral neck strength in a sideways fall: A three-dimensional finite element modeling study

“…Several finite element (FE) modeling and cadaveric experimental studies have consistently shown that a sideways fall exposes the femoral neck to the greatest risk of a fracture [7,[9][10][11][12][13]. Indeed, over 90% of hip fractures are directly caused by falls [14,15]. Therefore, if the superolateral cortical thickness could be maintained or even increased with appropriate exercise training, bone strength may be maintained and hip fracture risk reduced in old age.…”