International Orthopaedics (SICOT) DOI 10.1007/s00264-014-2646-x
ORIGINAL PAPER
Subsequent contralateral hip fractures: can at-risk patients be identified? An observational study of 5,102 patients Jiří Skála-Rosenbaum & Valér Džupa & Radek Bartoška & Daniel Říha & Petr Waldauf & Václav Báča
Received: 30 September 2014 / Accepted: 15 December 2014 # SICOT aisbl 2015
Abstract Purpose The aim of this study was to evaluate a sample of patients who sustained hip fractures during the years 1997– 2011 and identify risk factors for a subsequent contralateral hip fracture; one-year mortality rates were compared in both groups. Methods A total of 5,102 patients with hip fractures were prospectively studied to identify patients who had also suffered a subsequent, contralateral, hip fracture (SCHF). Those patients who had sustained a second fracture within 18 months of the initial fracture were then studied. All data were statistically processed. Results Within 18 months of the first fracture, a SCHF occurred in 105 patients (2.1 %). These patients were an average of three years older than those in the single fracture group. Risk factors for the development of a SCHF included: female gender, residing in a residential care facility, and limited mobility prior to injury. Trochanteric fractures did not represent a statistically significant risk factor for SCHF. More than threequarters of patients with subsequent injuries suffered the same type of fractures on the opposite side. Patients with subsequent
This article is original, it is not under consideration by another journal, and it has not been previously published. J. Skála-Rosenbaum (*) : V. Džupa : R. Bartoška : D. Říha Department of Orthopaedics and Traumatology, Third Faculty of Medicine, Charles University, and University Hospital Kralovske Vinohrady, Šrobárova 50, 100 34 Prague, Czech Republic e-mail: [email protected] P. Waldauf Department of Anaesthesiology and Resuscitation, Third Faculty of Medicine, Charles University, and University Hospital Kralovske Vinohrady, Prague, Czech Republic V. Báča Department of Anatomy, Third Faculty of Medicine, Charles University, Prague, Czech Republic
fractures had lower one-year mortality rates than patients with only one fracture. Conclusion Patients at greatest risk for a SCHF were women with limited mobility who resided in nursing homes for the elderly. The lower mortality rate associated with second fractures shows that the prognosis for such patients is good. Since the at-risk group is so well defined, prophylactic measures for these patients should be utilized in order to minimize the risk of additional fractures.
Keywords Contralateral hip fracture . Risk factors . Mortality
Introduction The risk of mortality in hip fracture patients over 65 years is three-fold higher than in that of the general population [1]; additionally, patients are at increased risk for premature death for many years after the hip fracture [2, 3]. Despite this tendency slowly declining in very developed countries [4], most countries continue to observe an annual increase in the number of hip fracture patients [5]. Nevertheless, the incidence of SCHFs has not changed over the last three decades [6, 7] and ranges from 4 to 15 % [8, 9]. Several authors have tried to analyse risk factors linked to SCHFs in the hopes of providing some type of prophylaxis [10–13]. However, monocentric studies tended to analyse only small numbers of patients, while multicentric studies evaluated larger, but nonhomogeneous populations in the form of national registries, which are subject to bias and are therefore less reliable. Our study deals with SCHFs for a precisely-defined city district over a period of 15 years. The aim was to characterize this group of patients, determine the incidence and possible
International Orthopaedics (SICOT)
influence of previous fractures, identify risk factors and define those patients suitable for prophylactic treatment.
Patients with a second hip fracture
Results The final group analysed included 105 patients with a SCHF. When evaluating the age of patients at the time of initial fractures, we were unable to find any difference in the age of patients with single or bilateral fractures. However, when assessing the age of patients at the time of the second fracture, a significant difference was observed when comparing patients with a single fracture and those with SCHFs (p
ORIGINAL PAPER
Subsequent contralateral hip fractures: can at-risk patients be identified? An observational study of 5,102 patients Jiří Skála-Rosenbaum & Valér Džupa & Radek Bartoška & Daniel Říha & Petr Waldauf & Václav Báča
Received: 30 September 2014 / Accepted: 15 December 2014 # SICOT aisbl 2015
Abstract Purpose The aim of this study was to evaluate a sample of patients who sustained hip fractures during the years 1997– 2011 and identify risk factors for a subsequent contralateral hip fracture; one-year mortality rates were compared in both groups. Methods A total of 5,102 patients with hip fractures were prospectively studied to identify patients who had also suffered a subsequent, contralateral, hip fracture (SCHF). Those patients who had sustained a second fracture within 18 months of the initial fracture were then studied. All data were statistically processed. Results Within 18 months of the first fracture, a SCHF occurred in 105 patients (2.1 %). These patients were an average of three years older than those in the single fracture group. Risk factors for the development of a SCHF included: female gender, residing in a residential care facility, and limited mobility prior to injury. Trochanteric fractures did not represent a statistically significant risk factor for SCHF. More than threequarters of patients with subsequent injuries suffered the same type of fractures on the opposite side. Patients with subsequent
This article is original, it is not under consideration by another journal, and it has not been previously published. J. Skála-Rosenbaum (*) : V. Džupa : R. Bartoška : D. Říha Department of Orthopaedics and Traumatology, Third Faculty of Medicine, Charles University, and University Hospital Kralovske Vinohrady, Šrobárova 50, 100 34 Prague, Czech Republic e-mail: [email protected] P. Waldauf Department of Anaesthesiology and Resuscitation, Third Faculty of Medicine, Charles University, and University Hospital Kralovske Vinohrady, Prague, Czech Republic V. Báča Department of Anatomy, Third Faculty of Medicine, Charles University, Prague, Czech Republic
fractures had lower one-year mortality rates than patients with only one fracture. Conclusion Patients at greatest risk for a SCHF were women with limited mobility who resided in nursing homes for the elderly. The lower mortality rate associated with second fractures shows that the prognosis for such patients is good. Since the at-risk group is so well defined, prophylactic measures for these patients should be utilized in order to minimize the risk of additional fractures.
Keywords Contralateral hip fracture . Risk factors . Mortality
Introduction The risk of mortality in hip fracture patients over 65 years is three-fold higher than in that of the general population [1]; additionally, patients are at increased risk for premature death for many years after the hip fracture [2, 3]. Despite this tendency slowly declining in very developed countries [4], most countries continue to observe an annual increase in the number of hip fracture patients [5]. Nevertheless, the incidence of SCHFs has not changed over the last three decades [6, 7] and ranges from 4 to 15 % [8, 9]. Several authors have tried to analyse risk factors linked to SCHFs in the hopes of providing some type of prophylaxis [10–13]. However, monocentric studies tended to analyse only small numbers of patients, while multicentric studies evaluated larger, but nonhomogeneous populations in the form of national registries, which are subject to bias and are therefore less reliable. Our study deals with SCHFs for a precisely-defined city district over a period of 15 years. The aim was to characterize this group of patients, determine the incidence and possible
International Orthopaedics (SICOT)
influence of previous fractures, identify risk factors and define those patients suitable for prophylactic treatment.
Patients with a second hip fracture
Results The final group analysed included 105 patients with a SCHF. When evaluating the age of patients at the time of initial fractures, we were unable to find any difference in the age of patients with single or bilateral fractures. However, when assessing the age of patients at the time of the second fracture, a significant difference was observed when comparing patients with a single fracture and those with SCHFs (p
