A multi-site review of second hip fractures across 6 Dublin teaching hospitals

Downey, Colum; Flannery, S; Murphy, Ben; Daly, T; Conway, Steve; Gaffar, Mohammed; Dawson, Peter; O’Kelly, Patrick; Collins, Denis; Kenny, Paddy; McCarthy, Tom; Cashman, James; Shortt, Conor P.; OʼDaly, Brendan J.; Hurson, Conor; Quinlan, John

doi:10.1007/s11845-021-02607-1

Cited by 3 publications

(7 citation statements)

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“…Contemporaneous accurate representation of fracture incidence and thus care needs are crucial for healthcare planning [ 19 ] and our study will aid in the appropriate upscaling of resources for delivering excellent orthopaedic care to this vulnerable group. The benefits of multidisciplinary team care and fracture liaison services have previously been demonstrated for the secondary prevention of hip fractures [ 20 ], and lessons learnt in this setting may play a role in helping to rehabilitate those particularly affected by lockdown measures.…”

Section: Discussionmentioning

confidence: 99%

Increasing hip fracture volume following repeated lockdowns: an Irish multicentre study of periods pre-Covid, during Covid lockdown and following vaccination

et al. 2022

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Background Older age groups were identified as a high-risk cohort for Covid-19 and thus were a focus of lockdown measures enacted internationally. Resultant decreased social mobility and physical activity levels are associated with sarcopenia, which may lead to increased risk of hip fracture upon resuming social integration and physical activities after easing of lockdown restrictions. Aims Our aim was to compare the incidence of hip fractures during the period following vaccination with subsequent relaxation of restrictions, to those prior to and during the Covid pandemic. Methods A multicentre retrospective cohort study was performed consisting of all patients presenting with a “hip” fracture to 3 regional trauma units over the relevant time periods in 2019, 2020 and 2021. Tallaght, Galway and Waterford University Hospitals are large academic teaching hospitals with a combined mixed urban and rural catchment of over 1 million people. Findings Four-hundred-fourteen patients in total were included in the final analysis, with 133 eligible hip fractures observed proceeding to operative treatment across the study period in 2019, 132 in 2020 and 149 in 2021, representing a 12.88% increase. Demographic data revealed similar patient cohorts with respect to age and gender, fracture pattern and treatment. Conclusions An increase in hip fracture volume was observed during the period post vaccination with subsequent relaxation of restrictions and increased social mobility, compared to those prior to and during the Covid pandemic. These findings have implications for hospital planning and orthopaedic resourcing as we navigate our way forward past the Covid-19 Pandemic.

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Section: Discussionmentioning

confidence: 99%

Increasing hip fracture volume following repeated lockdowns: an Irish multicentre study of periods pre-Covid, during Covid lockdown and following vaccination

et al. 2022

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“…Identi cation of these risk factors are key in improving the care and outcomes of patients. International Osteoporosis Foundation (IOF) speci cally endorses a multidisciplinary care model, recommending a dedicated coordinator acting as the liaison between both patient and the mulitidisciplinary team with their "Capturing the Fracture' initiative [1][2]19]. Fracture Liaison Service (FLS) is a multidisciplinary team that is designed to ensure improved outcomes in these patients and well as preventing fragility hip fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Fragility hip fractures are one of the most common orthopaedic presentation to the acute hospital [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“…Globally, approximately 2 million hip fractures occur annually and this is predicted to increase by three to four fold by 2050 [2]. Recently, gures from the National O ce of Clinical Audit (NOCA) in Ireland recorded 3,701 hip fracture cases in patients aged 60 and over, which accounts for 99% of all hip fracture cases nationally [3].…”

Section: Introductionmentioning

confidence: 99%

“…Recently, gures from the National O ce of Clinical Audit (NOCA) in Ireland recorded 3,701 hip fracture cases in patients aged 60 and over, which accounts for 99% of all hip fracture cases nationally [3]. These injuries remains a signi cant cause of morbidity and mortality with a 30-day mortality of 5.7-6.5% and 1-year mortality of 22% [1][2]. Additionally, fragility hip fractures have signi cant healthcare cost attached it its treatment and prevention.…”

Section: Introductionmentioning

confidence: 99%

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Is contralateral femoral neck-shaft angle predictive of timing of subsequent hip fracture?

Wahab

Downey

Lawlor

et al. 2022

Preprint

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IntroductionIn 2019, research showed that in the six acute adult Dublin hospitals, 1 in 11 patients with fragility hip fracture sustained a second contralateral hip fracture. These have implications of additional patient morbidity and cost to the health service. Relationship of the contralateral femoral neck-shaft angle (NSA) and timing to the second hip fracture have not been established previously. Our study aimed to establish the relationship of the contralateral femur NSA in patient who already sustained a fragility hip fracture and determine if we could predict the timing of the second hip fracture.MethodsA 7 year single institution retrospective cohort study of patients that presented with second fragility hip fracture from 2013-2019 were reviewed. Exclusion criteria are patients who were aged less than 60 years old, high energy injuries, or had a peri-prosthetic fractures. Plain films anteroposterior (AP) pelvis radiographs were reviewed on the National Integrated Medical Imaging System (NIMIS) McKessons. NSA of the contralateral hip prior to second hip fracture were measured with a standardized method with the TraumaCAD software. Correlation analysis performed with Stata SE statistical software.Results and discussionContralateral NSA is not statistically significant in predicting the timing to second hip fracture. Causes of fragility hip fracture and subsequent second hip fracture are multifactorial and multidisciplinary approach such as fracture liaison services are essential to improve the prevention and treatment of such injuries.

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Current approaches to secondary prevention after hip fracture in England and Wales — an analysis of trends between 2016 and 2020 using the National Hip Fracture Database (NHFD)

Mohsin¹,

Javaid²,

Johansen³

2023

Arch Osteoporos

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Summary Hip fractures are strong risk factors for further fractures. However, using the National Hip Fracture Database, we observed that in England and Wales, 64% of patients admitted on oral bisphosphonates were discharged on the same and injectable drug use varies from 0–67% and 0.2%-83.6% were deemed “inappropriate” for bone protection. This variability requires further investigation. Introduction A key aim for the National Hip Fracture Database (NHFD) is to encourage secondary fracture prevention of the 75,000 patients who break their hip annually in the UK, through bone health assessment and appropriate provision of anti-osteoporosis medication (AOM). We set out to describe trends in anti-osteoporosis medication prescription and examine the types of oral and injectable AOMs being prescribed both before and after a hip fracture. Methods We used data freely available from the NHFD www.nhfd.co.uk to analyse trends in oral and injectable AOM prescription across a quarter of a million patients presenting between 2016 and 2020, and more detailed information on the individual type of AOM prescribed for 63,705 patients from 171 hospitals in England and Wales who presented in 2020. Results Most patients (88.3%) are not taking any AOM when they present with a hip fracture. Half of all patients (50.8%) were prescribed AOM treatment by the time of discharge, but the proportion deemed ‘inappropriate for AOM’ varied hugely (0.2–83.6%) in different hospitals. Nearly two-thirds (64.2%) of those previously taking an oral bisphosphonate were simply discharged on the same type of medication. The total number of patients discharged on oral medication fell by over a quarter in these five years. The number discharged on injectables increased by nearly three-quarters to 14.2% over the same period, but remains hugely variable across the country, with rates ranging from 0–67% across different units. Conclusion A recent hip fracture is a strong risk factor for future fractures. The huge variability in approaches, and in particular the use of injectables, in different trauma units across England and Wales requires further investigation.

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A multi-site review of second hip fractures across 6 Dublin teaching hospitals

Cited by 3 publications

References 15 publications

Increasing hip fracture volume following repeated lockdowns: an Irish multicentre study of periods pre-Covid, during Covid lockdown and following vaccination

Increasing hip fracture volume following repeated lockdowns: an Irish multicentre study of periods pre-Covid, during Covid lockdown and following vaccination

Is contralateral femoral neck-shaft angle predictive of timing of subsequent hip fracture?

Current approaches to secondary prevention after hip fracture in England and Wales — an analysis of trends between 2016 and 2020 using the National Hip Fracture Database (NHFD)

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