The burden of second hip fractures: provincial surgical hospitalizations over 15 years

Abstract

The burden of second hip fractures: provincial surgical hospitalizations over 15 years Background: Second hip fractures account for up to 15% of all hip fractures. We sought to determine if the proportion of hip fracture surgeries for second hip fracture changed over time in terms of patient and fracture characteristics. Methods:We reviewed the records of patients older than 60 years hospitalized for hip fracture surgery between 1990 and 2005 in British Columbia. We studied the proportion of surgeries for second hip fracture among all hip fracture surgeries. Linear regression tested for trends across fiscal years for women and men. Results:We obtained 46 341 patient records. Second hip fracture accounted for 8.3% of hip fracture surgeries. For women the proportion of second hip fracture surgeries increased linearly from 4% to 13% with each age decade (p = 0.001) and across fiscal years (p = 0.002). In men the proportion of second hip fracture surgeries was 5% for each age decade between the ages of 60 and 90 years across fiscal years, increasing to 8% for men older than 90 years across fiscal years (p = 0.20). These sex-specific trends were similar for both pertrochanteric and transcervical fracture types. Conclusion:Second hip fracture surgeries account for an increasing proportion of hip fracture surgeries and may require more health care resources to minimize poorer reported outcomes. Future research should determine whether more health care resources are required to manage these patients and optimize their outcomes.Contexte : Les secondes fractures de la hanche représentent jusqu'à 15 % de la totalité des fractures de la hanche. Nous avons tenté de déterminer si la proportion de chirurgies de seconde fracture de la hanche avait évolué au fil du temps sur le plan des caractéristiques des patients et des fractures.

Contralateral non-simultaneous proximal femoral fractures in patients over 65 years old

“…Analysis of our data showed that the incidence of contralateral femoral fractures was 9.56%. This reflects findings from several previous studies in the literature [ 5 , 17 , 18 ]. The median time between the first and contralateral hip fracture was three years.…”

Orthogeriatric Care: Reviewing Improvements in Outcomes

“…In any case, the risk of second fracture is highest in the first months after the initial fracture and decreases thereafter [241], and seems to be shorter among patients who had suffered complications during the initial episode [246]. An increase in the rate of second hip fractures increased from 1990 to 2005 was observed in Canada [233], but decreased by 10% annually between 1999 -2009 in Spain [232], while it remained stable in the United Kingdom [240].…”

“…Approximately one third of patients with hip fractures have suffered another fragility fracture previously [228]. 7 -15% of patients admitted have a second hip fracture [229][230][231][232][233][234][235][236], with an accumulated incidence of 1.2 -3% in the first year and 9-10% at 8 years [7,[237][238][239][240][241][242][243][244], and can reach over 20% among patients with Alzheimer's disease [245]. Time between hip fracture varies upon study methodology and observation period; some authors state that over half of these occur in the first year after fracture [230,238] while other suggest the median time between hip fractures is over 3 years [232,236].…”

“…Compared to patients who suffer a first hip fracture, patients with second hip fractures are usually female, older, have extracapsular fractures and have poorer baseline mobility [231,233,234,244,251]. Approximately two thirds of patients have the same type of fracture on both occasions [236,252]; proximal femoral morphology may play a role in this phenomenon [252].…”

Preventing hip fractures with multidisciplinary teams: a Canadian perspective

“…With better vertebral fracture detection and response to an initial FF, hip fractures can be prevented, with a cost savings of about $27 000 per fracture in direct costs in hospital and in the year after surgery. 37 In addition, the assessment and treatment arms of care can be addressed through the role of nurse-led clinics, supervised by an orthogeriatrician, as done in Australia and the UK. By having a dedicated health care practitioner, specialized care tailored to patients with FFs can be delivered.…”