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T J, Kwek EBK. Are Intertrochanteric Fractures Evolving? Trends in the Elderly Population over a 10-Year Period. Clin Orthop Surg 2022; 14:13-20. [PMID: 35251536 PMCID: PMC8858907 DOI: 10.4055/cios20204] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 11/06/2022] Open
Abstract
Background Intramedullary devices for the fixation of intertrochanteric fractures are increasing in usage and popularity. This reflects either a shift in adoption of new technology or intertrochanteric fractures becoming more complex or unstable. This trend was observed in our institution, hence we set out to investigate if this was concordant with an associated change in the demographics of the patients or in the morphology of the intertrochanteric fracture pattern over a 10-year period. Methods This is a retrospective cross-sectional comparison undertaken for the first 100 consecutive elderly patients with intertrochanteric fractures admitted to our tertiary institution over 3 yearly intervals, in each of the years 2004, 2007, 2010, and 2013. Fractures were radiologically classified via the Evans and AO classifications. Patient demographics such as age, ethnicity, and comorbidities and surgical data including time, type of fixation, time to surgery, and length of stay were collected via case note reviews to identify possible trends. Results The overall mean age was 80.5 years, with no statistically significant trend among age, sex, ethnicity, and comorbidities over the 10-year period. The main finding was a rise in the proportion of unstable intertrochanteric fractures. The proportion of such fractures was 30% in 2004, 42% in 2007, 47% in 2010, and 62% in 2013 (p < 0.001). Patients admitted for intertrochanteric fractures also experienced a shorter hospital length of stay and an increasing trend towards early fracture fixation (p < 0.001), with a greater usage of intramedullary nails in the treatment of such fractures (p < 0.001). Conclusions Intertrochanteric fractures in elderly patients have evolved into more complex fractures over the past ten years, despite there being no change in the age of the patients over the same duration. This increasing proportion of unstable intertrochanteric fractures has brought about a greater tendency to fix these fractures with intramedullary implants.
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Affiliation(s)
- Jegathesan T
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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Alpantaki K, Papadaki C, Raptis K, Dretakis K, Samonis G, Koutserimpas C. Gender and Age Differences in Hip Fracture Types among Elderly: a Retrospective Cohort Study. MÆDICA 2020; 15:185-190. [PMID: 32952683 DOI: 10.26574/maedica.2020.15.2.185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objectives: To investigate the differences in distribution of intracapsular and extracapsular hip fractures among genders and age groups treated surgically. Materials and methods: This is a nine-year retrospective cohort study. The type of hip fractures, age, and sex-related as well as overall incidence among 2 430 patients aged over 65, surgically treated at the "Venizeleio" General Hospital of Heraklion, Crete, Greece, were explored and evaluated. Outcomes: Women suffered hip fractures 2.9 times more often than men. The majority of patients hospitalized with hip fracture were above 75 years of age (62.3% in females and 59.3% in males). The proportion of extracapsular and intracapsular fractures were 59.6% and 40.4% in men and 62.7% and 37.2% in women, respectively. Extracapsular-intertrochanteric fractures were found to increase dramatically with age in women (from 52.3% in patients younger than 75 to 58.8% in those older than 75; p-value=0.007), while in men they slightly increased with age (57.7% in patients older than 75, compared to 55.7% in those less than 75; p-value=0.62). Conclusion: The pattern of hip fractures was found to differ between genders and age groups in the present patients' population. Most likely, these findings reflect differences in the nature and rate of bone loss, and frequency of falling events between males and females. It has become evident that the two main hip fracture types (extracapsular and intracapsular) are distinct clinical entities. Hence, they should be addressed independently in terms of underlying causes and prevention strategies.
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Affiliation(s)
- Kalliopi Alpantaki
- Department of Orthopaedics, "Venizeleio" General Hospital of Heraklion, Crete, Greece
| | | | - Konstantinos Raptis
- Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, Greece
| | | | - George Samonis
- Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, Greece
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Farhang M, Mukka S, Bergström U, Svensson O, Sayed-Noor AS. The trend of radiological severity of hip fractures over a 30 years period: a cohort study. BMC Musculoskelet Disord 2019; 20:358. [PMID: 31391031 PMCID: PMC6686553 DOI: 10.1186/s12891-019-2739-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite advances in operative techniques and preoperative care, proximal femur fractures (PFF) still represent a great public health problem. Displacement and fracture stability have been assumed as important determinants of treatment modality and outcome in such fractures. Purpose of this study was to determine whether the radiological severity of PFF fractures has increased over time. METHODS In a cohort study, the plain radiographs of all patients with PFF aged over 50 years who were admitted to Umeå University Hospital in 1981/82, 2002 and 2012 were recruited to examine the types of fractures. RESULTS The ratio of undisplaced to displaced femoral neck (FN) fractures was 30 to 70% in 1981/82, 28 to 72% in 2002 and 25 to 75% in 2012. The ratio of stable to unstable intertrochanteric (IT) fractures was 64 to 36% in 1981/82, 68 to 32% in 2002 and 75 to 25% in 2012. The ratio of simple to comminute subtrochanteric fractures was 35 to 65% in 1981/82, 16 to 84% in 2002 and 12 to 88% in 2012. In both FN and IT fractures we found no statistical difference among these 3 study periods, p = 0.67 and p = 0.40. In subtrochanteric fractures we saw a tendency towards more comminute subtrochanteric fractures (1981/82 to 2012), p = 0.09. CONCLUSIONS We found no significant increment in the radiological severity of FN and IT over a 30 years' period. However, there was tendency towards an increase in comminute subtrochanteric fractures.
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Affiliation(s)
- Mehdy Farhang
- 0000 0001 1034 3451grid.12650.30Department of Surgical and Perioperative Sciences, Umeå University, 90187 Umeå, Sweden
| | - Sebastian Mukka
- 0000 0001 1034 3451grid.12650.30Department of Surgical and Perioperative Sciences, Umeå University, 90187 Umeå, Sweden
| | - Ulrica Bergström
- 0000 0001 1034 3451grid.12650.30Department of Surgical and Perioperative Sciences, Umeå University, 90187 Umeå, Sweden
| | - Olle Svensson
- 0000 0001 1034 3451grid.12650.30Department of Surgical and Perioperative Sciences, Umeå University, 90187 Umeå, Sweden
| | - Arkan S. Sayed-Noor
- 0000 0001 1034 3451grid.12650.30Department of Surgical and Perioperative Sciences, Umeå University, 90187 Umeå, Sweden
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Pan HH, Li CY, Chen TJ, Su TP, Wang KY. Association of polypharmacy with fall-related fractures in older Taiwanese people: age- and gender-specific analyses. BMJ Open 2014; 4:e004428. [PMID: 24682575 PMCID: PMC3975737 DOI: 10.1136/bmjopen-2013-004428] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To elucidate the associations between polypharmacy and age- and gender-specific risks of admission for fall-related fractures. DESIGN Nested case-control study. SETTING This analysis was randomly selected from all elderly beneficiaries in 2007-2008, and represents some 30% of the whole older insurers using Taiwan's National Health Insurance Research Database. PARTICIPANTS We identified 5933 cases newly admitted for fall-related fractures during 2007-2008, and 29 665 random controls free from fracture. PRIMARY AND SECONDARY OUTCOME MEASURES Polypharmacy was defined as the use of fall-related drugs of four or more categories of medications and prescribed related to fall within a 1-year period. Logistic regression models were employed to estimate the ORs and related 95% CIs. The interaction of polypharmacy with age and sex was assessed separately. RESULTS Compared with those who consumed no category of medication, older people who consumed 1, 2, 3 and ≥4 categories of medications were all at significantly increased odds of developing fall-related fractures, with a significant dose-gradient pattern (β=0.7953; p for trend <0.0001). There were significant interactions between polypharmacy and age, but no significant interactions between polypharmacy and gender. The dose-gradient relationship between number of medications category and risk of fall-related fractures was more obvious in women than in men (β=0.1962 vs β=0.1873). Additionally, it was most evident in older people aged 75-84 years (β=0.2338). CONCLUSIONS This population-based study in Taiwan confirms the link between polypharmacy and increased risk of fall-related fractures in older people; and highlights that elderly women and older people aged 75-84 years will be the targeted participants for further prevention from fall-related fractures caused by polypharmacy.
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Affiliation(s)
- Hsueh-Hsing Pan
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Chung-Yi Li
- Graduate Institute and Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kwua-Yun Wang
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
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Shao CJ, Hsieh YH, Tsai CH, Lai KA. A nationwide seven-year trend of hip fractures in the elderly population of Taiwan. Bone 2009; 44:125-9. [PMID: 18848656 DOI: 10.1016/j.bone.2008.09.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Revised: 06/06/2008] [Accepted: 09/07/2008] [Indexed: 10/21/2022]
Abstract
To investigate the recent longitudinal trend of hip fractures (including cervical and trochanteric fractures) in Taiwan's elderly population (> or =65 years), a nationwide descriptive epidemiological study was conducted using the database of the Bureau of National Health Insurance from 1996 through 2002. Frequencies and incidences of hip fracture by gender, fracture site, and age group were estimated, and the 7-year incidence trend was further evaluated. The results showed that a total of 75,482 hip fractures occurred during the study period with an incidence rate of 57.54 per 10,000 per year. Overall incidence significantly increased by 30% (p<0.0001), from 49.56 to 64.37 per 10,000 per year during the 7-year study period. The increase in rates was greater in males (36%) than in females (22%). The average female-to-male ratio was 1.76, lower than those in many countries. In females, the annual incidence of cervical fracture was higher than that of trochanteric fractures throughout the 7 years, while the incidence of trochanteric fractures was higher than cervical fractures each year in males (p<0.0001). The average annual incidence of patients older than 85 years was 9.9 times higher than that of aged 65 to 69 years in females and 7.9 times in males. Development and implementation of public health strategies for hip fractures should more focus on these subgroups in Taiwan's rapidly aging society.
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Affiliation(s)
- Chung-Jung Shao
- Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan
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Lönnroos E, Kautiainen H, Karppi P, Huusko T, Hartikainen S, Kiviranta I, Sulkava R. Increased incidence of hip fractures. A population based-study in Finland. Bone 2006; 39:623-7. [PMID: 16603427 DOI: 10.1016/j.bone.2006.03.001] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2005] [Revised: 01/03/2006] [Accepted: 03/01/2006] [Indexed: 11/27/2022]
Abstract
In Central Finland, the age-specific incidence of hip fractures did not change between the years 1982-1983 and 1992-1993 though the total number of hip fractures increased by 11% due to population aging. The objective of this study was to define the current hip fracture rates and the characteristics of patients with hip fracture. The population at risk consisted of 240,000 persons living in the Central Finland Health Care District. Hip fracture patients were identified by using the hospital discharge register, the operation lists, and the register of the Department of Anesthesiology. Patients' residential status, weight, and height, date and time of hip fracture, place of accident and mechanism and type of fracture were obtained from medical records. A total of 597 patients, 415 (69.5%) women and 182 (30.5%) men, were admitted to the hospital for treatment of an acute hip fracture in 2002-2003. The mean age of the patients was 79 (SD 13) years. Among patients aged > or =50 years (n = 577), 80.8% of the hip fractures had occurred indoors, 97.6% with a low-energetic mechanism, and 22.7% during the nighttime. The ratio of trochanteric to cervical fractures was 2:3. Between 1992-1993 and 2002-2003, the total number of hip fractures increased by 70%, from 351 to 597. The fracture rates per 1000 person-years in the age group > or =55 years were 2.0 and 3.9 in 1992-1993 and 2.8 and 5.6 in 2002-2003 for men and women, respectively. The corresponding age-adjusted incidence rate ratio (IRR) for men was 1.36 (95% CI: 1.06 to 1.76), P = 0.017, and for women 1.25 (95% CI: 1.07 to 1.47), P = 0.006. Among men, the IRR was highest in the age group 75-84 years, IRR = 1.67 (95% CI: 1.08 to 2.65), while among women, it was highest in the age group > or =85 years, IRR = 1.33 (95% CI: 1.02 to 1.75). The total number of hip fractures almost doubled within 10 years, and the age-adjusted incidence rate increased in both sexes. The accretion of the hip fracture incidence was more than could be explained merely by changes in population size and structure.
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Affiliation(s)
- Eija Lönnroos
- Department of Geriatrics, Central Finland Hospital, Jyväskylä, Finland.
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Giversen IM. Time trends of age-adjusted incidence rates of first hip fractures: a register-based study among older people in Viborg County, Denmark, 1987-1997. Osteoporos Int 2006; 17:552-64. [PMID: 16408148 DOI: 10.1007/s00198-005-0012-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2005] [Accepted: 09/14/2005] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A retrospective cohort study was performed to investigate if incidence rates of first hip fractures are changing in a Danish county. Study material was obtained from an excerpt from a computerized national health register and covers the period 1987-1997. METHODS First hip fractures were identified through a search 10 years back from the date of admission. To assess the 20-year trend, 1978 data were included. The study period saw inclusion of 3,036 first (1987-1997) and 122 first and recurrent (1978) hip fracture patients aged 50 years and older. Data were analyzed using weighted regression analysis. RESULTS Age-adjusted first hip fracture incidence rates increased significantly (P<0.001) for women, men, and pertrochanteric fractures. The rate of increase was 18 [95% confidence interval (CI), 12-25], 8 (95% CI, 4-12), and 10 (95% CI, 7-12) per 100,000 per year for women, men, and pertrochanteric fractures, respectively. The age-adjusted rate for both genders combined was 425 per 100,000 in 1997 (95% CI, 380-470). The incidence of cervical fractures was stable. If the rates of 1978 were included in the analysis, the cervical hip fractures also increased (P<0.001). The weighted average of female-male ratio was a stable 2.6 (95% CI, 2.4-2.8). Cervical-pertrochanteric ratio dropped to 1.2:1 (P<0.001). Mean age at admission rose from 78.9 to 80.8 years. CONCLUSION In conclusion, the results provided support for an increasing incidence of first hip fractures, even when aging of the population was accounted for.
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Affiliation(s)
- I M Giversen
- The National Board of Health, Islands Brygge 67, 2300 Copenhagen S, Denmark.
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Marks R, Allegrante JP, Ronald MacKenzie C, Lane JM. Hip fractures among the elderly: causes, consequences and control. Ageing Res Rev 2003; 2:57-93. [PMID: 12437996 DOI: 10.1016/s1568-1637(02)00045-4] [Citation(s) in RCA: 157] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This review examines all pertinent literature sources published in the English language between 1966 to the present concerning hip fracture epidemiology, hip fracture injury mechanisms, and hip fracture management strategies. These data reveal hip fractures have several causes, but among these, the impact of falls and muscle weakness, along with low physical activity levels seems to be the most likely explanation for the rising incidence of hip fracture injuries. Related determinants of suboptimal nutrition, drugs that increase fall risk and lower the safety threshold and comorbid conditions of the neuromuscular system may also contribute to hip fracture disability. A number of interventions may help to prevent hip fracture injuries, including, interventions that optimize bone mass and quality, interventions that help prevent falls and falls dampening interventions. Rehabilitation outcomes may be improved by comprehensive interventions, prolonged follow-up strategies and ensuring that all aging adults enjoy optimal health.
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Affiliation(s)
- Ray Marks
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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