The 13-year observation of hip fracture in Poland-worrying trend and prognosis for the future

Construction and validation of a nomogram prediction model for internal fixation failure after proximal femoral anti-rotation intramedullary nailing in the treatment of intertrochanteric fractures of the femur

The aim was to study the independent risk factors of internal fixation failure in proximal femoral anti-rotation intramedullary nailing for intertrochanteric femur fracture, and to build a nomogram prediction model accordingly. Clinical data of patients with intertrochanteric femoral rotor fractures admitted to the First People's Hospital of Longquanyi District from January 2018 to January 2023 were retrospectively collected. The occurrence of spiral blade cut out, internal fixation breakage, peri-internal fixation fracture, hip internal rotation deformity, and fracture nonunion within 1 year after surgery were included in the internal fixation failure group, and the rest were included in the internal fixation success group. Univariate and multivariate logistic regression analyses were used to determine the independent risk factors for postoperative internal fixation failure, and the corresponding nomogram was established. Subject operating characteristic curves and calibration curves were plotted to assess model performance, and to further improve the reliability of the validation results, internal validation was performed using Bootstrap combined with 10-fold cross-validation rows to assess the clinical utility of the model using decision curve analysis. Ultimately, 374 patients with intertrochanteric fractures were included in the study, and 57 patients were included in the internal fixation failure group, with an internal fixation failure rate of 15.24%. After univariate and multivariate logistic regression analyses, a total of 5 factors were identified as independent risk factors for internal fixation failure after intertrochanteric femur fracture surgery: unstable fracture, comorbid underlying disease, severe osteoporosis, a cusp distance of >30 mm, and poor quality of fracture reduction. Postoperative internal fixation failure of intertrochanteric fractures of femur is affected by multiple factors, and clinically orthopedic surgeons should formulate reasonable and effective solutions for high-risk patients in order to protect the surgical effect and improve the success rate of surgery.

Hip Fracture Incidence Over Twenty Years in Poland: The HiPoL Study

INTRODUCTION

In the previous report, we noted a significant increase in hip fracture incidence in the local study area. The aim of the study was the continuous observation of hip fracture incidence in the local community over the last 20 years and to estimate their projection for the next 30 years.

METHODS

Medical records of the patients aged 50 years and older in the period 2002 - 2021 (local data - area of the district Tarnowskie Góry and the city of Piekary Śląskie) with diagnosis ICD-10: S72.0; S72.1; and S72.2 (only the fragility fractures) were taken into analysis.

RESULTS

2,723 fragility hip fractures in the local area were registered (72 % in women). The increase in the rate was constantly observed, even during the COVID - 19 pandemic. The incidence rate ratio for the local population increased to 1.41. The incidence rate in 2021 was for the total population 230.2 (men 151.3; women 294.2). For comparison in 2002, it was 129.0 (men 48.8; women 192.4). In 2050 the number of fractures according to our new estimation will increase.

CONCLUSIONS

The number of fragility hip fractures in Polish men and women aged over 50 years in the local population increased. The epidemiological situation is still worsening. Therefore, especially due to the reduction of orthopedic beds and the aging population phenomenon the situation will be tragic to our patients.

Epidemiology and Management of Proximal Femoral Fractures in Italy between 2001 and 2016 in Older Adults: Analysis of the National Discharge Registry

This study aims to determine the annual incidence of proximal femoral fractures in Italy in the period between 2001 and 2016 among older adults, and to describe the trends in the clinical management of these cases. Data were retrieved from the National Hospital Discharge records issued by the Italian Ministry of Health and from the Italian Institute for Statistics. The number of hospitalizations increased between 2001 and 2016, while the age-adjusted yearly incidence decreased from 832.2 per 100,000 individuals to 706.2. The median age was 83 years (IQR 78-88) with a large majority of females (76.6%). The type of fracture varied with age in female subjects, with older women more frequently reporting pertrochanteric fractures. Therapeutic strategies for the different types of fracture depended on patients' age. During the study years, improvements in fracture classification and management strategies were observed, with a clear decreasing trend for non-operative solutions. In conclusion, the number of proximal femur fractures in older adults is growing, even if at a lower rate compared to population aging. The Italian surgical practice changed during the study period towards the implementation of the most recent guidelines.

One year of the COVID-19 pandemic in Poland-the incidence of osteoporotic forearm, arm, and hip fractures

The study attempts to analyse whether the COVID-19 pandemic affected the incidence of forearm, arm, and hip fractures during a 1-year observation period. Additionally, changes in the overall treatment costs of those fractures were estimated. During the COVID-19 pandemic, the incidence of forearm, arm, and hip fractures remained statistically unchanged, neither were any significant changes observed in the expenditure, incurred for the treatment of the fracture cases.

PURPOSE

The purpose of the study was to find out and evaluate if the consequences of COVID-19 pandemic (including lockdown and the fear of infection) influenced the incidence of osteoporotic forearm, arm, and hip fractures and to estimate the changes in the costs of their management during one-year observation period.

METHODS

The incidence of forearm, arm, and hip fractures was collected for the population, aged ≥ 50, residing at the district of Tarnowskie Góry and the Town of Piekary Śląskie, Poland, during 1 year of COVID-19 pandemic (from March 16th 2020 to March 15th 2021). The obtained results were compared with the number of corresponding limb fractures, recorded before the pandemic during five consecutive yearly periods, each starting from 16th March and ending on the 15th March of a subsequent year, the entire period covering the years 2015-2020. The rates of the analysed fractures were calculated per 100,000 inhabitants together with their economic impact.

RESULTS

The mean numbers and the incidence rates of upper extremity fractures were slightly lower during the COVID-19 pandemic than in the previous 5 years, whereas hip fracture figures remained almost stable. The observed changes were not statistically significant. That annual observation revealed a slight decrease in expenditure volumes, when compared to the analysed period before the pandemic (-0.33%).

CONCLUSION

The decreased incidence rate of forearm, arm, and hip fractures, observed during the first months of the COVID-19 pandemic, was not statistically significant in the 1-year observation. After several weeks/months under the shock, caused by government limitations and the fear of infection, the number of patients remained unchanged during the one-year observation.

The incidence of arm, forearm, and hip osteoporotic fractures during early stage of COVID-19 pandemic

The study analyzes whether the COVID-19 pandemic affects the incidence of arm, forearm, and hip fractures. Additionally, the change in the overall cost of those fractures treatment was estimated. During the COVID-19 pandemic, the incidence of arm, forearm, and hip fractures and the cost of fracture management are decreased.

INTRODUCTION

Purposes of the study were to analyze if COVID-19 pandemic influences the incidence of arm, forearm, and hip osteoporotic fractures and to estimate the changes in costs of their management.

METHODS

Data on arm, forearm, and hip fracture incidence were collected for inhabitants aged over 50 years in the district of Tarnowskie Góry and the city of Piekary Śląskie, South Poland, in the early stage of COVID-19 pandemic (77 days, from March 16th to May 31st 2020). These results were compared with the number of fractures noted in years 2015-2019 in the same period of the year. The ratio of analyzed fractures per 100,000 inhabitants was calculated.

RESULTS

The recorded numbers of fractures of arm, forearm, and hip were 13, 43, and 29, respectively. The respective mean number for fractures reported in corresponding period in 2015-2019 years was 23.6, 52, and 33. The year fracture incidence calculated per 100,000 inhabitants decreased by 45.8%, 18.4%, and 13.4%, respectively. The estimated numbers of avoided fractures extrapolated for the whole country for arm, forearm, and hip were 1722, 1548, and 947, respectively. The total number of avoided fractures was 4217. The expected nationwide cost reduction for the arm, forearm, and hip fracture management was estimated at € 568,260, € 332,820, and € 1,628,840, respectively. The total cost reduction was € 2,529,920 over the period of observation.

CONCLUSION

During COVID-19 pandemic, a decrease of arm, forearm, and hip fracture incidence was observed which may result in decrease of total costs for Polish healthcare system.

INCIDENCE AND TIME TREND OF HIP FRACTURES IN ROMANIA: A NATIONWIDE STUDY FROM 2008 TO 2018

BACKGROUND

Hip fractures are a major issue of public health as they are responsible for high morbidity, excess mortality and costs. There are differences in Europe and worldwide in the incidence rates of hip fractures and time trends, in the context of the population aging. Ten years ago, we characterized the incidence of hip fracture in Romania using data from the national hospital discharge register.

OBJECTIVE

This is the first Romanian study to assess the hip fracture incidence rates over a period of 11 years, between 2008 and 2018.

SUBJECTS AND METHODS

This analysis is a nationwide retrospective study on hospitals reporting primary DRG data on hip fracture, using a rigorous definition with both diagnostic and surgical procedure codes. The population aged 40+ was stratified in 5-year intervals and both the crude incidence rates and the adjusted incidence rates of hip fracture using standardization on age for the 2018 reference population were calculated in women and men.

RESULTS

From 2008 to 2018, the number of hip fractures rose by 53 % in women (from 7513 to 11512) and 22.4 % in men (from 4266 to 5220). Meanwhile, the Romanian population over 40 years increased by 12.5% in women and 14.2% in men. The crude incidence rate rose by 36.2% in women and 7.2% in men and the age-standardized incidence rates by 27.4% in women and 6% in men. These increases are mostly based on 85+ age populations' changes.

CONCLUSIONS

In Romania, the hip fractures incidence continues to grow throughout an 11-year-period, especially in women, representing an increasing burden for our society.

The Increase of Osteoporotic Hip Fractures and Associated One-Year Mortality in Poland: 2008-2015

INTRODUCTION

Hip fractures are a worldwide public health issue associated with significant mortality. Previous Polish studies reported an increasing trend in the number of hip fractures for both men and women, although lower than most other European countries.

MATERIALS AND METHODS

The Polish National Database was analyzed to examine osteoporotic hip fractures in the population aged 50 and over. Hip fracture incidence, rate, one-year mortality, and postoperative length of hospitalization were analyzed using the national health system data. Hospital discharge registry ICD-10 codes were reviewed from 2008 to 2015.

RESULTS

The incidence of hip fractures increased in both women and men by 19.4% and 14.2%, respectively. The female to male fracture ratio was 2.46. Mean postoperative hospitalization decreased from 13.6 to 11.2 days. The one-year mortality ranged between 30.45% to 32.8% for men and 26.2% to 28% for women. Of note, women aged 80-89 had the highest one-year mortality, 50.7%-55.4% after femoral neck fracture and 53%-58.5% after a pertrochanteric fracture.

CONCLUSIONS

Hip fractures in Poland are increasingly more prevalent in the aging population. The unfavorable trends observed in this study indicate higher annual mortality after hip fracture, compared with other European countries.