Elsevier

Injury

Volume 31, Issue 6, 1 July 2000, Pages 421-424
Injury

Contralateral hip fractures — can predisposing factors be determined?

https://doi.org/10.1016/S0020-1383(00)00012-7Get rights and content

Abstract

A case control study was carried out in the Orthopaedic Department of Bradford Royal Infirmary in an attempt to see if certain medical conditions, which can affect balance and stability, are more common in those who sustain a second proximal femoral fracture. Medical conditions included in the study were: late effects of cerebro–vascular accident, blindness, syncope and collapse, alcoholism, Alzheimer’s disease, epilepsy, Parkinsonism, ischaemic heart disease and senile dementia. The study group comprised 53 patients admitted to hospital between 1992 and 1998 with two separate proximal femoral fractures each on a different side. The control group comprised 530 patients selected from a general pool of 2080 proximal femoral fracture patients admitted to hospital during the same period. The control group patients were matched to the study group for age, sex, and time of occurrence of the first fracture. Results show significantly higher association of late effects of cerebro–vascular accident, blindness, syncope and collapse, and Alzheimer’s disease with subsequent contralateral proximal femoral fractures. This study supports a causal relationship between the above medical conditions and subsequent contralateral proximal femoral fractures. It may therefore be possible to identify patients who are at risk of returning with a second fracture.

Introduction

5–10% of all proximal femoral fractures are fractures of the contralateral femur in patients who have sustained a previous proximal femoral fracture [1], [2], [3], [4], [5]. The risk of suffering a proximal femoral fracture is higher in patients who have previously sustained a proximal femoral fracture than in the general population [5]. Possible factors increasing the risk of a second fracture have been studied [1], [2], [3], [6], [7]. K.E. Dretakis et al. [6] conclude that no significant association exists between the second fracture and age or sex. Furthermore there is no correlation with bone quality. However patients sustaining these fractures are prone to recurrent falls [6].

This study analyses the reasons for recurrent falls in order to ascertain if certain medical conditions which can affect the patients overall stability, are more common in those who sustain a second fracture.

Section snippets

Material and methods

The basic data for the study were obtained from the central computer system of the data information centre which has detailed information about all the patients admitted to Bradford Royal Infirmary from April 1992 onwards. All patients admitted to hospital with a primary diagnosis of proximal femoral fracture were identified and the information about all admission episodes pertaining to them was retrieved. Of 2080 patients with proximal femoral fractures a subgroup of patients was isolated:-

Observations and results

Two thousand and eighty patients were admitted with the primary diagnosis of proximal femoral fracture between April 1992 and September 1998. The average age at the time of first fracture was 78.9 years and 36/53 (67.92%) patients sustained their second contralateral fracture within 24 months of the first fracture (Fig. 1).

In 25 cases the first fracture was extracapsular and in 28 cases it was intracapsular. However, the second fractures were of the same type as the first fracture in 37/53

Background

Understanding of “second” contralateral hip fractures in the elderly is improving. In 1957 Stewart [4], in his study on proximal femoral fractures, quoted an incidence of 7.0% for subsequent contralateral fractures. Some relatively longer series reported the incidence of subsequent contralateral fractures at 2.4, 5.4, 5.6, 7.3, and 10.6% [1], [2], [3], [5], [8]. During this time it was found that the same type of fracture occurred frequently on the contralateral side [1], [2], [3], [6], [7] and

Conclusion

This study supports a cause and effect relationship between the late effects of cerebro–vascular accident, blindness, syncope and collapse, and Alzheimer’s disease with subsequent contralateral fractures. There are weak associations with epilepsy, alcoholism, and Parkinsonism, though the association is not significant at the P=0.05 level (P=0.058, P=0.089 and P=0.053, respectively).

An important aspect of managing a proximal femoral fracture is to prevent recurrence. Identifying the patient at

Acknowledgements

We would like to thank Consultant Geriatrician Dr J.S. Tucker for his valuable advice and support from time to time. Mr Andrew J. Scally, Lecturer, School of Health Studies (University of Bradford), has provided the statistical support for this study and we are grateful for his valuable service. We are also grateful to data information officers, Helen Taylor and Helen Jackson, who did the painstaking job of retrieving and providing the information on a large number of patients. The study would

References (12)

  • L.H. Rees et al.

    Alcohol-induced pseudo-Cushing’s syndrome

    Lancet

    (1977)
  • H.M. Schroder et al.

    Occurrence and incidence of the second hip fracture

    Clinical Orthopaedics and Related Research

    (1993)
  • D.A. Boston

    Bilateral fractures of the femoral neck

    Injury

    (1983)
  • E. Dretakis et al.

    Bilateral non-contemporary fractures of the proximal femur

    Acta Orthopaedic Scandinavia

    (1981)
  • I.M. Stewart

    Fracture of neck of femur

    British Medical Journal

    (1957)
  • P.A. Alffram

    An epidemiologic study of cervical and trochanteric fractures of the femur in an urban population

    Acta Orthopaedic Scandinavia

    (1964)
There are more references available in the full text version of this article.

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