Contralateral hip fractures — can predisposing factors be determined?
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.
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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
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The fate of proximal femoral fractures in the 10th decade of life: An analysis of 117 consecutive patients
2015, InjuryCitation Excerpt :A clearly lower incidence has been reported in other studies. These incidence rates varied with different inclusion criteria – particularly in association with the defined follow-up duration – and reached only 2–3% in more recent studies [16–18]. It is likely that the high incidence in our study resulted from the old age of the patients.
Meta-analysis of risk factors for the second hip fracture (SHF) in elderly patients
2014, Archives of Gerontology and GeriatricsCitation Excerpt :Therefore, it is vital to identify risk factors to prevent the occurrence of SHF in those sustaining initial hip fractures. Many risk factors have been identified for the SHF, including advanced age (Angthong, Suntharapa, & Harnroongroj, 2004; Souder et al., 2012; Vochteloo et al., 2012), female (Gaumetou, Zilber, & Hernigou, 2011; Rodaro, Pasqualini, Iona, & Di Benedetto, 2004), osteoporosis (Angthong et al., 2004; Yamanashi et al., 2004), dementia (Mitani, Shimizu, Abo, Hiroshi, & Youichi, 2010; Saxena & Shankar, 2000; Yamanashi et al., 2004), Parkinson's disease (Saxena & Shankar, 2000; Yamanashi et al., 2004), respiratory disease (Mitani et al., 2010) and lower vision (Angthong et al., 2004; Saxena & Shankar, 2000). However, these studies had some limitations such as a small sample size and the inclusion of a single or very few potential risk factors.
Risk factors for contra-lateral hip fracture in elderly patients with previous hip fracture
2013, InjuryCitation Excerpt :Therefore, it is important to act appropriately to prevent the occurrence of contralateral hip fracture. Several studies reported underlying risk factors of contralateral hip fracture, these include co-morbidities, osteoporosis, and psychotropic medication.10–15 However, few studies have taken into account postoperative risk factors.