Cargando…

Analysis of Risk Factors and Consequences of Consecutive Proximal Femur Fractures in Elderly Patients

Background Proximal femur fracture (PFF) carries significant morbidity, mortality, and cost implications to the health system. Subsequent contralateral fracture further decreases patient performance and increases the healthcare burden. This study aimed to identify and evaluate potential risk factors...

Descripción completa

Detalles Bibliográficos
Autores principales: Gurusinghe, Suranga, M Navaratnam, Devaraj, Weerasinghe, Konara, Gopinath, Girish, Uzoigwe, Chika, Joachim, Theophilus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575275/
https://www.ncbi.nlm.nih.gov/pubmed/34765330
http://dx.doi.org/10.7759/cureus.18527
_version_ 1784595645207674880
author Gurusinghe, Suranga
M Navaratnam, Devaraj
Weerasinghe, Konara
Gopinath, Girish
Uzoigwe, Chika
Joachim, Theophilus
author_facet Gurusinghe, Suranga
M Navaratnam, Devaraj
Weerasinghe, Konara
Gopinath, Girish
Uzoigwe, Chika
Joachim, Theophilus
author_sort Gurusinghe, Suranga
collection PubMed
description Background Proximal femur fracture (PFF) carries significant morbidity, mortality, and cost implications to the health system. Subsequent contralateral fracture further decreases patient performance and increases the healthcare burden. This study aimed to identify and evaluate potential risk factors for consecutive PFF. Methodology Pilgrim Hospital PFF database from 2012 to 2019 was retrospectively analyzed. Patients over 60 years with low-energy fractures were included. Pathological and atypical fractures and polytrauma were excluded. Results There were 114 patients (4.18%) with contralateral hip fractures out of a total of 2727 PFF patients; 80% were females. The mean age was 82 years for the first hip fracture and 85 years for the second. The average time interval between fractures was 36 months. The fracture pattern was the same on both sides in 74.3% of patients (P<0.0001). Out of 53 patients with cemented hip hemiarthroplasty (CHH) on one side, 31 patients (59%) had a second CHH for the contralateral side. Likewise, out of 48 patients who had dynamic hip screw fixation during the first admission, 33 patients (69%) had the same procedure on the contralateral side too. During the two consecutive admissions, the length of hospital stay was not significantly different (P=0.30), median American Society of Anesthesiologists (ASA) grades were 3, hyponatremia increased from 25% to 29% (P=0.5), mean decline in abbreviated mental test score (AMTS) was 0.4, deterioration of Clinical Frailty Score and Charlson morbidity index were from 4.5 to 5.9 (P<0.0001), and from 5.4 to 6.1, respectively, and institutional residency was increased from 23 to 46 (P>0.0014). Conclusion The similarity of fracture pattern bilaterally requiring similar surgical procedures is comparable with other literature. Even though there is minimal or no change in the ASA, AMTS, and hospital stay between the two admissions, there is a significant decline in clinical frailty, mobility status, and an increase in residential dependency following a subsequent fracture. Our findings demonstrate the importance of emphasizing secondary preventive measures to prevent a consecutive fracture.
format Online
Article
Text
id pubmed-8575275
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-85752752021-11-10 Analysis of Risk Factors and Consequences of Consecutive Proximal Femur Fractures in Elderly Patients Gurusinghe, Suranga M Navaratnam, Devaraj Weerasinghe, Konara Gopinath, Girish Uzoigwe, Chika Joachim, Theophilus Cureus Orthopedics Background Proximal femur fracture (PFF) carries significant morbidity, mortality, and cost implications to the health system. Subsequent contralateral fracture further decreases patient performance and increases the healthcare burden. This study aimed to identify and evaluate potential risk factors for consecutive PFF. Methodology Pilgrim Hospital PFF database from 2012 to 2019 was retrospectively analyzed. Patients over 60 years with low-energy fractures were included. Pathological and atypical fractures and polytrauma were excluded. Results There were 114 patients (4.18%) with contralateral hip fractures out of a total of 2727 PFF patients; 80% were females. The mean age was 82 years for the first hip fracture and 85 years for the second. The average time interval between fractures was 36 months. The fracture pattern was the same on both sides in 74.3% of patients (P<0.0001). Out of 53 patients with cemented hip hemiarthroplasty (CHH) on one side, 31 patients (59%) had a second CHH for the contralateral side. Likewise, out of 48 patients who had dynamic hip screw fixation during the first admission, 33 patients (69%) had the same procedure on the contralateral side too. During the two consecutive admissions, the length of hospital stay was not significantly different (P=0.30), median American Society of Anesthesiologists (ASA) grades were 3, hyponatremia increased from 25% to 29% (P=0.5), mean decline in abbreviated mental test score (AMTS) was 0.4, deterioration of Clinical Frailty Score and Charlson morbidity index were from 4.5 to 5.9 (P<0.0001), and from 5.4 to 6.1, respectively, and institutional residency was increased from 23 to 46 (P>0.0014). Conclusion The similarity of fracture pattern bilaterally requiring similar surgical procedures is comparable with other literature. Even though there is minimal or no change in the ASA, AMTS, and hospital stay between the two admissions, there is a significant decline in clinical frailty, mobility status, and an increase in residential dependency following a subsequent fracture. Our findings demonstrate the importance of emphasizing secondary preventive measures to prevent a consecutive fracture. Cureus 2021-10-06 /pmc/articles/PMC8575275/ /pubmed/34765330 http://dx.doi.org/10.7759/cureus.18527 Text en Copyright © 2021, Gurusinghe et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Orthopedics
Gurusinghe, Suranga
M Navaratnam, Devaraj
Weerasinghe, Konara
Gopinath, Girish
Uzoigwe, Chika
Joachim, Theophilus
Analysis of Risk Factors and Consequences of Consecutive Proximal Femur Fractures in Elderly Patients
title Analysis of Risk Factors and Consequences of Consecutive Proximal Femur Fractures in Elderly Patients
title_full Analysis of Risk Factors and Consequences of Consecutive Proximal Femur Fractures in Elderly Patients
title_fullStr Analysis of Risk Factors and Consequences of Consecutive Proximal Femur Fractures in Elderly Patients
title_full_unstemmed Analysis of Risk Factors and Consequences of Consecutive Proximal Femur Fractures in Elderly Patients
title_short Analysis of Risk Factors and Consequences of Consecutive Proximal Femur Fractures in Elderly Patients
title_sort analysis of risk factors and consequences of consecutive proximal femur fractures in elderly patients
topic Orthopedics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575275/
https://www.ncbi.nlm.nih.gov/pubmed/34765330
http://dx.doi.org/10.7759/cureus.18527
work_keys_str_mv AT gurusinghesuranga analysisofriskfactorsandconsequencesofconsecutiveproximalfemurfracturesinelderlypatients
AT mnavaratnamdevaraj analysisofriskfactorsandconsequencesofconsecutiveproximalfemurfracturesinelderlypatients
AT weerasinghekonara analysisofriskfactorsandconsequencesofconsecutiveproximalfemurfracturesinelderlypatients
AT gopinathgirish analysisofriskfactorsandconsequencesofconsecutiveproximalfemurfracturesinelderlypatients
AT uzoigwechika analysisofriskfactorsandconsequencesofconsecutiveproximalfemurfracturesinelderlypatients
AT joachimtheophilus analysisofriskfactorsandconsequencesofconsecutiveproximalfemurfracturesinelderlypatients