Epidemiology of Hip Fractures, a Retrospective Review
Fairbanks, Carson MD
Davis, Jacob MD
Sanchez, Hugo MD, PhD
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Purpose: To determine the epidemiology and fracture characteristics of hip fractures at a level two trauma center. To establish a hip fracture database to further research on the subject. Methods: An IRB exempt retrospective chart review was undertaken on consecutive patients 55 years of age and greater from December, 2010 through July, 2013 who sustained a proximal femur fracture from a ground level fall. All of these patients underwent operative fixation at a single, urban, level two trauma center. X-rays were reviewed by three Orthopedic surgeons blinded to patient identification and were characterized using the AO/OTA classification system into fractures of the femoral neck (FN), intertrochanteric region (IT), and subtrochanteric region (ST). Fracture classification and fixation method were recorded and combined with clinical information from the hip fracture database. Results: There were 986 patients that met study characteristics including 281 (28.5%) males and 705 (71.5%) females, the average age was 79.5 years old. Fracture characteristics included 91 (9.2%) non displaced FN, 332 (33.7%) displaced FN, 275 (27.9%) stable IT, 169 (17.1%) unstable IT, 82 (8.3%) reverse obliquity IT, 28 (2.8%) ST, and 9 (0.1%) peri-prosthetic fractures. The average length of stay was 5.9 days (range 1-36 days), and the most common discharge destinations were 526 (53.35%) patients to a skilled nursing facility and 303 (30.7%) to a rehabilitation facility. Only 76 (7.7%) of patients were discharged home. The in hospital mortality rate was 1.6% (16 patients). Conclusion: Hip fractures in the geriatric population are very common and lead to significant morbidity, mortality, and loss of pre-injury functional level. Understanding the epidemiology of these fractures will better guide patient care and allow us to formulate treatment protocols to best serve this vulnerable patient population. Further research should continue on, among other things, the appropriate types of fixation for these fractures, factors that influence length of stay, and ways to improve function after hip fracture. The aim of this research should be to reduce the physical, psychological, financial, and social burden that hip fractures have on both patients and society as a whole.