Background Classically, medical literature has described the association between the type of hip fracture with functional outcome to short and mid-term. To our knowledge, no previous study has been carried out to illustrate the factors present at the moment of a hip fracture as possible determinants of the type of fracture.
Objectives To analyze the presence of determining factors on the type of fracture at the moment of the event.
Methods Longitudinal, prospective study which included consecutively, from March 2009 up to December 2010, every patient who was admitted to the Orthopaedics Surgery Service of a tertiary hospital for hip fracture secondary to a low impact trauma. During admission, a protocolized visit was performed and the variables collected were introduced systematically to a data base. Through a direct interview and a review of the clinical record, we obtained the following data: a) sex, age, body mass index (BMI), b) type of fracture and surgical intervention, c) medical history and Charlson’s Comorbidity Index (CI), d) geriatric testing for dependence degree of daily basic life activities (Barthel’s Index, BI), for cognitive deterioration (Pfeiffer’s test) and global deterioration scale (GDS), and f) laboratory data (hemoglobin, creatinine, glomerular filtration rate, albumin, and bone mineral metabolism).
Results Of the 425 patients included, 72% were women with an average age of 84±8 years; the mean age for men was 81±8 years, having a significant difference (p<0,01). The mean BMI was 25,7±4,8 kg/m2.
The mean results for the different geriatric tests were: 1,7±2,0 for CI and 76±29 points for BI; 57% of patients had a normal Pfeiffer test and 16%, 14% and 13% showed mild, moderate or severe deterioration, respectively. The mean GDS score was 2,02 with a mode and median of 1.
The mean hemoglobin value was 118±19 g/L; the serum creatinine, 98±72 μmol/L (normal renal function in 65% of the patients, estimated by the MDRD-creatinine clearance rate); albumin levels were 31,4±4,3 g/L. Of the bone mineral metabolism parameters, calcidiol mean levels stand out with a mean of 29,2±24,7 nM/L.
The majority of fractures were either pertrochanteric (45%) or subcapital (43%); the remaining 12% corresponded to subtrochanteric, basicervical or transcervical fractures. The most frequent surgical procedure was placement of osteosynthesis material (59%); forty percent of patients received a prothesis replacement and only two were non surgically managed.
Subcapital fractures, regarding pertrochanteric fractures, were associated with a lower previous status estimated by the Barthel Index (71±33 vs. 79±24; p<0,01) and Pfeiffer test (55% vs. 45% of the patients with some degree of deterioration; p<0,05). A similar tendency, though not significative, was observed with the GDS. None of the other analized variables was related with the type of hip fracture.
Conclusions In patients with hip fracture, a more evident deterioration in functional status and a poorer previous cognitive state determines a larger frequency of subcapital fractures.
Disclosure of Interest None Declared
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