Retrospective Analysis of Epidemiological Characteristics of Elderly Hip Fractures

Abstract

Objective:To investigate the epidemiology and mortality rate

of elderly hip fractures which are commonly seen because of

increased life expectancy and osteoporosis.

Materials and Methods: 428 patients, who attended our clinic

and operated because of hip fracture in February 2010 –

May 2015, were included and retrospectively analysed in our

study. The patients, who were younger than 55 years old, operated

from the same hip, had pathologic fracture or periprosthetic

fracture were excluded. The fracture type, gender, age

group, co-morbidities, ASA (AmericanSociety of Anesthesiologists)

risk categories, distribution according to seasons, treatment

choice and operation day, first 3 month and one year

mortality rate of the patients were analysed.

Results: The mean age of the patients was 78.65 (55-100) and

64.49% of patients were female, 35.51% of patients were male.

Type of fracture distributon was as 226 (52.80%) trochanteric

fractures, 178 (41.59%) femoral neck fractures and 24 (5.61%)

subtrochanteric fractures. Hip fractures were mostly (50.47%)

in 75-84 age group. 28 (6.54%) patients attended after high

energy trauma, 400 (93.46%) patients attended after low energy

trauma. 84.58 percent of the patients were categorized as

ASA 3 risk or more than and 233 (53.44%) patients had 2 or

more comorbidities). The patients attended our clinic mostly

in winter and least in summer. A trend to fixation from arthroplasty

were detected in the treatment choice of patients.

In 2011, fixation is preferred as treatment choice in 32.39%

of patients, however in 2015 this rate increased to 77.27%.

Operation day mortality rate of patients was 0.93%; one year

mortality rate was 17,99%. Mortality rates of patients increased

with older age groups, and this increase was statistically

significant.

Conclusion: Epidemiological studies about hip fractures in

Turkish population are inadequate. After this study results,

the demographical risk factors of elderly hip fractures were

described. High mortality rate consistent with literature were

showed. This research’s results will be the guide to prevent hip

fractures in the risky population and a reference for further studies.

Keywords

• Elderly hip fractures,epidemiology

Yaşlılarda Kalça Kırıklarının Epidemiyolojik Özelliklerinin Retrospektif Analizi

Öz

Amaç: Artan yaşam süreleri ve osteoporoz nedeniyle sık karşılaşılan yaşlı kalça kırıklarının, epidemiyolojisini ve mortalite oranlarını araştırmak

Yöntem ve Gereç: Şubat 2010 - Mayıs 2015 yılları arasında kliniğimize başvuran ve ameliyat edilen 428 kalça kırığı olan hasta çalışmaya dahil edildi ve retrospektif olarak incelendi. Ellibeş yaş altı, daha önce aynı bölgeden ameliyat edilmiş, patolojik ve periprostetik kırıklı hastalar çalışma dışı bırakıldı.

Hastaların kırık tipi, cinsiyet, yaş grupları, kırık mekanizmaları, ek hastalıkları, ASA (Amerikan Anestezi Topluluğu) risk kategorileri, kırıkların mevsimlere göre dağılımı, yapılan tedavi yöntemleri ve hastaların ameliyat günü, ilk 3 ay ve 1.yıl mortalite oranları araştırıldı.

Bulgular: Hastalarımızın yaş ortalaması 78,65 (55-100)’ti ve %64,49’u kadın, %35,51’i erkek hastalardan oluşuyordu. Kırık tipi dağılımlarına göre; 226’sı (%52,80) trokanterik kırık, 178’i (%41,59) femur boyun kırığı, 24’ü (%5,61) subtrokanterik kırık şeklinde idi. En çok kalça kırığının görüldüğü yaş grubu; %50,47 ile 75-84 yaş arası bulundu. Yirmisekiz (%6,54) hasta yüksek enerjili travma, 400 (%93,46) hasta düşük enerjili travma sonrasında kalça kırığı ile başvurdu. Hastaların % 84,58’i anestezi tarafından ASA-3 veya daha fazla risk ile kategorize edildi, 233’ü (%53,44) iki ya da daha fazla ek kronik hastalığa sahipti. Hastalar en çok kış, en az yaz aylarında kalça kırıkları ile tarafımıza başvurdular. Hastaların tedavisinde yıllara göre artroplastiye kıyasla tespit tercihinin arttığı tespit edildi. 2011 yılında %32,39 oranında tespit tercih edilirken, bu oran 2015 yılında % 77,27’e ulaştı. Hastaların ameliyat günü mortalite oranı % 0,93; bir yıllık mortaliteleri %17,99 olarak bulundu. Hastaların mortalite oranlarının yaş grupları ile istatiksel olarak anlamlı şekilde arttığı görüldü. (p<0,05)

Sonuç: Kalça kırıklarının epidemiyolojisi ile ilgili Türk toplumu araştırma sayısı yetersizdir. Bu çalışma bulguları sonrasında yaşlı kalça kırıklarının demografik olarak risk faktörleri belirlendi. Yaşlılarda kalça kırıklarının literatür ile uyumlu olarak yüksek mortalite riski olduğu gösterildi. Elde edilen bulgular riskli popülasyon için gerekli önlemlerin alınmasında yol gösterici olacak, ileri çalışmalar için bir referans olacaktır.

Anahtar Kelimeler

• Yaşlı kalça kırıkları,epidemiyoloji

Kaynakça

1. 1. Salomon JA, Wang H, Freeman MK, et al. Healthy life expectancy for 187 countries, 1990-2010:a systematic analysis for the Global Burden Disease Study 2010. Lancet. 2012 15;380:2144-62.
2. 2. Quah C, Boulton C, Moran C. The influence of socioeconomic status on the incidence, outcome and mortality of fractures of the hip. J Bone Joint Surg(Br) 2011;93B:801–5
3. 3. Ghafoori S, Keshtkar A, Khashayar P. The risk of osteoporotic fracture sandits associating risk factors according to the FRAX model in the Iranian patients: a follow- up cohort. J Diabetes Metab Disord2014:22;13:93.
4. 4. Cooper C, Campion G, Melton. Hip fractures in theelderly: a world-wide projection. L J 3rd Osteoporos Int. 1992; 2:285-9.
5. 5. Bleibler F, Konnopka A, Benzinger P, Rapp K, König HH. The health burden and costs of incident fractures attributable to osteoporosis from 2010 to 2050 in Germany—a demographic simulation model. Osteoporos Int 2013: 24:835–847
6. 6. Tuzun S, Eskiyurt N, Akarirmak U, et al.Turkish Osteoporosis Society. Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study. OsteoporosInt. 2012;23:949-55.
7. 7. Kannus P, Parkkari J, Sievänen H, Heinonen A, Vuori I, Järvinen M. Epidemiology of hipfractures. Bone. 1996;18(1 Suppl):57S-63S
8. 8. Levine BR, Meere PA, DiCesare PE, Zuckerman JD. Hip fracture streated by arthroplasty. In: Callahan JJ, Rosenberg AA, Rubash HE, editors. Adult Hip. Vol. 2, 3rd ed. Philadelphia: LWW; 2007. 1187-211.

9. 9. Swiontkowski MF. Intracapsular hip fractures. In: Browner BD, Jupiter JB, Levine AM, Traon PG, editors. Skeletal trauma. Vol. 2, 2nd ed. Philadelphia: W.B. Saunders; 1998; 1751-832.
10. 10. Ozturk I, Toker S, Erturer E, Aksoy B, Seckin F. Analysis of risk factors affecting mortality in elderly patients (aged over 65 years) operated on for hip fractures. Acta Orthop Traumatol Turc 2008; 42: 16-21
11. 11. Uğurlu M., Yılmaz S., Deveci A., et al. The epidemiologic characteristics of patients that underwent surgery for hip fracture Turk J Med Sci 2012; 42: 299-305
12. 12. Türkiye İstatistik Kurumu; 2002, 2006, 2008, 2012, 2015 verileri URL: http//www.tuik.gov.tr.
13. 13. Hinton RY, Smith GS. The association of age, race, and sex with the location of proximal femoral fractures in the elderly. J Bone Joint Surg Am 1993; 75: 752-9.
14. 14. Koval KJ, Aharonoff GB, Rokito AS, Lyon T, Zuckerman JD. Patients with femoral neck and intertrochanteri c fractures. Are t hey the same? Clin Orth op Relat Res 1996; 166-72.
15. 15. Wu CC, Wang CJ, Shyu YI. More aggravated osteoporosis in lateral trochanter compared to femoral neck with age: contributing age difference between inter-trochanteric and femoral neck fractures in elderly patients. Injury 2009;40:1093-7
16. 16. Baumgaertner MR, Higgins TF. Femoral neck fractures. In: Bucholz RW, Heckman JD, ed. Rockwood and Green’s fractures in adults. Vol 2, 5th ed. Philadelphia: LWW; 2001.1579-634.
17. 17. Icks A, Haastert B, Wildner C, Becker C, Meyer G. Trend of hip fracture incidence in Germany 1995-2004: a population based study. Osteoporos Int 2008, 19: 1139-45.
18. 18. Brauer CA , Coca-Perraillon M , Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA 2009;302: 1573–1579
19. 19. Giannoudis PV, Har wood PJ, Court-Brown C, Pape HC. Severe and multiple trauma in olderpatients; incidenceandmortalit y. Injury 2009;40:362–367
20. 20. Osler T, Hales K, Baack B, et al. Trauma in the elderly. Am J Surg 1988;156:537–543
21. 21. Mor an CG, Wenn RT, Sikand M, Taylor AM. Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am 2005;87:483–489
22. 22. Milzman DP, Boulanger BR, Rodriguez A, Soderstrom CA, Mitchell KA, Magnant CM. Pre-existing disease in trauma patients: a predictor of fate independent of ageand injury severity score. J Trauma 1992;32:236–243
23. 23. Grønskag AB, Forsmo S, Romundstad P, Langhammer A, Schei B.Incidence and seasonal variation in hip fracture incidence among elderly women in Norway. The HUNT Study. Bone 2010; 46:1294-8
24. 24. Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, et al. Seasonal variation in the incidence of hip fractureamong white persons aged 65 years and older in the United States, 1984-1987. Am J Epidemiol 1991: 133: 996–1004
25. 25. Bischoff-Ferrari HA, Orav JE, Barrett JA, Baron JA. Effect of seasonality and weather on fracture risk in individuals 65 years and older. Osteoporos Int 2007: 18: 1225–1233
26. 26. Levy AR, Bensimon DR, Mayo NE, Leighton HG. Inclement weather and the risk of hip fracture. Epidemiology 1998: 9: 172–177 27. Rogmark C, Sernbo I, Johnell O, Nilsson JA. Incidence of hip fractures in Malmo, Sweden, 1992-1995. A trend-break. Acta Orthop Scand1999: 70: 19–22
27. 28. Lofthus CM, Osnes EK, Falch JA, et al. Epidemiology of hip fractures in Oslo, Norway. Bone 2001: 29: 413–418
28. 29. Iwamoto J, Takeda T, Matsumoto H. Sunlight exposure is important for preventing hip fractures in patients with Alzheimer’sdisease, Parkinson’s disease, or stroke. Acta Neurol Scand 2012 Apr;125:279-84.
29. 30. Frost SA, Nguyen ND, Black DA, Eisman JA, Nguyen TV. Risk factors for in-hospital post-hip fracture mortality. Bone 2011 Sep;49:553-8
30. 31. Alzahrani K, Gandhi R, Davis A, Mahomed N. In-hospital mortality following hip fracture care in southern Ontario.Can J Surg. 2010 Oct;53:294-8.
31. 32. Alvarez-Nebreda ML, Jiménez AB, Rodríguez P, Serra JA. Epidemiology of hip fracture in the elderly in Spain. Bone 2008;42:278-85
32. 33. LaVelle DG. Fractures of hip. In: Campbell’s Operative- Orthopaedics, 10th, Canale ST. (Ed), Mosby, Philadelphia 2003; 2873
33. 34. Wolinsky FD, Fitzgerald JF, Stump TE. The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study. Am J Public Health. 1997;87:398
34. 35. Panula J, Pihlajamäki H, Mattila VM, Jaatinen P, Vahlberg T, Aarnio P, Kivelä SL. Mortality and cause of death in hip fracture patients aged 65 or older: a population-based study. BMC Musculoskelet Disord 2011;12:105.
35. 36. LeBlanc ES, Hillier TA, Pedula KL, et al. Hip fracture and increased short-term but not long-term mortality in healthy older women. Arch Intern Med 2011;171:1831-7.