Hip Fractures In Elderly People Research Articles

Research Progress on the Treatment of Geriatric Intertrochanteric Femur Fractures with Proximal Femur Bionic Nails (PFBNs).

Intertrochanteric femur fracture is the most common hip fracture in elderly people, and the academic community has reached a consensus that early surgery is imperative. Proximal femoral nail anti-rotation (PFNA) and InterTan are the preferred internal fixation devices for intertrochanteric femur fractures in elderly individuals due to their advantages, such as a short lever arm, minimal stress shielding, and resistance to rotation. However, PFNA is associated with complications such as nail back-out and helical blade cut-out due to stress concentration. As a new internal fixation device for intertrochanteric femur fractures, the proximal femoral biodegradable nail (PFBN) addresses the issue of nail back-out and offers more stable fracture fixation, a shorter lever arm, and stress distribution compared to PFNA and InterTan. Clinical studies have shown that compared to PFNA, PFBNs lead to faster recovery of hip joint function, shorter non-weight-bearing time, and faster fracture healing. This article provides a literature review of the structural characteristics, biomechanical analysis, and clinical studies of PFBNs, aiming to provide a theoretical basis for the selection of internal fixation devices for the treatment of intertrochanteric femur fractures in elderly patients and to improve the quality of life of patients during the postoperative period.

Mapping Knowledge Structure and Themes Trends of Post-operative Rehabilitation of Hip Fractures in the Elderly: A Bibliometrics and Visualization Study.

BackgroundHip fractures are a common type of fracture in the elderly and are characterized by many complications and high mortality. Many topics concerning postoperative rehabilitation of hip fracture in elderly people still remain controversial, and the global research trend in this field has not yet been well studied. The aim of the present study was to illustrate the overall knowledge structure, development trends, and research hot spots of postoperative rehabilitation of hip fracture in elderly people.MethodsArticles and reviews regarding postoperative rehabilitation of hip fracture in elderly people from 2001 to 2021 were identified from the Web of Science database. An online bibliometric platform, CiteSpace, and VOSviewer software were used to generate visualization knowledge maps, including annual trends of publications, contributions of countries, institutions, authors, funding agencies, and journals, and clustering of keywords.ResultsA total of 1,724 publications were identified from Web of Science Core Collection (WoSCC). In the past 20 years, the number of published studies on the rehabilitation of hip fracture in the elderly has exhibited an overall upward trend. The USA was the leading contributor in this field, with the largest number of publications (354, 20.65%) and the most citations (13,786 times). The international cooperation map among relevant countries/regions indicated that the USA collaborated most closely with Canada and China. The University of Maryland and Professor Marcantonio were the most prolific institution and influential author, respectively. Injury: International Journal of the Care of the Injured was the most productive journal concerning the research of postoperative rehabilitation of hip fracture in elderly people. The keyword co-occurrence analysis identified six clusters: quality of life study, rehabilitation and outcomes study, cognitive impairment study, operative approaches study, mortality study, and osteoporosis study.ConclusionsThere will be an increasing number of publications on the research of postoperative rehabilitation of hip fracture in elderly people, and the United States will stay ahead in this field. Our findings could offer practical sources for scholars to understand the current status and trend of studies on rehabilitation of hip fracture in the elderly and provide references and suggestions for the development of related research in future.

Computational Analysis of Femoral Strength and Fracture Location of Normal, Osteoarthritis and Avascular Necrosis Femurs using CT-Image based Finite Element Method

Recent years, the risk of hip fractures in elderly people has exponentially increased due to a progressive loss of bone mass and bone structure deterioration due to osteoporosis and increased incidental falls. It is, therefore, expected that the prediction of femoral strength and fracture location of specific patient will be clinically very useful. It is also considered that some typical femoral diseases such as osteoarthritis (OA) and avascular necrosis (AVN) could affect the strength and fracture behaviour of the femurs. In this study, 130 computational femoral models were constructed using CT images of 73 patients. Then, CT image based finite element method (CT-FEM) combined with a damage mechanics analysis was applied to predict the fracture load as the femoral strength and the fracture location of the femoral models. The computational results exhibited that the fracture load tended to increase with increase of the volumetric bone mineral density (vBMD) estimated in the femoral head and neck region in all the three types of models, although AVN models showed much wider scatter in the data than the other two types. The bone fracture behaviour was expressed as expressed as the distribution of failure elements in the head and neck region. The bone fracture mainly took place in the neck region for all types of femoral model. In addition, a combination of the head and neck fracture was also observed in all the models. A combination of neck and intertrochanteric fracture was also observed in the normal and AVN groups.

Cognitive Impairment as the Principal Factor Correlated with the Activities of Daily Living Following Hip Fracture in Elderly People.

ABSTRACTObjectives:Hip fracture is a common injury occurring in elderly people and often impairs their activities of daily living (ADL). This study aimed to identify and analyze factors associated with ADL following hip fracture treatment.Methods:A total of 371 consecutive patients with hip fractures who were surgically treated in our hospital were enrolled. Among these, 103 patients who underwent acute- to recovery-phase postoperative rehabilitation at our hospital and whose motor scale of the functional independence measure (mFIM) score was ≥70 before the fracture were finally included in this study. Single and multiple regression analyses were performed to identify the factors correlated with ADL. The mFIM at hospital discharge was set as the outcome variable, and various clinical factors, such as fracture type, surgical technique, serum and biological data, mini-mental state examination (MMSE) score, and serial mFIM scores, were used as explanatory variables.Results:Only MMSE and preinjury mFIM scores were significantly correlated with mFIM at discharge, and MMSE had the larger effect on the outcome. Receiver operating characteristic curve analysis revealed an MMSE cutoff value of 20/21. Patients with an MMSE score of ≤20 showed a relatively poor recovery of mFIM from 2–3 weeks postoperatively compared with those with an MMSE score of ≥21.Conclusion:Cognitive impairment and the preinjury ADL level were correlated with short-term ADL outcomes following hip fracture. Cognitive impairment was the most important factor affecting ADL; treatment and postoperative rehabilitation should be carefully considered for cognitively disturbed patients from the acute phase after hip fracture.

Positioning a navigation-guided cephalic screw standard gamma 3 nail in intertrochanteric fractures: preliminary experience

Objective. Hip fractures in elderly people occur in up to 18% of women and 6% of men, with almost 50% located at lateral proximal femur. Surgical treatment prevents complications secondary to immobilization. Intramedullary fixation has the advantages of reduced blood loss and shorter surgical time. The rate of complications rate is around 20%, represented by screw jamming, refractures, implant breakage, or its medial migration, although the most common is cut-out. As a general consensus, a tip-apex-distance (TAD) of > 25 mm and incorrect cephalic screw position are predictive factors of cut-out. Methods. The aim of this study is to evaluate the incidence of cut-out in patients treated with intramedullary nail fixation associated with a computer-guided system to place the cephalic screw. We present a small case series of 10 patients. Results. Interventions were performed heterogeneously by different surgeons. Mean TAD was 13.3 mm. Positioning resulted on average 2 mm lower and 1 mm anterior than planned by the system. At a mean follow-up time of 6.5 months, there were no cut-outs. Conclusions. Further studies with longer follow-up are needed, but preliminary results showed that a navigation system for cephalic screw positioning can be helpful in intramedullary fixation of proximal lateral femur fractures to prevent cut-out.

Integrated hip fracture care pathway (IHFCP): reducing complications and improving outcomes.

Introduction:Hip fractures in elderly people are increasing. A five-year Integrated Hip Fracture Care Pathway (IHFCP) was implemented at our hospital for seamlessly integrating care for these patients from admission to post discharge. We aimed to evaluate how IHFCP improved process and outcome measures in these patients.Methods:A study was conducted over a five-year period on patients with acute fragility hip fracture who were managed on IHFCP. The evaluation utilised a descriptive design, with outcomes analysed separately for each of the five years of the programme. First-year results were treated as baseline.Results:The main improvements in process and outcome measures over five years, when compared to baseline, were: (a) increase in surgeries performed within 48 hours of admission from 32.5% to 80.1%; (b) reduced non-operated patients from 19.6% to 11.9%; (c) reduced average length of stay at acute hospital among surgically (from 14.0 ± 12.3 days to 9.9 ± 1.0 days) and conservatively managed patients (from 19.1 ± 22.9 to 11.0 ± 2.5 days); (d) reduced 30-day readmission rate from 3.2% to 1.6%; and (e) improved Modified Functional Assessment Classification of VI to VII at six months from 48.0% to 78.2%.Conclusion:The IHFCP is a standardised care path that can reduce time to surgery, average length of stay and readmission rates. It is distinct from other orthogeriatric care models, with its ability to provide optimal care coordination, early transfer to community hospitals and post-discharge day rehabilitation services. Consequently, it helped to optimise patients’ functional status and improved their overall outcome.

Incidence and costs of hip fractures in elderly Italian population: first regional-based assessment.

We aimed at evaluating the burden of hip fractures in elderly Italian population at the regional level. We analyzed national hospitalizations records 2007-2014 to compute standardized hospitalizations rates (SHR) due to hip fractures per 10,000 inhabitants at the regional level and average annual percent change (AAPC), along with related costs. Hip fractures occurred in people over 65years increased from 89,601 to 94,525 over 8years. The overall increase in the number of hospitalizations is attributable only to people aged ≥85. Actually, in the 65-74 and 74-84 age groups, totalhospitalizations decreased from 13,396 to 12,268 and from 40,733 to 37,786 respectively, while they increased from 35,472 to 44,471 in people aged ≥85 (women = 28,605 and men = 6,867 in 2007; women = 34,636 and men = 9,835 in 2014). Almost 50% of hip fractures were found to have been experienced by patients aged 85 or older in 2014 (with women ≥ 85 representing 36.6% of total fractures), in accordance with the higher prevalence of osteoporosis in this age group. Fractures increase in people aged ≥ 85 was two-folds higher in males (AAPC: + 5.0%; P > 0.05) than in females (AAPC: + 2.6%; P > 0.05). Increases in the number of hospitalizations and related costs were observed for all the regions, with the only exception of Lazio (AAPC: - 4.6%; P < 0.05) and Friuli Venezia Giulia (hip fractures AAPC: - 1.9%; P < 0.05). The most significant increases in hip fractures and related costs were recorded in Calabria (+ 2.7%), Campania (+ 2.2%), and Lombardia (+ 2.0%). At the national level, SHR per 10,000 inhabitants due to hip fractures decreased in all three examined age groups (65-74, 75-84, and ≥ 85), both in males and females during the 8-year period (P < 0.05). This reduction was confirmed also when looking at the regional dataset, with few exceptions concerning female population (AAPC not statistically significant). When looking at the SHR per 10,000 inhabitants for the entire nation, we recorded a decreasing trend also in females aged 85years old and over but not in males ≥ 85. Actually, men aged ≥ 85 showed increased HR per 10,000 in 10 regions out of 20. Direct hospitalization and rehabilitation costs increased in all the regions over the 8-year period (although at different rates), except for Friuli Venezia Giulia (where costs decreased from 21 to 19 million Euros) and Lazio (from 107 to 87 million Euros). Lombardia and Piemonte were the regions spending the highest amount of money to treat hip fractures in elderly people (151 and 95 million Euros in the year 2014, respectively). Hip fractures in the elderly population remain a major public health issue in all Italian regions, especially in people aged 85years old and over, although the problem is starting to become more controlled compared with the past. Women represent the majority of hip fractures, but the highest increasing rate has been observed in men. Pilot projects at regional level targeting elderly people at higher risk of fractures and treatment compliance are needed.

Outdoor Air Pollution and Hip Fracture in UK

Background: Until now, only a few studies have evaluated the impact of air pollution on BMD and associated fractures, and their results are controversial. Methods: We constructed a cohort of all NFHD beneficiaries (513,540 patients) in the UK from 2013 to 2018. Averages of particulate matter in suspension < 2.5μm (PM2.5), particulate matter in suspension < 10μm (PM10), ozone (O3), nitrogen dioxide (NO2), and sulphur dioxide (SO2) were estimated according to the person's residence. The incidence rate ratio, and all-cause mortality within 30 days post-fracture (ACM30D) rate ratios were estimated using generalized additive models. Results: The incidence of hip fracture (IHF) and ACM30D showed a positive association with PM2.5, PM10, and NO2. This association was negative for O3 levels. Each increase of 1 μg/m3 in PM2.5, PM10, and NO2 will cause a 1.83%, 1.77%, and 0.81% higher rate, respectively, of the IHF, and also a 1.79%, 1.61%, and 0.57% higher rate, respectively, of the ACM30D. When we restricted the analysis to low-level exposure of air pollutants, we continued to see the same results. Conclusions: Our study proved a moderate, direct association between IHF, ACM30D and the levels of specific air pollutants in the entire NHFD population. A reduction of levels of PM2.5, PM10, and NO2 may contribute to decrease the incidence, and associated mortality of hip fracture in elderly people. Our study highlights the influence of air pollution on hip fractures, which is one of the main causes of death in the elderly population. Funding Statement: Financial support for this study is from the National Natural Science Foundation of China (81871789, 81772358, 81702214); the Natural Science Foundation of Jiangsu Province (BK20180052). Declaration of Interests: All the authors declare that the research was conducted in the absence of any commercial or financial relationships which could be construed as a potential conflict of interest. Ethical Approval Statement: The institutional review board at Soochow University approved this study.

Energy absorption and thermal comfort of segmented pad for hip protective garment

PurposeThe purpose of this paper is to investigate the influence and relationship of segment area and opening area in segmented protective pad in comparison to non-segmented pad to the energy absorption and performance attributes relevant to thermophysiological wear comfort.Design/methodology/approachThe compressive stress-strain curves were obtained using Instron Tester and were used to analyse the energy absorption of the pads and the segmented pad assemblies. The dry thermal resistance and evaporative resistance of the non-segmented and segmented protective pads were obtained using MTNW Sweating Guarded Hot Plate.FindingsThe compression test results and performance attributes relevant to thermophysiological wear comfort test result demonstrated that the area segment and opening area of segmented pad influenced their energy absorption value, dry thermal resistance value and evaporative resistance value (permeability index value).Originality/valueThe results are expected to be useful for design and engineering of hip impact protective garments. Hip impact protective pads are used to prevent hip fractures in elderly people as a result of fall.

Effect of early surgery after hip fracture in elderly people

Effect of early surgery after hip fracture in elderly people

A systematic review of hip fractures in elderly people

Objective To study the age peak of incidence, pathologic sites, therapeutic effect and complications of different treatment for hip fractures in the elderly. Methods Hip fractures, therapy, were used as key words to search articles both in English and Chinese from 1979 to 2017. The articles were filtrated by title, abstract and full text and 32 of them were left. All the patients were objects of this study, but the repeated cases were excluded. The patients’ data such as age of onset, gender, fracture type, operation method, follow-up time, and complications were collected and analyzed by systematic analysis. Results Data of 2 758 patients in 32 papers had been collected for analysis. There were 1791 femoral neck fractures and 967 intertrochanteric fractures, with a ratio of 1.85∶1. The patients’ age of onset was ranging from 54 to 92 years old, with an average of 76.7 years old, and the age peak of incidence was from 70 to 79 years old. The sex ratio was 1∶1.66 (1 037 males: 1721 females). All the patients had been followed up for 0.5 to 18 years, (average, 7.8 years). Among 927 femoral neck fractures who were treated by 3 lag screws, there were 278 cases of non-union (29.9%), 139 femoral head necrosis(15.1%) and 19 internal fixation loosening (2.0%); but for 183 femoral neck fractures who were treated by dynamic hip screws (DHS), there were 51 cases of non-union (28.1%), 31 femoral head necrosis(17.0%), 3 internal fixation losening(1.8%), and 27 cutting effect (15%). Then for 400 femoral neck fractures who were treated by hemiarthroplasty, there were 6 cases of dislocation(1.5%), 14 shaft fracture (3.5%), 8 deep infection (2.0%); while for 281 femoral neck fractures who were treated by total hip arthroplasty, there were 14 cases of dislocation (5.0%), 11 shaft fracture (4.0%), and 10 deep infection (3.5%). On the other hand, for 354 intertrochanteric fractures who were treated by proximal femoral nail or proximal femoral nail antirotation internal fixation (PFN or PFNA), there were 18 cases of trochanter fracture (5.0%), 28 hip varus (8.1%), 32 displacement (9.0%); and for 210 intertrochanteric fractures who were treated by Gamma nail, there were 17 cases of trochanter fracture (7.9%), 11 cutting effect (5.0%), 6 displacement (3.0%); and for 135 intertrochanteric fractures who were treated by DHS, there were 8 cases of cutting effect (6.1%), 7 displacement (5.2%); and for 101 intertrochanteric who were treated by proximal femoral locking plate, there were 5 cases of displacement (5.0%); Also for 89 intertrochanteric fractures who were treated by hemiarthroplasty, there were 2 cases of dislocation(1.8%), 3 shaft fracture (3.0%), 1 deep infection(1.5%); and for 78 intertrochanteric fractures who were treated by total hip arthroplasty, there were 4 cases of dislocation (4.8%), 3 shaft fracture (4.0%), 2 deep infection (2.5%). Conclusion The elderly hip fractures’ age peak of incidence is from 70 to 79 years old, and femoral neck fracture takes up a majority of it. Female patients are more than male patients. The femoral neck fractures are mainly treated by 3 lag screws internal fixation; non-union and femoral head necrosis are the common complications postoperation. While the intertrochanteric fractures are mainly treated by proximal femoral nails; displacement, hip varus and trochanter fractures are the common complications postoperation. The artificial hip replacement is the effective remedy measure for secondary femoral head necrosis after hip fractures. Key words: Aged; Hip; Fractures, bone; Review

Hip Fractures in Elderly People: Surgery or No Surgery? A Systematic Review and Meta-Analysis.

Introduction:Increasing numbers of patients with hip fractures also have advanced comorbidities. A majority are treated surgically. However, a significantly increasing percentage of medically unfit patients with unacceptably high risk of perioperative death are treated nonoperatively. Important questions about patients’ prefracture quality of life (QOL) and future perspectives should be asked before considering different treatment options to assess what kind of treatment is advisable in frail elderly high-risk patients with a hip fracture.Objective:The aim of this review was to provide an overview of differences in mortality, health-related QOL [(HR)QOL], functional outcome, and costs between nonoperative management (NOM) and operative management (OM) of hip fractures in patients above 65 years.Methods:A systematic literature search was performed in EMBASE, OvidSP, PubMed, Cochrane Central, and Web of Science for observational studies and trials. Observational studies and randomized controlled trials comparing NOM with OM in hip fracture patients were selected. The methodological quality of the selected studies was assessed according to the Methodological Index for Nonrandomized Studies (MINORS) or Furlan checklist.Results:Seven observational studies were included with a total of 1189 patients, of whom 242 (20.3%) were treated conservatively. The methodological quality of the studies was moderate (mean: 14.7, standard deviation [SD]: 1.5). The 30-day and 1-year mortalities were higher in the nonoperative group (odds ratio [OR]: 3.95, 95% confidence interval [CI]: 1.43-10.96; OR: 3.84, 95% CI: 1.57-9.41). None of the included studies compared QOL, functional outcome, or health-care costs between the 2 groups.Conclusion:This systematic review and meta-analysis demonstrated that only a few studies with small number of patients comparing NOM with OM were published. A significantly higher 30-day and 1-year mortality was revealed in nonoperatively treated hip fracture patients. No data were found examining (HR)QOL and costs. Further work is needed to enable shared decision-making and to initiate NOM in frail elderly patients with advanced comorbidity and limited life expectancy.

Assessment of Mortality in Postoperative Hip Fractures in a Rural Tertiary Care Centre

Background: Peritrochanteric hip fractures in elderly people leads to prolonged immobilization and increased risk of death. Elderly people having co morbidities such as diabetes, hypertension and cardiovascular diseases, along with hip fractures results in increase the mortality of the patients post operatively1,2. The objective of this study is to determine the relation of mortality during one year post operative period after hip surgery to associated co morbidities. Methods: In this retrospective study patients aged 60 and above admitted during the period from April 2014 to June 2015 in the department of orthopaedics at a rural tertiary care centre for surgical intervention for peri trochanteric hip fractures were included. A sample size of 56 patients operated during this period was considered in this study. Results: Out of 56 patients operated, 9 patients died during first year post operative period.Of them 4 were males and 5 females. 2 patients died in first one month of follow up, one due to aspiration pneumonia and second patient from septicaemia. 3 patients died in first 3 months of follow up due to deep vein thrombosis leading to pulmonary embolism, cardiac failure and cerebro-vasular accident. 4 patients died due to cardiac failure between 3 months to one year postoperative period. Out of 9 death 4 were in hospital 3 in home, one in old age home and one person in unknown place. In 9 deaths 3 patients had bipolar prosthesis,2 dynamic hip screws fixation, 2 with proximal femoral locking compression plate, 2 with proximal femoral nailing and 1 with Austin Moore prosthesis. Death of patients more than 75 years were 5 and between 65-74 years was 4. Conclusion: Hip fractures are one of the common causes of increasing mortality in elderly population. However early recognition of patients with hip fracture and admission to hospital, prompt identification of the co morbidities and treating them with early surgery and mobilization would geatly reduce the risk of morbidity and mortality.

Common complications in hip fracture surgery: Tips/tricks and solutions to avoid them.

Surgical management of hip fractures in elderly people is challenging and complications relating to surgery could be devastating. They often lead to reoperation and revision surgery and can be associated with significantly increased morbidity and mortality. The most common surgical complications after internal fixation of hip fractures include cut-out, nonunion, Z-effect/medial migration, periimplant failure and avascular necrosis. High quality surgical fixation is of outmost importance to avoid surgical complications. This article presents the aetiology, risk factors and incidence of perioperative and post-fracture fixation complications. Technical tips and tricks for a successful fixation as well as the contemporary evidence surrounding the augmentation of osteoporotic bone fixation in internal fixation of hip fractures are discussed.

Hip Fracture After Stroke in the Elderly: Trends in the Beginning of the 21st Century and Projections into the Future in Australia

Aims: To estimate age- and sex-specific incidence rates and time trends of post-stroke hip fracture (HF) in the Australian Capital Territory (ACT) and to present projections of future post-stroke HF incidence in Australia until 2051. Methods: Analysis of annual age- and sex-specific standardized (to 2006 Australian population) post-stroke HF incidence rates in older stroke survivors (aged ≥ 60 years) over an 11 year period (between 1999/2000 and 2009/2010). Projections of number of post-stroke HF in 2021 and 2051 are based on demographic predictors obtained from the Australian Bureau of Statistics. Results: Over the study period among 1784 stroke survivors HF was recorded in 61 (3.42%) subjects (40 women and 21 men), indicating a HF incidence rate of 6.31 per 1000 stroke person-years. The standardized annual post-stroke HF incidence rate (per 100,000 person-years) in women was 1.7 times higher than in men (18.9 vs. 11.1 per, p = 0.008), and in the oldest group (.80 years) compared to aged 60–69 years was 10 times higher for women (47.54 vs. 4.73) and 4 times higher for men (26.65 vs. 6.50). Post-stroke HF occurred on average within the first 2.3 years, about 2 times more often in women aged ≥ 75 years (p = 0.033) and in survivors after an ischaemic stroke (p = 0.052), but age per se did not affect the time to HF. During the 11-year period the incidence rates of post-stroke HF decreased annually in total by 17.9%. Conclusions: Post-stroke HF is relatively common, prevalent in women and occurs on average within 2.3 years after the stroke. The incidence of post-stroke HF in elderly people is decreasing. However, because of population ageing and increasing number of stroke survivors, the absolute number of post-stroke patients sustaining a HF and their proportion among the total HF population could be expected to increase.

Visual Impairment and Hip Fractures: A Case-Control Study in Elderly Patients

Aims: To investigate the relationship between visual impairment and fall-related hip fracture and to determine the etiology of visual impairment in a population of elderly patients with hip fracture. Methods: A case-control study compared 96 patients diagnosed with hip fracture to a randomly selected control group of 103 patients without hip fracture. Inclusion criteria for the case group were as follows: patients aged 60 years and over with a hip fracture. Clinical assessment included visual acuity and ophthalmic examination. Results: Forty-three patients with hip fracture had a visual impairment compared to only 12 patients in the control group. Visual impairment was a significant risk factor for hip fracture (OR = 6.15; 95% CI 2.98-12.69). Twenty-seven hip fracture patients had an uncorrected refractive error compared to only 15 controls (OR = 2.78; 95% CI 0.92-8.35). There was no significant difference of dense cataract between both groups (OR = 2.28; 95% CI 0.75-6.93). Fourteen hip fracture patients had a macular degeneration compared to only 8 controls (OR = 5.63; 95% CI 1.57-20.18), and 10 patients had suspicion of glaucoma compared to only 5 controls (OR = 10.65; 95% CI 2.21-51.3). Conclusion: Visual impairment was significantly associated with an increased risk of hip fracture in elderly people. There are many etiologies that may contribute to hip fractures, most notably refractive error, cataract, macular degeneration and glaucoma.

Study protocol: High-protein nutritional intervention based on β-hydroxy-β-methylbutirate, vitamin D3 and calcium on obese and lean aged patients with hip fractures and sarcopenia. The HIPERPROT-GER study

IntroductionLoss of muscle strength is associated with falls, which, in turn, are the main cause of hip fractures in elderly people. The factors that most influence loss of strength in elderly people are a decrease in muscle mass, i.e. sarcopenia, and an increase in fat, i.e. obesity. MethodsA prospective randomized clinical trial among patients who have undergone an operation for a traumatic hip fracture and who are aged 65 or above will be implemented. We shall compare a control diet against a high-protein diet enriched with β-hydroxy-βmethylbutirate, calcium and vitamin D. The diet will be administered during 30 days of hospitalization in the orthopaedic geriatric rehabilitation unit. There will be 50 patients in each arm of the study. The main objective is to assess whether the experimental diet, together with rehabilitation, improves functional recovery, measured on the Barthel index. Secondary objectives are to assess changes in body composition and the prevalence of sarcopenia, obesity and mortality one year after the hip fracture. We shall also assess whether there is a relationship between specific inflammatory markers, sarcopenia and functional recovery. ConclusionsAgeing is accompanied by changes in body composition that increase the risk of falls and progressive functional loss. These factors are a public health problem because they are highly associated with disability in older people. The present study seeks to gain knowledge of those factors that are most often associated with the onset of disability and those that can be modified through diet.

THU0378 Predictors of One-Year Mortality in Elderly Hip Fracture Patients

BackgroundThere is growing evidence that devastating consequences of hip fracture can possibly be counteracted with multidisciplinary inpatient rehabilitation3. Recognition of variables that influence mortality at an early stage is needed...

Incidence and costs of hip fractures vs strokes and acute myocardial infarction in Italy: comparative analysis based on national hospitalization records

ObjectivesAs osteoporotic fractures are becoming a major health care problem in countries characterized by an increasing number of older adults, in this study we aimed to compare the incidence and costs of hip fragility fractures in Italian elderly people versus those of major cardiovascular diseases (strokes and acute myocardial infarctions [AMI]) occurring in the whole adult population.MethodsWe analyzed hospitalization records maintained at the national level by the Italian Ministry of Health for the diagnosis of hip fractures (ICD-9-CM codes 820–821), AMI (code 410), hemorrhagic (codes 430, 431, 432) and ischemic strokes (codes 433–434), and TIA (code 435) between 2001–2005. Cost analyses were based on diagnosis-related groups.ResultsThe incidence of hip fractures in elderly people has increased (+12.9% between 2001 and 2005), as well as that of AMI (+20.2%) and strokes (hemorrhagic: +9.6%; ischemic: +14.7) occurring in the whole adult population; conversely, hospitalization due to TIA decreased by a rate of 13.6% between 2001 and 2005. In 2005, the hospital costs across the national health care system that were associated with hip fragility fractures in the elderly were comparable to those of strokes (both hemorrhagic and ischemic), which occurred in the whole Italian adult population. Moreover, these costs were higher than those generated by AMI and TIA. Rehabilitation costs following strokes reached about 3 billion Euros in 2005, but rehabilitative costs of hip fractures and AMI were comparable (about 530 million Euros in 2005).ConclusionThe burden of hip fragility fractures in Italy is comparable to that of AMI and strokes.

Variations in Bone Mineral Density of Proximal Femora of Elderly People With Hip Fractures: A Case-Control Analysis

Bone mass as represented by bone mineral density (BMD) is the most important factor determining bone strength. Elderly people with and without hip fractures were compared with the BMD of the proximal femora. The correlation between hip fractures in elderly patients and osteoporosis was investigated. Eighty-seven consecutive elderly patients (≥65 years; average age, 77.5 years) with 87 unilateral hip fractures (39 femoral neck and 48 intertrochanteric fractures) were compared with 87 consecutive elderly persons (≥65 years; average age, 77.7 years) without hip fractures. Dual-energy X-ray absorptiometry was used to assess the BMD. The BMD of the total hip, greater trochanter, lesser trochanter, and femoral neck was significantly different between people with and without hip fractures (p = 0.002, 0.012, 0.011, and <0.001, respectively). All BMD values for patients with fractures were lower. Moreover, the BMD of the total hip, greater trochanter, lesser trochanter, and femoral neck was significantly different between people with intertrochanteric fractures and those without hip fractures (p < 0.001, <0.001, 0.003, and <0.001, respectively). Between patients with femoral neck fractures and those with intertrochanteric fractures, only the BMD value of the greater trochanter was significantly different (p = 0.04). The severity of osteoporosis may affect the risk of hip fractures in elderly people. The risk of intertrochanteric fractures may be determined simply by BMD, but the risk of femoral neck fractures may be determined by multiple factors. Intertrochanteric fractures may start at the greater trochanter due to its low BMD.