Skip to main content
Top
Published in: Clinical Orthopaedics and Related Research® 12/2012

01-12-2012 | Clinical Research

Do Concomitant Fractures With Hip Fractures Influence Complication Rate and Functional Outcome?

Authors: Benjamin Buecking, MD, Christina Wack, MD, Ludwig Oberkircher, MD, Steffen Ruchholtz, MD, Daphne Eschbach, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 12/2012

Login to get access

Abstract

Background

Owing to the aging population, the incidence of hip fractures is increasing. While concomitant fractures are not uncommon, it is unclear how they influence subsequent function.

Questions/purposes

Therefore, we determined (1) the incidence, type and treatment of concomitant fractures accompanying hip fractures, (2) the length of hospital stay, (3) the impact of concomitant fractures on mortality and complication rate, and (4) patients’ function.

Methods

We retrospectively reviewed 402 patients older than 60 years with hip fractures. We recorded the presence of concomitant fractures and their treatment. We analyzed the duration of hospital stays, in-hospital mortality, perioperative complications, and function. We recorded function with the Barthel Index, Harris hip score, and timed up and go test. For this study we followed patients 1 year.

Results

Twenty-two patients (5%) had concomitant fractures, the most frequent being proximal humeral fractures (n = 8) and distal radius fractures (n = 6). Patients without and with concomitant fractures had similar lengths of hospitalization (mean, 14 days; 95% CI, 13–15 days), in-hospital mortality (5% with concomitant fractures, 6% without concomitant fractures), and incidence of complications (41% versus 40%). Function at discharge and last followup were similar in both groups.

Conclusion

The most frequent concomitant fractures were typical osteoporotic fractures (radial and humeral fractures). Concomitant fractures did not influence length of hospitalization, in-hospital mortality, complication rate, and function. Hip fracture and comorbidities predicted the incidence of complications and patients’ function.

Level of Evidence

Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Literature
1.
go back to reference Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int. 2009;20:1633–1650.PubMedCrossRef Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int. 2009;20:1633–1650.PubMedCrossRef
3.
go back to reference Aros B, Tosteson AN, Gottlieb DJ, Koval KJ. Is a sliding hip screw or im nail the preferred implant for intertrochanteric fracture fixation? Clin Orthop Relat Res. 2008;466:2827–2832.PubMedCrossRef Aros B, Tosteson AN, Gottlieb DJ, Koval KJ. Is a sliding hip screw or im nail the preferred implant for intertrochanteric fracture fixation? Clin Orthop Relat Res. 2008;466:2827–2832.PubMedCrossRef
4.
go back to reference Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–196.PubMedCrossRef Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–196.PubMedCrossRef
5.
go back to reference Bertram M, Norman R, Kemp L, Vos T. Review of the long-term disability associated with hip fractures. Inj Prev. 2011;17:365–370.PubMedCrossRef Bertram M, Norman R, Kemp L, Vos T. Review of the long-term disability associated with hip fractures. Inj Prev. 2011;17:365–370.PubMedCrossRef
7.
go back to reference Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383.PubMedCrossRef Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383.PubMedCrossRef
8.
go back to reference Cornwall R, Gilbert MS, Koval KJ, Strauss E, Siu AL. Functional outcomes and mortality vary among different types of hip fractures: a function of patient characteristics. Clin Orthop Relat Res. 2004;425:64–71.PubMedCrossRef Cornwall R, Gilbert MS, Koval KJ, Strauss E, Siu AL. Functional outcomes and mortality vary among different types of hip fractures: a function of patient characteristics. Clin Orthop Relat Res. 2004;425:64–71.PubMedCrossRef
10.
go back to reference Di Monaco M, Vallero F, Castiglioni C, Di Monaco R, Tappero R. Low levels of 25-hydroxyvitamin D are associated with the occurrence of concomitant upper limb fractures in older women who sustain a fall-related fracture of the hip. Maturitas. 2011;68:79–82.PubMedCrossRef Di Monaco M, Vallero F, Castiglioni C, Di Monaco R, Tappero R. Low levels of 25-hydroxyvitamin D are associated with the occurrence of concomitant upper limb fractures in older women who sustain a fall-related fracture of the hip. Maturitas. 2011;68:79–82.PubMedCrossRef
11.
go back to reference Di Monaco M, Vallero F, Di Monaco R, Mautino F, Cavanna A. Functional recovery after concomitant fractures of both hip and upper limb in elderly people. J Rehabil Med. 2003;35:195–197.PubMedCrossRef Di Monaco M, Vallero F, Di Monaco R, Mautino F, Cavanna A. Functional recovery after concomitant fractures of both hip and upper limb in elderly people. J Rehabil Med. 2003;35:195–197.PubMedCrossRef
12.
go back to reference Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213.PubMedCrossRef Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213.PubMedCrossRef
13.
go back to reference Gulcelik NE, Bayraktar M, Caglar O, Alpaslan M, Karakaya J. Mortality after hip fracture in diabetic patients. Exp Clin Endocrinol Diabetes. 2011;119:414–418.PubMedCrossRef Gulcelik NE, Bayraktar M, Caglar O, Alpaslan M, Karakaya J. Mortality after hip fracture in diabetic patients. Exp Clin Endocrinol Diabetes. 2011;119:414–418.PubMedCrossRef
14.
go back to reference Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.PubMed Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.PubMed
15.
go back to reference Hutchings L, Fox R, Chesser T. Proximal femoral fractures in the elderly: how are we measuring outcome? Injury. 2011;42:1205–1213.PubMedCrossRef Hutchings L, Fox R, Chesser T. Proximal femoral fractures in the elderly: how are we measuring outcome? Injury. 2011;42:1205–1213.PubMedCrossRef
17.
go back to reference Icks A, Haastert B, Wildner M, Becker C, Meyer G. Trend of hip fracture incidence in Germany 1995-2004: a population-based study. Osteoporos Int. 2008;19:1139–1145.PubMedCrossRef Icks A, Haastert B, Wildner M, Becker C, Meyer G. Trend of hip fracture incidence in Germany 1995-2004: a population-based study. Osteoporos Int. 2008;19:1139–1145.PubMedCrossRef
18.
go back to reference Koval KJ, Skovron ML, Aharonoff GB, Zuckerman JD. Predictors of functional recovery after hip fracture in the elderly. Clin Orthop Relat Res. 1998;348:22–28.PubMed Koval KJ, Skovron ML, Aharonoff GB, Zuckerman JD. Predictors of functional recovery after hip fracture in the elderly. Clin Orthop Relat Res. 1998;348:22–28.PubMed
19.
go back to reference Kristensen MT. Factors affecting functional prognosis of patients with hip fracture. Eur J Phys Rehabil Med. 2011;47:257–264.PubMed Kristensen MT. Factors affecting functional prognosis of patients with hip fracture. Eur J Phys Rehabil Med. 2011;47:257–264.PubMed
20.
go back to reference Lawrence VA, Hilsenbeck SG, Noveck H, Poses RM, Carson JL. Medical complications and outcomes after hip fracture repair. Arch Intern Med. 2002;162:2053–2057.PubMedCrossRef Lawrence VA, Hilsenbeck SG, Noveck H, Poses RM, Carson JL. Medical complications and outcomes after hip fracture repair. Arch Intern Med. 2002;162:2053–2057.PubMedCrossRef
21.
go back to reference Lefaivre KA, Macadam SA, Davidson DJ, Gandhi R, Chan H, Broekhuyse HM. Length of stay, mortality, morbidity and delay to surgery in hip fractures. J Bone Joint Surg Br. 2009;91:922–927.PubMedCrossRef Lefaivre KA, Macadam SA, Davidson DJ, Gandhi R, Chan H, Broekhuyse HM. Length of stay, mortality, morbidity and delay to surgery in hip fractures. J Bone Joint Surg Br. 2009;91:922–927.PubMedCrossRef
22.
go back to reference Lohmann R, Frerichmann U, Stöckle U, Riegel T, Raschke MJ. [Proximal femoral fractures in the elderly: analysis of data from health insurance providers on more than 23 million insured persons–part 1] [in German]. Unfallchirurg. 2007;110:603–609.PubMedCrossRef Lohmann R, Frerichmann U, Stöckle U, Riegel T, Raschke MJ. [Proximal femoral fractures in the elderly: analysis of data from health insurance providers on more than 23 million insured persons–part 1] [in German]. Unfallchirurg. 2007;110:603–609.PubMedCrossRef
23.
go back to reference Lübke N, Meinck M, Von Renteln-Kruse W. [The Barthel Index in geriatrics: a context analysis for the Hamburg Classification Manual] [in German]. Z Gerontol Geriatr. 2004;37:316–326.PubMedCrossRef Lübke N, Meinck M, Von Renteln-Kruse W. [The Barthel Index in geriatrics: a context analysis for the Hamburg Classification Manual] [in German]. Z Gerontol Geriatr. 2004;37:316–326.PubMedCrossRef
24.
go back to reference Marks R. Hip fracture epidemiological trends, outcomes, and risk factors, 1970-2009. Int J Gen Med. 2010;3:1–17.PubMed Marks R. Hip fracture epidemiological trends, outcomes, and risk factors, 1970-2009. Int J Gen Med. 2010;3:1–17.PubMed
25.
go back to reference Miedel R, Törnkvist H, Ponzer S, Söderqvist A, Tidermark J. Musculoskeletal function and quality of life in elderly patients after a subtrochanteric femoral fracture treated with a cephalomedullary nail. J Orthop Trauma. 2011;25:208–213.PubMedCrossRef Miedel R, Törnkvist H, Ponzer S, Söderqvist A, Tidermark J. Musculoskeletal function and quality of life in elderly patients after a subtrochanteric femoral fracture treated with a cephalomedullary nail. J Orthop Trauma. 2011;25:208–213.PubMedCrossRef
26.
go back to reference Mulhall KJ, Ahmed A, Khan Y, Masterson E. Simultaneous hip and upper limb fracture in the elderly: incidence, features and management considerations. Injury. 2002;33:29–31.PubMedCrossRef Mulhall KJ, Ahmed A, Khan Y, Masterson E. Simultaneous hip and upper limb fracture in the elderly: incidence, features and management considerations. Injury. 2002;33:29–31.PubMedCrossRef
27.
go back to reference Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39:142–148.PubMed Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39:142–148.PubMed
28.
go back to reference Reuling EM, Sierevelt IN, van den Bekerom MP, Hilverdink EF, Schnater JM, van Dijk CN, Goslings JC, Raaymakers EL. Predictors of functional outcome following femoral neck fractures treated with an arthroplasty: limitations of the Harris hip score. Arch Orthop Trauma Surg. 2012;132:249–256.PubMedCrossRef Reuling EM, Sierevelt IN, van den Bekerom MP, Hilverdink EF, Schnater JM, van Dijk CN, Goslings JC, Raaymakers EL. Predictors of functional outcome following femoral neck fractures treated with an arthroplasty: limitations of the Harris hip score. Arch Orthop Trauma Surg. 2012;132:249–256.PubMedCrossRef
29.
go back to reference Sennerby U, Farahmand B, Ahlbom A, Ljunghall S, Michaëlsson K. Cardiovascular diseases and future risk of hip fracture in women. Osteoporos Int. 2007;18:1355–1362.PubMedCrossRef Sennerby U, Farahmand B, Ahlbom A, Ljunghall S, Michaëlsson K. Cardiovascular diseases and future risk of hip fracture in women. Osteoporos Int. 2007;18:1355–1362.PubMedCrossRef
30.
go back to reference Shabat S, Gepstein R, Mann G, Kish B, Stern A, Fredman B, Nyska M. Does the combination of a simultaneous subcapital fracture of humerus and hip fracture in elderly patients carry a prognostic value? Arch Gerontol Geriatr. 2002;35:71–77.PubMedCrossRef Shabat S, Gepstein R, Mann G, Kish B, Stern A, Fredman B, Nyska M. Does the combination of a simultaneous subcapital fracture of humerus and hip fracture in elderly patients carry a prognostic value? Arch Gerontol Geriatr. 2002;35:71–77.PubMedCrossRef
31.
go back to reference Tidermark J, Zethraeus N, Svensson O, Törnkvist H, Ponzer S. Quality of life related to fracture displacement among elderly patients with femoral neck fractures treated with internal fixation. J Orthop Trauma. 2002;16:34–38.PubMedCrossRef Tidermark J, Zethraeus N, Svensson O, Törnkvist H, Ponzer S. Quality of life related to fracture displacement among elderly patients with femoral neck fractures treated with internal fixation. J Orthop Trauma. 2002;16:34–38.PubMedCrossRef
32.
go back to reference Tow BP, Chua BS, Fook-Chong S, Howe TS. Concurrent fractures of the hip and wrist: a matched analysis of elderly patients. Injury. 2009;40:385–387.PubMedCrossRef Tow BP, Chua BS, Fook-Chong S, Howe TS. Concurrent fractures of the hip and wrist: a matched analysis of elderly patients. Injury. 2009;40:385–387.PubMedCrossRef
33.
go back to reference White SM, Griffiths R. Projected incidence of proximal femoral fracture in England: a report from the NHS Hip Fracture Anaesthesia Network (HIPFAN). Injury. 2011;42:1230–1233.PubMedCrossRef White SM, Griffiths R. Projected incidence of proximal femoral fracture in England: a report from the NHS Hip Fracture Anaesthesia Network (HIPFAN). Injury. 2011;42:1230–1233.PubMedCrossRef
34.
go back to reference Youm T, Aharonoff G, Zuckerman JD, Koval KJ. Effect of previous cerebrovascular accident on outcome after hip fracture. J Orthop Trauma. 2000;14:329–334.PubMedCrossRef Youm T, Aharonoff G, Zuckerman JD, Koval KJ. Effect of previous cerebrovascular accident on outcome after hip fracture. J Orthop Trauma. 2000;14:329–334.PubMedCrossRef
Metadata
Title
Do Concomitant Fractures With Hip Fractures Influence Complication Rate and Functional Outcome?
Authors
Benjamin Buecking, MD
Christina Wack, MD
Ludwig Oberkircher, MD
Steffen Ruchholtz, MD
Daphne Eschbach, MD
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 12/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-012-2419-z

Other articles of this Issue 12/2012

Clinical Orthopaedics and Related Research® 12/2012 Go to the issue

Symposium: ABJS Carl T. Brighton Workshop on Hip Preservation Surgery

Preliminary Pain and Function After Labral Reconstruction During Femoroacetabular Impingement Surgery

Symposium: ABJS Carl T. Brighton Workshop on Hip Preservation Surgery

What Are the Factors Associated With Acetabular Correction in Perthes-like Hip Deformities?

Symposium: ABJS Carl T. Brighton Workshop on Hip Preservation Surgery

Do Plain Radiographs Correlate With CT for Imaging of Cam-type Femoroacetabular Impingement?