Skip to main content
Top
Published in: European Journal of Trauma and Emergency Surgery 3/2014

01-06-2014 | Review Article

Epidemiology of pertrochanteric fractures: our institutional experience

Authors: J. N. Lamb, M. Panteli, S. G. Pneumaticos, P. V. Giannoudis

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2014

Login to get access

Abstract

Purpose

Hip fractures, a common manifestation of fragility fractures, represent a major cause of morbidity and mortality in the elderly population and may have devastating consequences to the patient, their family, and society thereafter. We attempted to define the epidemiology of pertrochanteric fractures treated at a large university teaching hospital in the UK and compared our findings with the national and international literature.

Methods

Between April 2008 and March 2013, we conducted a retrospective cohort study at our institution. All adult patients sustaining a proximal femoral fracture were included in our study. The following parameters were collected and evaluated: (1) demographics, (2) fracture pattern, (3) American Society of Anaesthesiologists (ASA) grade, (4) type of pre-injury mobilization, and (5) method of stabilization. Our findings were then compared to the national data as published in the National Hip Fracture Database (NHFD).

Results

Over a period of 5 years, 3,036 proximal femoral fractures were managed at our institution, with 916 (30.2 %) being classified as pertrochanteric fractures (250 male; mean age 82.0, SD 11.2). No significant change in the incidence of pertrochanteric fractures was evident during the same period. Between 2012 and 2013, 51,705 proximal femoral fractures were recorded in England, of which 19,569 (37.8 %) were classified as pertrochanteric fractures. Comparison between pertrochanteric and intracapsular fractures with respect to their demographics did not reveal any significant difference. In female patients, the relative incidence of pertrochanteric fractures was shown to increase with age. However, this was not the case in the male population.

Conclusions

The incidence of pertrochanteric fractures remained unchanged over the last 5 years. The relative incidence of pertrochanteric fractures is higher in elderly females; this may be explained by reduced bone mineral density and reduced trochanteric bone strength. Rigorous preventive treatments of osteoporosis should be considered in high-risk patients, along with improved safety measures to reduce falls.
Literature
2.
go back to reference Wiles MD, Moran CG, Sahota O, Moppett IK. Nottingham Hip Fracture Score as a predictor of one year mortality in patients undergoing surgical repair of fractured neck of femur. Br J Anaesth. 2011;106(4):501–4. doi:10.1093/bja/aeq405.PubMedCrossRef Wiles MD, Moran CG, Sahota O, Moppett IK. Nottingham Hip Fracture Score as a predictor of one year mortality in patients undergoing surgical repair of fractured neck of femur. Br J Anaesth. 2011;106(4):501–4. doi:10.​1093/​bja/​aeq405.PubMedCrossRef
4.
go back to reference Maxwell MJ, Moran CG, Moppett IK. Development and validation of a preoperative scoring system to predict 30 day mortality in patients undergoing hip fracture surgery. Br J Anaesth. 2008;101(4):511–7. doi:10.1093/bja/aen236.PubMedCrossRef Maxwell MJ, Moran CG, Moppett IK. Development and validation of a preoperative scoring system to predict 30 day mortality in patients undergoing hip fracture surgery. Br J Anaesth. 2008;101(4):511–7. doi:10.​1093/​bja/​aen236.PubMedCrossRef
8.
go back to reference Svedbom A, Hernlund E, Ivergård M, Compston J, Cooper C, Stenmark J, et al. Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos. 2013;8(1–2):1–218. doi:10.1007/s11657-013-0137-0. Svedbom A, Hernlund E, Ivergård M, Compston J, Cooper C, Stenmark J, et al. Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos. 2013;8(1–2):1–218. doi:10.​1007/​s11657-013-0137-0.
10.
go back to reference Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2013;8(1–2):136. doi:10.1007/s11657-013-0136-1.PubMedCentralPubMedCrossRef Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2013;8(1–2):136. doi:10.​1007/​s11657-013-0136-1.PubMedCentralPubMedCrossRef
12.
15.
go back to reference Cavaignac E, Lecoq M, Ponsot A, Moine A, Bonnevialle N, Mansat P, et al. CT scan does not improve the reproducibility of trochanteric fracture classification: a prospective observational study of 53 cases. Orthop Traumatol Surg Res. 2013;99(1):46–51. doi:10.1016/j.otsr.2012.09.019.PubMedCrossRef Cavaignac E, Lecoq M, Ponsot A, Moine A, Bonnevialle N, Mansat P, et al. CT scan does not improve the reproducibility of trochanteric fracture classification: a prospective observational study of 53 cases. Orthop Traumatol Surg Res. 2013;99(1):46–51. doi:10.​1016/​j.​otsr.​2012.​09.​019.PubMedCrossRef
16.
18.
go back to reference Krischak GD, Augat P, Beck A, Arand M, Baier B, Blakytny R, et al. Biomechanical comparison of two side plate fixation techniques in an unstable intertrochanteric osteotomy model: sliding hip screw and percutaneous compression plate. Clin Biomech (Bristol, Avon). 2007;22(10):1112–8. doi:10.1016/j.clinbiomech.2007.07.016.CrossRef Krischak GD, Augat P, Beck A, Arand M, Baier B, Blakytny R, et al. Biomechanical comparison of two side plate fixation techniques in an unstable intertrochanteric osteotomy model: sliding hip screw and percutaneous compression plate. Clin Biomech (Bristol, Avon). 2007;22(10):1112–8. doi:10.​1016/​j.​clinbiomech.​2007.​07.​016.CrossRef
19.
go back to reference Lofman O, Berglund K, Larsson L, Toss G. Changes in hip fracture epidemiology: redistribution between ages, genders and fracture types. Osteoporos Int. 2002;13(1):18–25.PubMedCrossRef Lofman O, Berglund K, Larsson L, Toss G. Changes in hip fracture epidemiology: redistribution between ages, genders and fracture types. Osteoporos Int. 2002;13(1):18–25.PubMedCrossRef
21.
22.
go back to reference Mautalen CA, Vega EM, Einhorn TA. Are the etiologies of cervical and trochanteric hip fractures different? Bone. 1996;18(3 Suppl):133S–7S.PubMedCrossRef Mautalen CA, Vega EM, Einhorn TA. Are the etiologies of cervical and trochanteric hip fractures different? Bone. 1996;18(3 Suppl):133S–7S.PubMedCrossRef
25.
go back to reference Finsen V, Johnsen LG, Trano G, Hansen B, Sneve KS. Hip fracture incidence in central Norway: a follow-up study. Clin Orthop Relat Res. 2004;419:173–8.PubMedCrossRef Finsen V, Johnsen LG, Trano G, Hansen B, Sneve KS. Hip fracture incidence in central Norway: a follow-up study. Clin Orthop Relat Res. 2004;419:173–8.PubMedCrossRef
27.
go back to reference National Hip Fracture Database national report 2013 (database on the internet) (2013). Accessed 19/11/2013. National Hip Fracture Database national report 2013 (database on the internet) (2013). Accessed 19/11/2013.
29.
go back to reference Statistics OFN. Population estimates for UK, England and Wales, Scotland and Northern Ireland, mid-2011 and mid-2012. Office for National Statistics. http://www.ons.gov.uk (2013). Accessed 23/11/2013. Statistics OFN. Population estimates for UK, England and Wales, Scotland and Northern Ireland, mid-2011 and mid-2012. Office for National Statistics. http://​www.​ons.​gov.​uk (2013). Accessed 23/11/2013.
30.
go back to reference Kim SH, Meehan JP, Blumenfeld T, Szabo RM. Hip fractures in the United States: 2008 nationwide emergency department sample. Arthritis Care Res. 2012;64(5):751–7. doi:10.1002/acr.21580.CrossRef Kim SH, Meehan JP, Blumenfeld T, Szabo RM. Hip fractures in the United States: 2008 nationwide emergency department sample. Arthritis Care Res. 2012;64(5):751–7. doi:10.​1002/​acr.​21580.CrossRef
31.
go back to reference Michaelsson K, Weiderpass E, Farahmand BY, Baron JA, Persson PG, Ziden L, et al. Differences in risk factor patterns between cervical and trochanteric hip fractures. Swedish hip fracture study group. Osteoporos Int. 1999;10(6):487–94.PubMedCrossRef Michaelsson K, Weiderpass E, Farahmand BY, Baron JA, Persson PG, Ziden L, et al. Differences in risk factor patterns between cervical and trochanteric hip fractures. Swedish hip fracture study group. Osteoporos Int. 1999;10(6):487–94.PubMedCrossRef
33.
go back to reference Baudoin C, Fardellone P, Sebert JL. Effect of sex and age on the ratio of cervical to trochanteric hip fracture. A meta-analysis of 16 reports on 36,451 cases. Acta Orthop Scand. 1993;64(6):647–53.PubMedCrossRef Baudoin C, Fardellone P, Sebert JL. Effect of sex and age on the ratio of cervical to trochanteric hip fracture. A meta-analysis of 16 reports on 36,451 cases. Acta Orthop Scand. 1993;64(6):647–53.PubMedCrossRef
35.
go back to reference Karagas MR, Lu-Yao GL, Barrett JA, Beach ML, Baron JA. Heterogeneity of hip fracture: age, race, sex, and geographic patterns of femoral neck and trochanteric fractures among the US elderly. Am J Epidemiol. 1996;143(7):677–82.PubMedCrossRef Karagas MR, Lu-Yao GL, Barrett JA, Beach ML, Baron JA. Heterogeneity of hip fracture: age, race, sex, and geographic patterns of femoral neck and trochanteric fractures among the US elderly. Am J Epidemiol. 1996;143(7):677–82.PubMedCrossRef
37.
go back to reference Koval KJ, Aharonoff GB, Rokito AS, Lyon T, Zuckerman JD. Patients with femoral neck and intertrochanteric fractures. Are they the same? Clin Orthop Relat Res. 1996;330:166–72.PubMedCrossRef Koval KJ, Aharonoff GB, Rokito AS, Lyon T, Zuckerman JD. Patients with femoral neck and intertrochanteric fractures. Are they the same? Clin Orthop Relat Res. 1996;330:166–72.PubMedCrossRef
38.
go back to reference Beringer TR, Clarke J, Elliott JR, Marsh DR, Heyburn G, Steele IC. Outcome following proximal femoral fracture in Northern Ireland. Ulster Med J. 2006;75(3):200–6.PubMedCentralPubMed Beringer TR, Clarke J, Elliott JR, Marsh DR, Heyburn G, Steele IC. Outcome following proximal femoral fracture in Northern Ireland. Ulster Med J. 2006;75(3):200–6.PubMedCentralPubMed
40.
41.
go back to reference Association BO. The care of patients with fragility fracture. British Orthopaedic Association. 2011. Association BO. The care of patients with fragility fracture. British Orthopaedic Association. 2011.
42.
go back to reference Centre NCG. The management of hip fracture in adults. In: Excellence NIfHaC, editor. 2011. Centre NCG. The management of hip fracture in adults. In: Excellence NIfHaC, editor. 2011.
43.
go back to reference Anglen JO, Weinstein JN. Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg Am. 2008;90(4):700–7. doi:10.2106/jbjs.g.00517.PubMedCrossRef Anglen JO, Weinstein JN. Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg Am. 2008;90(4):700–7. doi:10.​2106/​jbjs.​g.​00517.PubMedCrossRef
Metadata
Title
Epidemiology of pertrochanteric fractures: our institutional experience
Authors
J. N. Lamb
M. Panteli
S. G. Pneumaticos
P. V. Giannoudis
Publication date
01-06-2014
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 3/2014
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-014-0375-x

Other articles of this Issue 3/2014

European Journal of Trauma and Emergency Surgery 3/2014 Go to the issue