Elderly patients with two episodes of fragility hip fractures form a special subgroup

D Ip, FK Ip
Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Hong Kong

Purpose. To identify the demographic features of patients aged 65 years or older admitted with 2 episodes of fragility hip fractures.

Methods. From July 2003 to December 2004 inclusive, 50 consecutive elderly patients underwent surgery for a second episode of hip fracture. Patients in a very poor physical condition and therefore unfit for surgery were excluded. Risk factors of fractures in both episodes and whether risk factors were corrected after the first episode were analysed. Detailed radiological assessment and charting of elderly mobility scores and Barthel index were completed and the one-year mortality rate documented. The rehabilitation periods for the 2 episodes of hip fracture were compared.

Results. Most patients were female and had trochanteric fractures. In patients aged 65 to 75 years, the incidence of femoral neck fracture occurred as often as trochanteric fracture; while trochanteric fracture was predominant in older patients. Subclinical osteomalacia and undiagnosed hyperthyroidism was found in 3 of the 7 younger patients. Only 30% of them were on treatment for osteoporosis after the first fracture, which underlines the importance of osteoporosis treatment in these patients.

Conclusion. Elderly patients with 2 episodes of fragility hip fractures form a special subgroup among geriatric hip fracture patients. Fall prevention programmes and treatment for osteoporosis are recommended.