Abstract
Introduction
In an ageing population the incidence of patients sustaining a neck of femur fracture is likely to rise. Whilst the neck of femur fracture is thought to be a pre-terminal event in many patients, there is little literature following this common fracture beyond 1 year. With improving healthcare and increasing survival rate, it is likely that a proportion of patients live to have subsequent fractures. However little is known about if these occur and what the epidemiology of these fractures are.
Aim
To describe the epidemiology of fractures sustained over a ten year period in patients who had an “index” neck of femur fracture.
Method
All patients from the Lothian region, who sustained a neck of femur fracture and were admitted to the Royal Infirmary of Edinburgh in Scotland between 01/01/2000 and 31/12/2000 were prospectively identified and had their orthopaedic notes and where appropriate death records retrospectively reviewed in Aug 2010, to identify further fractures and orthopaedic treatments. Patients admitted from without the Lothian region were excluded from the study.
Other information regarding their pre-injury medical history, what surgery was performed, age, social status, co-morbidities and where relevant cause and date of death were recorded.
Results
In the year 2000 there were 628 patients identified as having sustained a neck of femur fracture giving an incidence of 12/10,000/year.
534 (85%) of the 628 fractures were sustained by falls, with the remainder being direct trauma, pathological or an unknown cause. The mean age of patient at the time of sustaining the neck of femur fracture was 87.5 years old, with a range of 17 to 101 years old.
136 (21.7%) patients went on to sustain further fractures. The top five most frequent fractures involved the contralateral neck of femur (55; 31%), radius (34; 19%), humerus (24; 13.4%), ipsilateral femur (19; 10.6%) and tibia (10; 5.6%). 32 (23.5%) people sustained multiple fractures after the initial hip index fracture. 24% of patients had previously sustained some form of fracture prior to their index neck of femur fracture.
Conclusion
Our results demonstrate that over a fifth of patients who sustain a neck of femur fracture will sustain a further fracture in the next ten years. Rather than regarding a neck of femur fracture as a terminal event, resources and support should be directed at preventing further fractures in this high risk population. As patients live longer and health care and the treatment of neck of femur fractures improves it is likely that the incidence of further fractures will rise. We believe our results will be useful for all departments treating neck of femur fractures.
