Purpose: We conducted a prospective study among elderly women with a first hip fracture to document survival and functional outcome, and to determine whether outcomes differ by fracture type.

Methods: The design was a one-year prospective cohort study in the context of standard day-to-day clinical practice. The main outcome measures were survival and functional outcome, both at hospital discharge and one year later. Functional outcome was assessed using the Rapid Disability Rating Scale version-2.

Results: Of the 170 women originally enrolled, 86 (51%) had an intertrochanteric and 84 (49%) a femoral neck fracture. There were no significant differences between the two groups with respect to median age (80 and 78 years, respectively), type and number of comorbidities, and prefracture residence at the time of injury. At hospital discharge, intertrochanteric hip-fracture patients had a higher mortality (relative risk [RR] 9.8; 95% confidence interval [CI]: 1.3 to 74.6; p=0.006) and were functionally more impaired (0.4 units difference in ability to walk independently; p=0.005). One year later, mortality was still significantly higher after intertrochanteric fracture (RR 2.5; 95% CI: 1.3 to 5.1; p=0.008), but functional outcome among surviving patients was similar in both groups. During the one-year period after hospital discharge, a significant functional recovery was observed regardless of fracture type (improvement by 3.9 units [p=0.003] and by 2.6 units [p=0.015] in patients with intertrochanteric and femoral neck fractures, respectively). In both groups, this recovery was reflected in a significant improvement in walking ability (p< 0.001 and p=0.006, respectively) and mobility (p=0.004 and p< 0.001, respectively).

Conclusions: We conclude that intertrochanteric fractures are associated with increased mortality compared to femoral neck fractures. Functional outcome differs according to fracture type at hospital discharge, but these differences do not persist over time. Our data provide evidence that these findings cannot be explained by differences in age or comorbidity. Differences in survival suggest that the two main types of hip fractures should be analyzed separately in clinical and epidemiological studies.

Aims: To explore potential predictors of functional outcome one year after the injury in elderly women who sustained a displaced intracapsular hip fracture and who were treated with internal fixation, hemiarthroplasty, or total hip arthroplasty.

Methods: Eighty-four women aged > 50 years were enrolled on a consecutive basis in this one-year prospective cohort study reflecting standard day-to-day clinical practice. The main outcome measure was the Rapid Disability Rating Scale version-2 applied at hospital discharge and one year later.

Results: The total hip arthroplasty group was younger (p< 0.001) and had a better functional status than the internal fixation or hemiarthroplasty groups (p< 0.001) at hospital discharge. One year later, the best function was still observed in the total arthroplasty group, but the differences were small and failed to achieve the level of statistical significance. During that one-year period, walking ability or mobility did not change significantly after total hip arthroplasty, but a significant proportion of the women developed cognitive impairment, including mental confusion, uncooperativeness, and depression (p< 0.001).

Overall, the most significant predictors of poor functional status one year after fracture were increasing age (p=0.005), living in an institution at time of injury (p=0.034), and poor functional status at discharge (p< 0.001).

Conclusions: In elderly women with a displaced intra-capsular hip fracture, total hip arthroplasty is associated with a functional benefit within the first months after surgery. However, the extent to which this functional benefit is maintained over time, is less clear. Our results support the need for randomised clinical trials among elderly women with a displaced intracapsular hip fracture to quantify the extent to which the early functional benefit of total hip arthroplasty is maintained in the long run or compromised by progressive cognitive impairment and other negative determinants of functional outcome.

Aims: The aim of our study was to compare relative risk of hip fracture after wrist or spine fracture, in both men and women. Methods: We performed a systematic literature review of cohort studies reported since 1982 that included low-trauma wrist or spine fracture as a risk factor for subsequent hip fracture among (white) women and men aged 50 years or older. A fixed effects meta-analysis was used to calculate a common relative risk (RR) with 95% confidence interval (95% CI). Results: Ten cohort studies (six from the U.S.A. and four from Europe) contributed to this meta-analysis. Among postmenopausal women, RRs for future hip fracture after wrist and spine fracture were 1.53 (95% CI 1.34–1.74, p< 0.001) and 2.22 (95% CI 1.95–2.52, p< 0.001), respectively. The RR was significantly higher after spine fracture than after wrist fracture (p< 0.001). Among ageing men, these RRs for future hip fracture were 3.26 (95% CI 2.08–5.11, p< 0.001) and 3.54 (95% CI 2.01–6.23, p< 0.001), respectively. In contrast to the observation in women, this difference was not statistically significant (p=0.82).

The RR was significantly higher in men than in women after wrist fracture (p=0.002), but not after spine fracture (p=0.12). Conclusions: Recent studies have shown consistent and strong prospective associations of hip fracture with previous wrist or spine fracture among postmenopausal women. The findings of our meta-analysis confirm these results and extend them to ageing men. In addition, our results indicate that wrist and spine fractures are equally important risk factors for future hip fracture in ageing men.

Aims:We conducted a prospective study among elderly women with a femoral neck fracture to determine if medical care costs during the one-year period after hospital discharge differ by surgical procedure type. In addition, we analysed potential predictors of costs. Methods: The design was a one-year prospective cohort study assessing day-to-day clinical practice. Eighty-four women were enrolled. Direct costs of care were documented during the oneyear period after hospital discharge and expressed in Euro (€) per hip-fracture patient. Multiple regression analyses were performed to explore potential predictors of costs. Results: Three fracture groups were defined by the type of surgical repair. Total-hiparthroplasty patients were significantly younger than hemiarthroplasty or internal-fixation patients (median age 71, 81, and 80 years, respectively; p = 0.001). Average costs during the one-year follow up period after hospital discharge were lower after total hip arthroplasty (e 9,486) than after hemiarthroplasty (€ 12,146) or internal fixation (€ 15,687), although these trends failed to achieve the level of statistical significance (p = 0.322). A multivariate regression model identified two significant determinants of increased costs: increasing age (p = 0.023) and living in an institution at time of injury (p = 0.004). Conclusions: Direct costs of care during the one-year period after hospital discharge among elderly women with a femoral neck fracture do not depend on the type of surgical procedure. Increasing age and living in an institution at time of injury, on the other hand, are strong predictors of increased costs during the one-year period after hospital discharge.