The purpose of this study was to identify changing
trends in the pattern of distribution of the type and demographics
of fractures of the hip in the elderly between 2001 and 2010. A
retrospective cross-sectional comparison was conducted between 179
fractures of the hip treated in 2001, 357 treated in 2006 and 454
treated in 2010. Patients aged <
60 years and those with pathological
and peri-prosthetic fractures were excluded. Fractures were classified
as stable extracapsular, unstable extracapsular or intracapsular
fractures. The mean age of the 179 patients (132 women (73.7%)) treated
in 2001 was 80.8 years (60 to 96), 81.8 years (61 to 101) in the
357 patients (251 women (70.3%)) treated in 2006 and 82.0 years
(61 to 102) in the 454 patients (321 women (70.1%)) treated in 2010
(p = 0.17). There was no difference in the gender distribution between
the three study years (p = 0.68). The main finding was a steep rise in the proportion of unstable
peritrochanteric fractures. The proportion of unstable extracapsular
fractures was 32% (n = 57) in 2001, 35% (n = 125) in 2006 and 45%
(n = 204) in 2010 (p <
0.001). This increase was not significant
in patients aged between 60 and 69 years (p = 0.84), marginally
significant in those aged between 70 and 79 years (p = 0.04) and
very significant in those aged >
80 years (p <
0.001). The proportion
of intracapsular fractures did not change (p = 0.94). At present, we face not only an increasing number of fractures
of the hip, but more demanding and complex fractures in older patients
than a decade ago. This study does not provide an explanation for
this change. Cite this article:
Pelvic discontinuity with associated bone loss is a complex challenge in acetabular revision surgery. Reconstruction using ilio-ischial cages combined with trabecular metal acetabular components and morsellised bone (the component-cage technique) is a relatively new method of treatment. We reviewed a consecutive series of 26 cases of acetabular revision reconstructions in 24 patients with pelvic discontinuity who had been treated by the component-cage technique. The mean follow-up was 44.6 months (24 to 68). Failure was defined as migration of a component of >
5 mm. In 23 hips (88.5%) there was no clinical or radiological evidence of loosening at the last follow-up. The mean Harris hip score improved significantly from 46.6 points (29.5 to 68.5) to 76.6 points (55.5 to 92.0) at two years (p <
0.001). In three hips (11.5%) the construct had migrated at one year after operation. The complications included two dislocations, one infection and one partial palsy of the peroneal nerve. Our findings indicate that treatment of pelvic discontinuity using the component-cage construct is a reliable option.
