Aim: Rehospitalisation following surgery is widely regarded as an important outcome measure. In this study we identified causes of readmission following surgery, in proximal hip fracture patients.

Method: A total of 267 patients underwent surgery for proximal hip fractures in one year (2001–2002) at our institution. Notes of these patients were reviewed to look for readmissions within three months.

Results: A total of 43 (16.1%) patients died during initial hospital admission episode. Of the remaining 224 patients, 46 (20.5%) patients had an emergency unplanned readmission back to the hospital, within 3 months of discharge. 9 admissions (19.5% of readmissions, 4.01% of discharged patients) were due to operative site complications. 8 patients (17.3% of readmissions, 3.5% of discharged patients) were referred back for suspected thromboembolic events. 29 admissions (63.04% of readmissions, 12.9% of discharged patients) were due to other medical problems. Of these 18 medical problems could be attributed to preceding hip fracture. 15 patients died during this 2nd admission episode. 10 of these patients could have their ‘cause of death’ attributable to previous hip fracture, though this was not mentioned in their death certificates. A total of 8 patients had died in community in the 3 months following discharge giving a total mortality of 24.7% (66/267 patients) within 3 months.

Conclusions: Hip fracture is underreported as a cause of prolonged morbidity and mortality. A high percentage of these patients were readmitted adding to resource crunch. An understanding of the causes of readmission would help to decrease this workload.

Although there have been many studies of the epidemiology of hip fractures in the older population, including the assessment of bone density and the predictive value of a Cole’s fracture in particular for later hip fracture, there has not previously been an analysis of combined presentation of hip and upper limb fractures. We performed this study to examine the incidence and risk factors of such combined injuries and to assess the impact these have on rehabilitation and subsequent treatment in order to formulate a possible clinical pathway or treatment protocol for such patients.

The study was performed retrospectively, with all patients admitted over 3 years with fractured neck of femur being reviewed. Of the 681 patients admitted over this period of time (324 intracapsular and 357 extracapsular fractured necks of femur), 22 were found to have a contemporaneous fracture of the upper limb. The associated upper limb fractures were distal radius (n=11), olecranon (n=5) and neck of humerus (n=6), with the same ratio of intracapsular to extra-capsular fractures as the whole group. The female to male ratio in both isolated hip and combined fracture groups was the same at 3:1. The mean patient age was 77.6 years for isolated hip fractures and 78.4 for the combined group. The usual mechanism of injury in both groups was a fall onto the side, but patients in the combined group also typically described having the arm outstretched for protection. The mean total length of stay in hospital for isolated hip fracture was 10.9 days and for combined fractures was 23.2 days (p< 0.05, ANOVA). Exact details were not retrievable from the nursing homes taking some of these patients, but from the data obtained there was a trend apparent for more of the combined group to require such care and for longer. In summary, it is obvious that patients sustaining combined upper limb and hip fractures can become a significant burden on already busy hospital services. These patients therefore require an even more concerted effort at rehabilitation than those patients with isolated hip fractures. We therefore now recommend the use of a specific clinical pathway or protocol including early fixation, immediate co-ordinated multidisciplinary team involvement and rehabilitation, with everyone involved with the treatment of these patients, doctors, physiotherapists, occupational therapists and others, being aware of these extra requirements. Issues for further analysis in these patients include assessing the contribution of bone density to such double fractures, the associated risk of further fractures and therefore whether such patients require further treatment or protective measures.