Community-based Study on Hip Fracture in a Rural Area in Northeast Indiana

Background/Objective: There are few studies in the literature focused on rural hip fracture epidemiology, and fewer still that consider hip fractures at a specific county level or trauma center (TC) region. The aim of this study is to elucidate patterns of injury events and injury burden of hip fractures in a rural trauma center in northeast Indiana. Patients and Measurements: We ascertained 2019 hip fracture cases that consisted of three sets of data, namely, emergency department visits (ED), hospitalizations (IP), and deaths from clinical databases. We analyzed the cases by fracture type, measured incidence rates (IRs) per 1,000 county residents and described the injury pattern of hip fractures by variables such as county of residence, age, and sex. We considered the mechanism of injury (cause) of the fractures as well as the injury burden based on the above three sets. Results: A ratio of roughly 2:1 was found for extracapsular to intracapsular hip fractures. Injury patterns showed that the study counties had similar incidence rates with a range of 0.96 to 1.41 per 1,000 residents. Males and females ages 0-69 years had similar incidences of hip fracture. Overall, females had a 41% higher incidence rate of hip fractures than males. Injury burden indicated a similar distribution of ED to IP to mortality cases across the five study counties, and the majority (98.4%) of hip fractures with known causes of injury were due to falls. Conclusions and Potential Impact: We elucidated the injury patterns and burden of hip fractures in a verified level II trauma center region. The results of this study have the potential benefit for the future development of hip fracture prevention programs for rural, elderly populations in northeast Indiana.

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Does Care at a Trauma Center Affect Geriatric Hip Fracture Patients?

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320911865 ◽

2020 ◽

Vol 11 ◽

pp. 215145932091186

Author(s):

Jordan B. Pasternack ◽

Matthew L. Ciminero ◽

Michael Silver ◽

Joseph Chang ◽

Piyush Gupta ◽

...

Keyword(s):

Hip Fracture ◽

Outcome Measures ◽

Hip Fractures ◽

Complication Rate ◽

Trauma Center ◽

Secondary Outcome ◽

Transfusion Rate ◽

Geriatric Hip Fracture ◽

Level 1 ◽

Level 1 Trauma Center

Introduction: With respect to care setting, there are mixed results in the literature with respect to the role of trauma centers in management of isolated geriatric hip fractures. During a transition from a Level 3 to a Level 1 trauma center, significant protocol changes were implemented that sought to standardize and improve the care of hip fracture patients. The objective of this study was to determine the effects of this transition on the management, efficiency, morbidity, mortality, and discharge of geriatric hip fracture patients. Methods: A retrospective chart review of geriatric hip fractures treated operatively was conducted. Two cohorts were compared: hip fractures in the year prior to (2015) and year following (2017) Level 1 Trauma designation. Primary outcome measures were length of stay (LOS), transfusion rate, complication rate, and mortality rate. Secondary outcome measures were time from emergency department (ED) arrival to medical optimization, time from medical optimization to surgery, time from ED arrival to surgery, and discharge destination. Results: There were no differences in LOS, transfusion rate, or complication rate between the two cohorts. There was a nonsignificant trend toward lower in-hospital mortality after the transition (2.24% vs 0.83%). There were no differences in time from ED arrival to medical optimization, time from medical optimization to surgery, time from ED arrival to surgery, and percentage of patients discharged home between the cohorts. Discussion: Management of operative geriatric hip fractures at our institution has remained consistent following transition to a Level 1 trauma center. There was a trend toward lower mortality after transition, but this difference was not statistically significant. We attribute the variety of findings in the literature with respect to trauma center management of hip fractures to individualized institutional trauma protocols as well as the diverse patient populations these centers serve.

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From ER to OR: Results After Implementation of Multidisciplinary Pathway for Fragility Hip Fractures at a Level I Trauma Center

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320927383 ◽

2020 ◽

Vol 11 ◽

pp. 215145932092738

Author(s):

Kenoma Anighoro ◽

Carla Bridges ◽

Alexander Graf ◽

Alexander Nielsen ◽

Tannor Court ◽

...

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Trauma Center ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Complication Rates ◽

Blood Products ◽

Total Blood ◽

Fragility Hip Fracture ◽

Level I

Introduction: Hip fractures are one of the most common indications for hospitalization and orthopedic intervention. Fragility hip fractures are frequently associated with multiple comorbidities and thus may benefit from a structured multidisciplinary approach for treatment. The purpose of this article was to retrospectively analyze patient outcomes after the implementation of a multidisciplinary hip fracture pathway at a level I trauma center. Materials and Methods: A retrospective review of 263 patients over the age of 65 with fragility hip fracture was performed. Time to surgery, hospital length of stay, Charlson Comorbidity Index (CCI), American Society of Anesthesiologists, complication rates, and other clinical outcomes were compared between patients treated in the year before and after implementation of a multidisciplinary hip fracture pathway. Results: Timing to OR, hospital length of stay, and complication rates did not differ between pre- and postpathway groups. The postpathway group had a greater CCI score (pre: 3.10 ± 3.11 and post: 3.80 ± 3.18). Fewer total blood products were administered in the postpathway group (pre: 1.5 ± 1.8 and post: 0.8 ± 1.5). Discussion: The maintenance of clinical outcomes in the postpathway cohort, while having a greater CCI, indicates the same quality of care was provided for a more medically complex patient population. With a decrease in total blood products in the postpathway group, this highlights the economic importance of perioperative optimization that can be obtained in a multidisciplinary pathway. Conclusion: Implementation of a multidisciplinary hip fracture pathway is an effective strategy for maintaining care standards for fragility hip fracture management, particularly in the setting of complex medical comorbidities.

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Physical Activity and Hip Fracture Disability: A Review

Journal of Aging Research ◽

10.4061/2011/741918 ◽

2011 ◽

Vol 2011 ◽

pp. 1-18 ◽

Cited By ~ 24

Author(s):

Ray Marks

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Hip Fracture ◽

Hip Fractures ◽

English Language ◽

Public Health Problem ◽

Fracture Prevention ◽

Activity Levels ◽

The Many ◽

Key Terms

Objective. The present paper examines pertinent literature sources published in the peer-reviewed English language between 1980 and November 1, 2010 concerning hip fractures. The aim was to highlight potential intervention points to offset the risk of incurring a hip fracture and its attendant disability.Methods. An in-depth search of the literature using the key terms: disability, epidemiology, hip fracture, prevention, and risk factors was conducted, along with data from the author's research base detailing the disability associated with selected hip fracture cases. All articles that dealt with these key topics were reviewed, and relevant data were tabulated and analyzed.Results. Hip fractures remain an important but potentially preventable public health problem. Among the many related remediable risk factors, low physical activity levels are especially important. Related determinants of suboptimal neuromuscular function also contribute significantly to hip fracture disability.Conclusion. Physical activity participation can help to reduce the prevalence and excess disability of hip fractures and should be encouraged.

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SO072INCIDENCE OF FRACTURES BEFORE AND AFTER DIALYSIS INITIATION AMONG INCIDENT DIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa139.so072 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Ken Iseri ◽

Juan Jesus Carrero ◽

Marie Evans ◽

Li Felländer-Tsai ◽

Hans Berg ◽

...

Keyword(s):

Hip Fracture ◽

Incidence Rate ◽

Hip Fractures ◽

Temporal Pattern ◽

Incidence Rates ◽

Fracture Incidence ◽

Dialysis Initiation ◽

Dialysis Patients ◽

Initiation Of Dialysis ◽

Before And After

Abstract Background and Aims The incidence of fractures is markedly higher in dialysis patients than in pre-dialysis patients, but it is not clear to what extent the initiation of dialysis as such is associated with accelerated fracture incidence or if fracture rates are already increasing prior to dialysis start among incident dialysis patients. Here we investigated the temporal pattern of occurrence of a first major osteoporotic fracture (MOF) among incident dialysis patients in the pre-dialysis period and in the period following dialysis initiation. Method We analyzed data from Swedish Renal Registry (SRR) and identified 9041 incident dialysis patients (2005 -2015; age 67 years, 67% men). We identified all first MOF (MOFfirst) in hip, spine, humerus and forearm during 12 months before and after dialysis initiation. Using flexible parametric hazard models and Fine-Gray analysis accounting for competing risk of death and renal transplantation, we estimated adjusted fracture incidence rates and predictors of MOFfirst. Results During the whole follow-up period, there were 361 fractures including 196 hip fractures. The crude incidence rate of MOFfirst (n=157) before dialysis initiation was 17/1000 patient-years and after initiation of dialysis the incidence rate of MOFfirst increased to 24/1000 patient-years. Overall the adjusted MOFfirst incidence rates increased from 6 months before initiation of dialysis, fluctuated, and stabilized at a higher rate than that of the baseline rate after 12 months. The adjusted hip fracture rate rose steeply 3 months before dialysis initiation, declined 3 months after dialysis initiation, fluctuated, and then became stabilized. On the contrary, the adjusted incidence rates of other fractures, i.e., non-hip fractures, appeared to be stable all the time, before as well as after initiation of dialysis. Female gender, higher age and previous history of MOF had a negative impact on fracture incidence rates before and after dialysis initiation. Conclusion We conclude that the incidence of MOFfirst is increasing already from 6 months prior to dialysis initiation among incident dialysis patients, and that there is a further increase following dialysis initiation. For hip fracture, which was the most common MOF, the temporal pattern of incidence rates was compressed to a high risk period lasting from 3 months before to 3 months after dialysis initiation, underlining the need of increased attention to prevent hip fractures in incident dialysis patients during this critical period.

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Recent trends in the incidence of hip fracture in Tottori Prefecture, Japan: changes over 32 years

Archives of Osteoporosis ◽

10.1007/s11657-020-00823-3 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Hiroshi Hagino ◽

Mari Osaki ◽

Reiko Okuda ◽

Shinpei Enokida ◽

Hideki Nagashima

Keyword(s):

Hip Fracture ◽

Incidence Rate ◽

Hip Fractures ◽

Trochanteric Fracture ◽

Incidence Rates ◽

Number Of Patients ◽

Neck Fracture ◽

Tottori Prefecture ◽

Changes Over Time ◽

Over Time

Abstract Summary The incidence rate of hip fracture in Tottori Prefecture tended to increase until 2018 in men, but it did not increase after 2010 in women. By type of fracture, the incidence rate of femoral neck fractures also increased over time in men, but no other changes were observed from 2010. Purpose The aims of this study were to determine the sex-, age-, and fracture-type-specific incidence rates of hip fractures in Tottori Prefecture between 2007 and 2018 and to compare the results with our past results to identify changes over time. Methods All hip fractures in people aged 35 years or older living in Tottori Prefecture were surveyed from 2007 to 2018 throughout the entire prefecture, and the age- and sex-specific incidence rates were calculated. The incidence rates from 1986 to 1988, 1992 to 1994, 1998 to 2000, and 2004 to 2006 previously reported were used for the analysis. Results In men, the age-adjusted number of patients adjusted by demographic structure based on the mean incidence rate for each 3-year period from 1986 to 2018 showed an increase in incidence over time compared with the incidence for 1986–1988 (p < 0.001). In women, the incidence rose over time compared with the incidence for 1986–1988 until 2004–2006 (p < 0.001), and no further increase was observed from 2010. The age-specific incidence rates of neck fracture in men were higher in 2010–2012 and 2016–2018 compared with 2004–2006 (p < 0.001), but those in women showed no increase with time. Those of trochanteric fracture did not change over time in either men or women. Conclusion The hip fracture incidence rate in Tottori Prefecture, Japan, tended to increase until 2018 in men, but it did not increase after 2010 in women.

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EPIDEMIOLOGY OF FRACTURES OF THE PROXIMAL FEMUR IN ELDERLY RESIDENTS OF YAKUTSK

Osteoporosis and Bone Diseases ◽

10.14341/osteo201539-12 ◽

2015 ◽

Vol 18 (3) ◽

pp. 9-12

Author(s):

V V Epanov ◽

A K Lebedev ◽

A A Epanova ◽

I P Semenov ◽

G A Palshin ◽

...

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Bone Fractures ◽

Osteoporotic Fractures ◽

Population Based ◽

Incidence Rates ◽

Fracture Incidence ◽

Hip Fracture Incidence ◽

The Republic ◽

A Minor

Bone fractures of the skeleton with a minor injury is a clinical manifestation of osteoporosis and its population-based marker. The incidence of hip fracture varies in different geographic areas and ethnic groups. The aim was to study incidence of hip fractures in patients older than 40 years in the Republic of Sakha (Yakutia, Russian federation) in 2011-2013 and to compare the data with the previous study at the same region performed in 1997-2003. Material and methods. The study is a part of a multi-center international project «Epidemiological study of osteoporotic fractures in Eurasia (EVA).» It was a retrospective study followed by a prospective one. In the retrospective part the information on hip fracture cases registered in the official documents of the orthopedic service in 2011-2012 was collected. The prospective part was conducted in 2013, it was aimed at the identification of the patients with a hip fracture, applied not only in orthopedic department but also to other medical professionals, such as general practitioners. Results. Overall, in three years 426 hip fractures were reported in the city of Yakutsk. The total number of fractures in women was 286 (67.1%), in men - 140 (32.9%). We observed the increase in hip fracture incidence in 2013 (192 cases per 100,000 population in men and 283 per 100,000 in women 50 years old and older) which was 12% higher than in 2011 and 2012. We owe it to improved registration of hip fractures in the group of women 85 years old and older. The hip fracture incidence in this study significantly exceed the data of previous study 15 years ago. Conclusion. In recent years, there is an increase in incidence rates of hip fracture in Yakutsk due to improved hospitalization rates in orthopedic service.

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Hip Protectors and their Role in Hip Fracture Prevention: A Review

McGill Journal of Medicine ◽

10.26443/mjm.v8i1.378 ◽

2020 ◽

Vol 8 (1) ◽

Author(s):

Paul David Cowling

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

English Language ◽

Elderly Population ◽

Fracture Prevention ◽

Future Research ◽

Hip Protector ◽

Hip Protectors ◽

National Healthcare ◽

Randomised Controlled

Hip fractures cause severe worldwide morbidity and loss of independence, costing national healthcare systems millions of pounds each year. The incidence is increasing with the expanding elderly population common of many Western countries. Hip protectors have been progressively studied in recent years focussing upon their use in hip fracture prevention, and compliance levels. This review aims to determine the effectiveness of protectors, and also investigates compliance levels. A search for English language Randomised Controlled Trials (RCTs) testing effectiveness of hip protectors was performed on Medline and Embase. Nine articles fulfilling the search criteria were found. Each was reviewed for hip protector effectiveness and compliance rates within the study, with results and conclusions critically-appraised. Of the nine articles, six (66.6%) found hip protectors to be effective in preventing hip fractures in selective populations. However, poor compliance rates were found in all reviewed trials. Future research should therefore focus upon improving compliance rates in the studied population.

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Epidemiology of Hip Fractures in Two Regions of Ukraine

Journal of Osteoporosis ◽

10.1155/2018/7182873 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

V. V. Povoroznyuk ◽

N. V. Grygorieva ◽

J. A. Kanis ◽

E. V. McCloskey ◽

H. Johansson ◽

...

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Long Term Care ◽

The Elderly ◽

Incidence Rates ◽

Fracture Incidence ◽

Regional Studies ◽

Term Care ◽

Younger Men

Worldwide, the number of hip fractures, the most important osteoporotic complication in the elderly, continues to increase in line with the ageing of the population. In some countries, however, including the Ukraine, data on the incidence of hip fracture are limited. This article describes the first analysis to characterize the incidence of hip fracture in the Ukrainian population from the age of 40 years. It is based on data from two regional studies, namely, the Vinnitsa city study and the STOP study, which were performed during 1997–2002 and 2011-2012 years, respectively. Hip fracture incidence rates were demonstrated to increase with increasing age. The rates were higher among younger men than women, however, with a female preponderance from the age of 65 years upwards. The incidence of hip fractures in Ukraine is 255.5 per 100,000 for women aged 50 years and older and 197.8 per 100,000 for men of the corresponding age. Overall, the incidence of hip fracture was comparable with data from neighboring countries, such as Poland and Romania. Hip fractures constitute a serious healthcare problem in Ukraine, and changes in healthcare are required to improve the management and long-term care of osteoporosis and its complications.

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HIP FRACTURES IN 5 YEARS AT HUE UNIVERSITY HOSPITAL

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2013.6.8 ◽

2014 ◽

pp. 47-50

Author(s):

Duy Binh Ho ◽

Nghi Thanh Nhan Le ◽

Maasalu Katre ◽

Koks Sulev ◽

Märtson Aare

Keyword(s):

Hip Fracture ◽

Femoral Neck ◽

Hip Fractures ◽

Age Groups ◽

Femoral Fractures ◽

Femoral Neck Fractures ◽

University Hospital ◽

High Risk Population ◽

Intertrochanteric Fractures ◽

Significant Difference

Aim: This study aimed to review the clinical findings and surgical intervention of the hip fracture at the Hue University Hospital in Vietnam. Methods:The data of proximal femoral fractures was collected retrospectively. All patients, in a period of 5 years, from Jan 2008 to December 2012, suffered either from intertrochanteric or femoral neck fractures. The numbers of patients were gathered separately for each year, by age groups (under 40, 40-49, 50-59, 60-69, 70-79, older) and by sex. We analyzed what kind of treatment options were used for the hip fracture. Results:Of 224 patients (93 men and 131 women) studied, 71% patients are over 70 years old, 103 women and 56 men (p<0.05). For patients under 40 years, there were 1 woman and 11 men (p<0.05). There were 88 intertrochanteric and 136 femoral neck fractures. There was no significant difference in the two fractures between men and women. The numbers of hip fracture increased by each year, 29/224 cases in 2010, 63/224 cases in 2011, 76/224 cases in 2012. Treatment of 88 intertrochanteric fractures: 49 cases (55.7%) of dynamic hip screw (DHS), 14 cases of hemiarthroplasty (15.9%), 2 cases of total hip replacement (2.3%). Treatment of 136 femoral neck fractures: 48 cases of total replacement (35.3%), 43 cases of hemiarthroplasty (31.6%), 15 cases of screwing (11%). In cases of 40 patients (17.9%) hip fracture was managed conservatively, 23 were femoral neck fractures and 17 were intertrochanteric fractures. Conclusions: Hip fracture is growing challenge in Hue medical university hospital. The conservative approach is still high in people who could not be operable due to severe medical conditions as well as for patients with economic difficulties. Over 70% of the hip fractures in people 70+ are caused by osteoporosis. The number of hip fracture is increasing in the following years, most likely due to the increase in the prevalence of osteoporosis. Early detection and prevention of osteoporosis should be addressed, particularly in high risk population. More aggressive surgical approach should be implemented in order to improve the quality of life in patients with hip fractures. Key words:Hip fracture.

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The effects of information platform-based nursing on preventing venous thromboembolism (VTE) in patients with hip fractures (Preprint)

10.2196/preprints.20947 ◽

2020 ◽

Author(s):

Yuan Gao ◽

Xiaojie Fu ◽

Mingxing Lei ◽

Pengbin Yin ◽

Qingmei Wang ◽

...

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Subgroup Analysis ◽

Nursing Intervention ◽

Control Group ◽

Study Group ◽

Drug Compliance ◽

Information Platform ◽

The Difference ◽

Length Of Hospitalization

BACKGROUND Mobile apps are becoming increasingly relevant to health care. Apps have been used to improve symptoms, quality of life, and adherence for oral drugs in patients with cancers, pregnancy, or chronic diseases, and the results were satisfying . OBJECTIVE This study aims to develop an information platform with the help of a mobile app and then evaluate whether information platform-based nursing can improve patient’s drug compliance and reduce the incidence of VTE in patients with hip fractures. METHODS We retrospectively analyzed hip fracture patients performed with traditional prevention and intervention of VTE (control group) between January 2008 and November 2012, and prospectively analyzed hip fracture patients conducted with nursing intervention based on the information platform (study group) between January 2016 and September 2017. The information platform can be divided into medical and nursing care end and the patient’s end. Based on the information platform, we could implement risk assessments, monitoring management and early warnings, preventions and treatments, health educations, follow-up and other aspects of nursing interventions for patients. We compared basic characteristics, outcomes including drug compliance, VTE occurrence, and mean length of hospitalization between the two groups. Besides, a subgroup analysis was performed in the study group according to different drug compliances. RESULTS Regarding baseline data, patients in the study group had more morbidities than those in the control group (P<0.05). The difference of drug compliance between the two groups was statistically significant (P<0.001): 64.7% of the patients in the control group had poor drug compliance and only 6.1% patients had poor drug compliance in the study group. In terms of VTE, 126 patients (10.7%) in the control group had VTE, while only 35 patients (7.1%) in the study group had VTE, and the difference was statistically significant (P=0.024). Moreover, the average length of hospitalization in the study group was also significantly lower than that in the control group (10.4 d vs. 13.7 d, P=0.000). Subgroup analysis of the study group showed that the incidence of VTE in patients with non-compliance, partial compliance, and good compliance was 56.7%, 5.8% and 2.8%, respectively (P=0.000). CONCLUSIONS Poor drug compliance leads to higher VTE occurrence. The information platform-based nursing can effectively improve the compliance of patients with hip fracture and thus significantly reduce the incidence of VTE.

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