Characteristics of proximal femoral fractures

Características de las fracturas de fémur proximal

Introduction: Hip fractures may occur in the femoral head, neck or intertrocantheric line. Treatment is based on, type and location of the fracture and patient’s age and comorbidities.
Objective: To describe hip fracture characteristics and risk factors in patients seen at Hospital de San José of Bogotá between January 2014 and June 2016.
Methods: A case series study. Adults with primary fractures and a complete medical record were included. Those with prior surgical management of ipsilateral proximal femoral and pathologic fractures were excluded. Data collection was based on clinical records.
Results: 96 patients were included, 66.7% females, mean age 81 years (IQR 29 – 93 years), and comorbidities such as hypertension (58.3%), coronary artery disease (16.7%), diabetes mellitus (8.3%), tobacco smoking (9.4%), Alzheimer’s (14.6%) and osteoporosis (4.2%) present in 69.8%. Intertrochanteric fracture (69.8%) caused by a fall from own height (93.8%) was the commonest fracture. The most widely used treatment was fixation (50%) followed by arthroplasty (43.8%). Osteosynthesis by an intramedullary long proximal femoral nail was the most common fixation method used (77.1%). Major complications were postoperative mortality (5.2%), component loosening and reoperations (3.1%), pressure ulcers, pneumonia, pulmonary thromboembolism and periprosthetic fractures in 2.1%.
Conclusions: Hip fractures associated with significant morbidity and mortality are common in elders. It is essential to provide timely treatment and to count on prevention programs regarding this pathology.

1. Rüedi TP, Murphy WM. AO principles of fracture management. Stuttgart; New York; Davos Platz [Switzerland]: Thieme; AO Pub.; 2007.

2. Koval KJ, López-Durán Stern L. Fracturas femorales en el anciano. Madrid: Editorial SECOT; 2013.

3. Centers for Disease Control and Prevention. CDC recommendations regarding selected conditions affecting women’s health. Inside: Continuing Education Examination. Atlanta: Centers for Disease Control and Prevention (CDC). Department of Health and Human Services; 2000. p. 74.

4. Grisso JA, Kelsey JL, Strom BL, Chiu GY, Maislin G, O’Brien LA, et al., The Northeast Hip Fracture Study Group. Risk factors for falls as a cause of hip fracture in women. N Engl J Med. 1991;324:1326–31.

5. Melton LJ 3rd, Thamer M, Ray NF, Chan JK, Chesnut CH 3rd, Einhorn TA, et al. Fractures attributable to osteoporosis: Report from the National Osteoporosis Foundation Journal of bone and mineral research. J Bone Miner Res. 1997;12:16–23. Epub 1997/01/01.

6. Ardila E, Guzmán M, Cristancho P, Méndez L, Puig A, Medina F, et al. Características de las fracturas de cadera: a propósito del análisis de historias clínicas en tres hospitales universitarios colombianos. Rev Metab Óseo Min. 2004;2:155–60.

7. Carmona F. Osteoporosis en Santa Fe de Bogotá. Colombia: Instituto Nacional de Salud; 1999.

8. Valles Figueroa JFJ, Malacara Becerra M, Mont Landerreche GG, Suárez Ahedo CE, Cárdenas Elizondo JL. Tratamiento quirúrgico de las fracturas de cadera. Acta Ortop Mex. 2010;24:242–7.

9. Riggs BL, Melton LJ. The worldwide problem of osteoporosis: Insights afforded by epidemiology. Bone. 1995;17 5 Suppl:11S–505S.

10. Stevens JA, Olson S. Reducing falls and resulting hip fractures among older women. MMWR Recomm Rep. 2000;49(RR-2):3–12.

11. Kannus P, Parkkari J, Sievänen H, Heinonen A, Vuori I, Järvinen M. Epidemiology of hip fractures. Bone. 1996;18 1 Suppl:57S–63S.

12. Benítez Herrera A, Romero Y, Enrique L, Ramírez Aguera PJ, Rodríguez Aguera E. Fracturas trocantéricas: tratamiento de urgencia con el sistema AO. Rev Cuba Ortop Traumatol. 1993;7(1/2):24–9.

13. Parker MJ, Myles JW, Anand JK, Drewett R. Cost-benefit analysis of hip fracture treatment. J Bone Joint Surg Br. 1992;74:261–4.

14. Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: Prospective observational cohort study. BMJ. 2005;331:1374. Epub 2005/11/22.

15. Garden RS. Reduction and fixation of subcapital fractures of the femur. Orthop Clin North Am. 1974;5:683–712.

16. Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. J Bone Joint Surg Am. 1979;61:216–21.

17. Kamel HK, Hussain MS, Tariq S, Perry HM, Morley JE. Failure to diagnose and treat osteoporosis in elderly patients hospitalized with hip fracture. Am J Med. 2000;109:326–8.

18. Morelo L, Cano C. Caracterit́icas de las fracturas de cadera en pacientes ancianos del Hospital Universitario de San Ignacio, seguimiento a un an ̃o. Rev Asoc Colomb Gerontol Geriatr. 2001;15:299–306.