Email updates

Keep up to date with the latest news and content from Journal of Trauma Management & Outcomes and BioMed Central.

Open Access Research

Clinical profiles and risk factors for outcomes in older patients with cervical and trochanteric hip fracture: similarities and differences

Alexander A Fisher13*, Wichat Srikusalanukul13, Michael W Davis13 and Paul N Smith23

Author Affiliations

1 Department of Geriatric Medicine, The Canberra Hospital, PO Box 11, Woden, ACT 2606, Australia

2 Department of Orthopaedic Surgery, The Canberra Hospital, PO Box 11, Woden, ACT 2606, Australia

3 The Canberra Hospital, Australian National University Medical School, Canberra, ACT 2606, Australia

For all author emails, please log on.

Journal of Trauma Management & Outcomes 2012, 6:2  doi:10.1186/1752-2897-6-2

Published: 15 February 2012

Abstract

Background

Data on clinical characteristics and outcomes in regard to hip fracture (HF) type are controversial. This study aimed to evaluate whether clinical and laboratory predictors of poorer outcomes differ by HF type.

Methods

Prospective evaluation of 761 consecutively admitted patients (mean age 82.3 ± 8.8 years; 74.9% women) with low-trauma non-pathological HF. Clinical characteristics and short-term outcomes were recorded. Haematological, renal, liver and thyroid status, C-reactive protein, cardiac troponin I, serum 25(OH) vitamin D, PTH, leptin, adiponectin and resistin were determined.

Results

The cervical compared to the tronchanteric HF group was younger, have higher mean haemoglobin, albumin, adiponectin and resistin and lower PTH levels (all P < 0.05). In-hospital mortality, length of hospital stay (LOS), incidence of post-operative myocardial injury and need of institutionalisation were similar in both groups. Multivariate analysis revealed as independent predictors for in-hospital death in patient with cervical HF male sex, hyperparathyroidism and lower leptin levels, while in patients with trochanteric HF only hyperparathyroidism; for post-operative myocardial injury dementia, smoking and renal impairment in the former group and coronary artery disease (CAD), hyperparathyroidism and hypoleptinaemia in the latter; for LOS > 20 days CAD, and age > 75 years and hyperparathyroidism, respectively. Need of institutionalisation was predicted by age > 75 years and dementia in both groups and also by hypovitaminosis D in the cervical and by hyperparathyroidism in the trochanteric HF.

Conclusions

Clinical characteristics and incidence of poorer short-term outcomes in the two main HF types are rather similar but risk factors for certain outcomes are site-specific reflecting differences in underlying mechanisms.

Keywords:
Hip fracture type; Clinical characteristics; Predictors of outcomes