Survival and functional outcome according to hip fracture type: A one-year prospective cohort study in elderly women with an intertrochanteric or femoral neck fracture
Introduction
Hip fractures are classified according to the anatomic location of fracture into fractures of the femoral neck (cervical, intracapsular) or intertrochanteric (extracapsular) regions [38], [46]. However, most survival studies in hip fracture patients have not analyzed these different fracture types separately [7], [9], [13], [21], [22], [23], [33], [35], [39], [47], [48]. In those survival studies that did focus on fracture type, women with an intertrochanteric fracture were found to be almost twice as likely to die than those with a femoral neck fracture [1], [3], [6], [8], [12], [15], [24], [25], [29], [34], [43], [45], [49], but it remains unclear if and to what extent these differences in mortality might be due to differences in comorbidity.
Data on potential differences in long-term functional outcome between both hip fracture types are even more sparse and conflicting, with some studies reporting less functional recovery 1 year after injury among patients with an intertrochanteric fracture [24] and other studies reporting similar functional outcomes [3], [15], [26], [28], [36], [37], [45]. Moreover, differences in baseline characteristics between intertrochanteric and femoral neck fracture patients in these studies make it difficult to interpret these results. More specifically, differences in age and comorbidity – known determinants of mortality and functional outcome after hip fracture [5] – may have confounded the results.
In a one-year prospective cohort study conducted among unselected, consecutively recruited elderly women with a first hip fracture [4], [5], [17], we observed no differences in age and pre-fracture comorbidities between our patients with an intertrochanteric or a femoral neck fracture. In this regard, this cohort provides an opportunity to address the question as to whether mortality and functional outcome are affected directly by hip fracture type.
Section snippets
Study design and source of study population
The current paper is based on a large observational study undertaken between November 1995 and July 1996 with the aim to collect data on risk factors for hip fracture, current surgical practice, mortality, clinical outcome, and costs of care after hip fractures in women aged 50 years and older. A detailed description of the study design, recruitment strategy, participant characteristics, outcome assessment, and statistical analysis has been previously published [4], [5], [17].
Briefly, at four
Participants’ characteristics
All eligibility criteria were met by a total of 184 hip fracture patients, of which 170 (92.4%) accepted to participate. Patients or their relatives who declined to participate typically did so because they did not want to participate in a long-term study. Of the 170 women originally enrolled, 84 (49%) and 86 (51%) women had a femoral neck fracture or an intertrochanteric fracture, respectively, with a corresponding ratio of femoral neck to intertrochanteric fracture patients of 0.98.
Table 1
Discussion
Our findings provide evidence that mortality and functional outcome following a hip fracture vary according to fracture type. At hospital discharge, women who sustained an intertrochanteric hip fracture had a higher mortality and were less able to walk independently than women with a femoral neck fracture. One year later, mortality was still higher after intertrochanteric fracture, but functional outcome among surviving patients was not different between both groups.
An increase in mortality in
Acknowledgments
We are indebted to the participating women and their families. We would also like to thank Health Management Creative (Brussels) for the professional way they ensured the interviews and the follow-up of patients.
S. Boonen and D. Vanderschueren are both Senior Clinical Investigator of the Fund for Scientific Research-Flanders, Belgium (F.W.O.-Vlaanderen) and holders of the Leuven University Chair in Metabolic Bone Diseases, supported by Roche & GSK.
This paper was selected for oral presentation
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All members of the study group are listed in the Acknowledgments section.