Displaced intracapuslar hip fractures in the working age alcohol-abusing patient

Management of alcohol-abusing patients presenting with intracapsular hip fractures is controversial. The aim of this study was to compare the management and outcome of working-age alcohol-abusing patients with similar-aged controls. Patients were identified from a prospectively collected database of trauma admissions. Full case notes were available for 78 patients under 65 of age presenting with a displaced intacapsular fracture at a teaching hospital between 1998 and 2002. Thirty seven patients had evidence of alcohol abuse. Alcohol-abusing patients presented to hospital later (p = 0.05), underwent surgery a median of 18 hours later (p = 0.011) and required a longer post operative stay (p = 0.003) compared to non-abusers. Despite this, the results of internal fixation were comparable. There was no significant difference between alcohol-abusers and non-abusers in rates of avascular necrosis (6.9% vs 9.7%; odds ratio 0.69, 0.11-4.47) or revision surgery (0.21 vs 0.10 procedures/ patient; odds ratio 1.49, 0.30-7.33). The high rates of alcohol abuse in this low-velocity trauma population suggest such patients are at increased risk of osteoporosis. Routine screening for osteoporosis should be considered in working-age alcohol abusers. After subcapital fracture, reduction and internal fixation is an acceptable treatment in this sub-group of patients.