Diabetes mellitus and hip fracture: a study of 5966 cases

Diabetes mellitus, and especially type II diabetes, is a widespread and increasing problem in the western world due to the high rates of obesity. It has also been shown in previous studies that diabetics have impaired fracture healing. The aim of this study was to see exactly what role diabetes plays in hip fracture because it is a partially modifiable disease, and to see whether there are any changes that we could make to our practice to improve patient outcome.

We analysed the characteristics and outcomes for 477 hip fracture patients who were known to be diabetic at the time of admission, against 5489 non-diabetic hip fracture patients.

At the time of admission the diabetic patients were more likely to be using walking aids [268/477 (56%) versus 2455/5489 (45%), p<0.0001], have a more restricted walking ability and a higher mean ASA grade (2.9 versus 2.6, p<0.0001). Diabetics patients were more likely to develop cardiac post-operative complications [26/477 (5.5%) versus 146/5489 (2.7%), p=0.0008] and to develop pressure ulcers [34/477 (7.1%) versus 171/5489 (3.1%), p<0.0001]. Hospital stay was increased for those with diabetes (25 days versus 21 days, p 0.006). No difference in surgical complications was seen between groups. At one year, recovery of function was similar for diabetic patients compared to those without diabetes.

These findings show diabetics are at an increased risk of specific complications and have a longer length of hospital stay but generally make a normal recovery thereafter.