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Age-related hip fractures in men: clinical spectrum and short-term outcomes
G Poór1, E J Atkinson, D G Lewallen
1Department of Health Science Research, Mayo Clinic, Rochester, Minnesota 55905, USA.
Abstract:
Clinical spectrum, treatment and short-term outcomes were assessed among the 131 Rochester, Minnesota, men who contracted an initial hip fracture due to moderate trauma during 1978-89. Three-fourths of falls leading to hip fracture occurred indoors with little seasonality, and 91% of fractures were in men 65 years of age or older. The ratio of cervical to intertrochanteric femur fractures was 1.4:1, and there was a tendency toward more neurological conditions among the patients with cervical fractures. Hemiarthroplasty and total hip replacement were mostly performed for cervical fractures, while internal fixation was preferred for intertrochanteric fractures. In-hospital mortality was 11.5%, and the 30-day case fatality rate was 16.0%. Age and postoperative deterioration of mental status significantly increased the risk of early death, the latter even after adjustment in a multivariate model, while comorbidity had a suggestive but not statistically significant influence on mortality. More than half the men were discharged to nursing homes, and 79% of the patients who survived at 1 year resided in nursing homes or intermediate care facilities or were attended by home care. Only 41% of survivors recovered their prefracture level of functioning and nearly 60% of patients limped and required a cane or walker. After implementation of the prospective payment system in 1984, the length of hospital stay was reduced, but there was no change in early mortality rates, in the duration of physical therapy following fracture or in attendance at nursing homes. The results of this population-based study demonstrate the strong impact of hip fractures on short-term outcomes in men.
Insights
Hip fractures in men over 65, often from indoor falls, lead to significant disability and high mortality rates. Post-fracture care impacts long-term functioning and facility dependence, highlighting the severe consequences of these injuries.
Area of Science:
- Geriatric Medicine
- Orthopedic Surgery
- Public Health
Background:
- Hip fractures are a significant health concern in elderly men.
- Moderate trauma is a common cause of hip fractures in this demographic.
- Understanding the clinical spectrum and outcomes is crucial for patient care.
Purpose of the Study:
- To assess the clinical spectrum, treatment, and short-term outcomes of hip fractures in men.
- To identify risk factors for early mortality after hip fracture.
- To evaluate the impact of healthcare policy changes on hip fracture outcomes.
Main Methods:
- Population-based study of 131 men with initial hip fractures from moderate trauma (1978-1989) in Rochester, Minnesota.
- Analysis of fracture types (cervical vs. intertrochanteric), treatments, and in-hospital/30-day mortality.
- Evaluation of functional recovery, discharge destinations, and impact of the prospective payment system.
Main Results:
- 91% of fractures occurred in men aged 65+, with falls predominantly indoors.
- In-hospital mortality was 11.5%, and 30-day fatality was 16.0%. Age and mental status deterioration were key mortality predictors.
- Over half of men went to nursing homes; only 41% regained prefracture function, with many requiring mobility aids.
Conclusions:
- Hip fractures in men have a profound impact on short-term outcomes, including high mortality and functional decline.
- Postoperative mental status is a critical factor influencing early death risk.
- Despite healthcare system changes, significant challenges remain in recovery and long-term care for male hip fracture patients.