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Cervical hip fractures do not occur in arthrotic joints. A clinicoradiographic study of 256 patients
E K Dretakis1, K A Steriopoulos, G M Kontakis
1Department of Orthopaedics-Traumatology, University General Hospital, Crete, Greece.
Insights
Elderly individuals with fully mobile hip joints and normal knees are more prone to cervical hip fractures than trochanteric fractures after a fall. These endogenic factors are crucial for fracture type determination.
Area of Science:
- Orthopedics
- Geriatric Medicine
- Biomedical Engineering
Background:
- Cervical hip fractures are common in the elderly, often resulting from falls.
- Understanding endogenic factors can help predict fracture type and inform prevention strategies.
Purpose of the Study:
- To investigate intrinsic patient factors associated with cervical hip fractures.
- To compare endogenic factors in patients with cervical versus trochanteric hip fractures.
Main Methods:
- Retrospective study of 256 patients with hip fractures (230 cervical, 26 other).
- Clinical and radiographic assessment of hip and ipsilateral knee condition.
- Evaluation of pre-fracture mobility levels.
- Comparison of 100 cervical fracture patients with 100 age- and sex-matched trochanteric fracture patients.
Main Results:
- All patients with cervical fractures had macroscopically normal hip joints and no radiographic evidence of arthrosis.
- 64% of patients were fully mobile pre-fracture; 34% used a cane.
- 88% had normal ipsilateral knees; 12% had moderate arthrosis.
- A normal hip joint was essential for cervical fractures; normal knees and high mobility were significant contributing factors compared to trochanteric fractures.
Conclusions:
- Pre-fracture mobility, normal ipsilateral knee, and a healthy hip joint are key endogenic factors differentiating cervical from trochanteric hip fractures in the elderly.
- These findings highlight the importance of assessing patient-specific factors beyond the fall mechanism.
Abstract:
We studied endogenic factors for the occurrence of cervical hip fractures in 256 patients. 230 underwent hemiarthroplasty, and 26 were treated with internal fixation or without surgery. The condition of the fractured hip and of the ipsilateral knee, as well as the mobility of the patient before the fracture, were studied in all 256 patients. The removed femoral heads were examined, photographed and radiographs were taken with sensitive film. The acetabulum and the femoral head were macroscopically normal in all 230 cases and there was no radiographic evidence of arthrosis. 64% of the patients were fully mobile before the fracture, 34% were mobile with the aid of a cane and 2% were dependent. In 88%, the ipsilateral knee was normal both clinically and radiographically, and in 12%, there was moderate arthrosis. When comparing the mobility before the fracture and the condition of the ipsilateral hip and knee in 100 patients having a cervical fracture with 100 patients having a trochanteric fracture matched for age and sex, we found that a normal hip joint was sine qua non while a normal ipsilateral knee and a fully mobile individual were important additional conditions for the occurrence of a cervical hip fracture, instead of a trochanteric one, after a fall in an elderly person.