Every second of every day, an older adult falls.* Hip fractures are one of the most serious injuries resulting from falls among elderly patients. Each year, more than 300,000 elderly patients ages 65 and older are hospitalized for hip fractures.† Of these fractures, 95 percent are a result of a same-level fall that usually occurs by falling sideways. Almost three-quarters of hip fractures occur in women, although the chance of breaking one’s hip, regardless of gender, increases with age.† These fractures often lead to a loss of physical independence and lower quality of life.
The proximal femur comprises the femoral head, the femoral neck, and the trochanteric region, which includes the greater and lesser trochanters. Three types of hip fractures occur in the trochanteric region. The first type is an intertrochanteric fracture that occurs between the greater and lesser trochanter; the second type is a sub-trochanteric fracture that occurs distal to the trochanters; and the third type of fracture is proximal to the trochanters, called a femoral neck fracture. The femoral neck has a fragile vascular supply and, therefore, is susceptible to poor outcomes of avascular necrosis and nonunion.‡
Age is a key factor
Patients with femoral neck fractures fall into one of two evidence-based groups based on their physiologic, rather than their chronologic, age. The “young” patients often sustain injuries as a result of high-energy mechanisms. These young patients may have associated traumatic injuries but have strong physiologic reserves and few comorbidities. Furthermore, their bones can tolerate internal fixation.
On the other side of the spectrum are the “old” or “elderly” patients, who sustain femoral neck fractures as a result of low-energy trauma (same-level falls). These elderly patients present with isolated injuries and have fewer functional demands, poor bone quality, multiple medical comorbidities, and decreased functional reserve. This group is more likely to require a hip arthroplasty (replacement).‡
To examine the occurrence of femoral neck fractures, medical records contained in the National Trauma Data Bank® (NTDB®) research dataset for admission year 2015 were searched using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Specifically searched were records that included a diagnosis code of 820 (fracture of neck of femur).
A total of 67,094 records were found, of which 62,312 contained a discharge status, including 14,859 patients discharged to home, 14,798 to acute care/rehab, and 30,811 sent to skilled nursing facilities; 1,844 died. Of these patients, 62 percent were women, on average 73.6 years of age, had an average hospital length of stay of 6.6 days, an intensive care unit length of stay of 5.4 days, an average injury severity score of 10.5, and were on the ventilator for an average of 5.9 days. Of those tested for alcohol, almost 28 percent (2,447 out of 8,863) tested positive. Most of these injuries (61 percent) occurred in the home and only a minority of patients (approximately one-quarter) were discharged to home (see Figure 1).
Figure 1. Hospital discharge status
Helping patients avoid hip fractures
Elderly adults can avoid hip fractures by taking a few precautions. First, they should take steps to strengthen their bones and prevent falls. This patient group should also ask their physicians to review their medications to see if any may result in sleepiness or dizziness, assess for possible Vitamin D deficiencies, and screen for osteoporosis. Patients should have their vision checked annually.
Elderly patients should be encouraged to make their home safer by eliminating items that could produce a fall, such as loose throw rugs, and by adding grab bars around the tub, shower, and toilet. Installing railings on both sides of all stairs is a great precautionary measure, as is ensuring the living space features adequate lighting. After all, no one wants to fall and break one’s (femoral) neck.
Throughout the year, we will be highlighting these data through brief monthly reports in the Bulletin. The NTDB Annual Report 2016 is available on the American College of Surgeon’s website. In addition, information is available on our website about how to obtain NTDB data for more detailed study. If you are interested in submitting your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at firstname.lastname@example.org.
Statistical support for this article was provided by Chrystal Caden-Price, Data Analyst, NTDB.
*Centers for Disease Control and Prevention. STEADI [Stopping Elderly Accidents, Deaths, & Injuries] materials for your older patient. Available at: www.cdc.gov/steadi/patient.html. Accessed March 28, 2017.
†Centers for Disease Control and Prevention. Hip fractures among older adults. Available at: www.cdc.gov/homeandrecreationalsafety/falls/adulthipfx.html. Accessed March 24, 2017.
‡Forsh DA, Ferguson TA. Contemporary management of femoral neck fractures: The young and the old. Curr Rev Musculoskelet Med. 2012;5(3):214-221.