Elsevier

Injury

Volume 47, Issue 10, October 2016, Pages 2182-2188
Injury

Twelve-month mortality and functional outcomes in hip fracture patients under 65 years of age

https://doi.org/10.1016/j.injury.2016.05.033Get rights and content

Abstract

Introduction

There has been a recent call for improved functional outcome reporting in younger hip fracture patients. Younger hip fracture patients represent a different population with different functional goals to their older counterparts. Therefore, previous research on mortality and functional outcomes in hip fracture patients may not be generalisable to the younger population. The aims of this study were to report 12-month survival and functional outcomes in hip fracture patients aged <65 years and predictors of functional outcome.

Methods

Hip fracture patients aged <65 years (range 17–64) registered by the Victorian Orthopaedic Trauma Outcomes Registry over four years were included and their 12-month survival and functional outcomes (Extended Glasgow Outcome Scale) reported. Ordered multivariable logistic regression was used to identify predictors of higher function.

Results

There were 507 patients enrolled in the study and of the 447 patients (88%) with 12-month outcomes, 24 (5%) had died. The majority of patients had no comorbidities or pre-injury disability and were injured via road trauma or low falls. 40% of patients sustained additional injuries to their hip fracture. 23% of patients had fully recovered at 12 months and 39% reported ongoing moderate disability. After adjusting for all key variables, odds of better function 12-months post-fracture were reduced for patients with co-morbidities, previous disability or additional injuries, those receiving compensation or injured via low falls.

Conclusions

While 12-month survival rates were satisfactory in hip fracture patients aged under 65 years, their functional outcomes were poor, with less than one quarter having fully recovered 12 months following injury. This study provides new information about which patients may have difficulty returning to their pre-injury level of function. These patients may require additional or more intensive post-discharge care in order to fulfil their functional goals and continue to contribute productively to society.

Introduction

Hip fracture is a significant injury, associated with an increased risk of mortality, loss of mobility and reduced quality of life [1], [2]. In Australia, 91.3 people per 100,000 population are hospitalised due to hip fracture each year, with 91 per cent occurring in people aged 65 years and over [3]. Considering the frequency of hip fractures in the elderly, it is understandable that most research up until now has focussed on this population [4]. However, with an increased risk of fracture healing complications and significant lifelong functional impairment, analysing the outcomes of younger hip fracture patients is warranted [5], [6].

Younger hip fracture patients represent a different population to older hip fracture patients, with the majority being injured as a result of high energy trauma rather than falls [7]. They are also more likely to survive their hip fractures and have different functional recovery goals to older patients [8]. Therefore, previous research focussing on the outcomes of elderly hip fracture patients is unlikely to be generalisable to the younger population, and it has been acknowledged that there is a critical need for studies reporting outcomes in the younger patient subgroup [6]. In particular, a recent review of research on younger hip fracture patients (aged 15–60) identified a clear gap in the literature of studies including patient-reported functional outcomes, with the majority of previous research focussing on short-term clinical outcomes and mobility alone [6].

Hip fracture can have a detrimental effect on many different aspects of function, including mobility, work, leisure and social function and all of these can impact upon a patient’s quality of life [9]. Being able to capture these multiple dimensions of function is particularly important for younger patients, who may have increased functional demands and more active lifestyles than elderly hip fracture patients, and can provide an indication of the full extent of recovery expected.

The aims of this study were to i) describe the 12-month survival and functional outcomes in hip fracture patients aged <65 years of age; and ii) determine predictors of functional outcome in this population 12 months after hip fracture.

Section snippets

Setting

The Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) is a comprehensive monitoring system for orthopaedic trauma in Victoria, Australia and one of very few registries in the world to routinely measure long-term functional outcomes of hip fracture patients [10]. The registry captures data about all adult patients (aged ≥16 years) with an orthopaedic emergency admission (>24 h) to four hospitals in Victoria, Australia: one regional trauma centre, one metropolitan trauma centre and the two

Profile of patients

From July 2009 to June 2013, there were 3607 hip fracture cases recorded in the VOTOR dataset representing 16% of all VOTOR patients. The flow of patients through the study is presented in Fig. 1. A total of 507 patients (14%) were aged under 65 years and 447 of these patients (88%) were followed up at 12 months. At 12 months post-injury, 24 of these patients (5%) had died, seven before discharge from their initial hospitalisation and 17 in the 12 months following discharge from hospital. There

Discussion

Younger hip fracture patients are a small, but important subgroup within the wider hip fracture population. This study reported the 12-month survival and functional outcomes, and predictors of functional outcome in hip fracture patients aged under 65 years of age. Patients in this study were distinctly different from the usual cohort of hip fracture patients, who are older, mainly female, often frail with multiple comorbidities, and most commonly injured by falling [24].

The proportion of

Conclusions

While 12-month survival rates were satisfactory in hip fracture patients aged under 65 years, their functional outcomes were poor, with less than one quarter having fully recovered 12 months following injury. Patients who are at risk of a poor functional outcome are those who have co-morbidities, previous disability or additional injuries, are receiving compensation or are injured via a low fall. These patients may require more intensive rehabilitation or a more graded approach to therapy in

Conflict of interest

The authors of this manuscript certify that they have NO affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or

Acknowledgements:

Melissa Hart, Sue McLellan, Adrian Buzgau, David Attwood and the Steering Committee of VOTOR are thanked for their assistance with this project. The Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) is funded by the Transport Accident Commission via the Institute for Safety, Compensation and Recovery Research (ISCRR). Christina Ekegren is supported by a National Health and Medical Research Council of Australia Early Career Fellowship (GNT1106633). Belinda Gabbe was supported by a National

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