From the Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT.
J Am Acad Orthop Surg Glob Res Rev. 2023 Jul 7;7(7). doi: 10.5435/JAAOSGlobal-D-23-00001. eCollection 2023 Jul 1.
Geriatric hip fractures are common and associated with high morbidity and mortality. This study aimed to evaluate the incidence, timing, and risk factors of contralateral hip fracture after initial hip fracture.
Initial hip fractures in patients older than 65 years were abstracted from the national, administrative M91Ortho PearlDiver data set. Incidence and timing of contralateral hip fractures in the following 10 years were identified. Kaplan-Meier survival analysis until contralateral hip fracture was conducted. To account for patient mortality over the later years, 2-year univariate and multivariate analyses were used to determine factors predictive of contralateral hip fracture.
Of the initial 104,311 hip fractures identified, contralateral hip fracture in the 10 years that followed was identified for 7,186 (6.9%), of which 68.4% occurred in the first 2 years. Kaplan-Meier survival analysis until contralateral fracture revealed the 10-year incidence to be 12.9% when controlling for those lost from the data set during the study period. Multivariate logistic regression revealed independent predictors of contralateral hip fracture in the 2 years after index hip fracture, when the incidence was greatest, to be female sex (odds ratio [OR] 1.15), body mass index < 20 (OR 1.30), and percutaneous pinning surgery for initial hip fracture fixation (OR 1.58) (P < 0.0001 for each).
In a national cohort of 104,311 geriatric hip fractures, Kaplan-Meier analysis for contralateral hip fracture found the 10-year incidence to be 12.9%, of which nearly 70% were in the first 2 years, and predisposing factors were defined. As such, future research should aim to identify the cause and mitigate the risk of secondary contralateral hip fractures in geriatric patients.
老年髋部骨折很常见，且与高发病率和高死亡率相关。本研究旨在评估初次髋部骨折后对侧髋部骨折的发生率、时间和危险因素。
从全国性的行政 M91Ortho PearlDiver 数据集中提取年龄大于 65 岁的初次髋部骨折患者。确定接下来 10 年内对侧髋部骨折的发生率和时间。进行 Kaplan-Meier 生存分析，直到发生对侧髋部骨折。为了考虑患者在后期的死亡率，使用单变量和多变量分析在接下来的 2 年确定对侧髋部骨折的预测因素。
在所确定的 104311 例初次髋部骨折中，在随后的 10 年内发现了 7186 例（6.9%）对侧髋部骨折，其中 68.4%发生在最初的 2 年内。Kaplan-Meier 生存分析直到对侧骨折显示，在控制研究期间从数据集中丢失的患者后，10 年的发生率为 12.9%。多变量逻辑回归显示，在初次髋部骨折后 2 年对侧髋部骨折的独立预测因素为女性（比值比[OR] 1.15）、体重指数<20（OR 1.30）和经皮钢针内固定初次髋部骨折（OR 1.58）（均 P < 0.0001）。
在一项全国性的 104311 例老年髋部骨折队列中，Kaplan-Meier 分析对侧髋部骨折的 10 年发生率为 12.9%，其中近 70%发生在最初的 2 年内，并确定了易患因素。因此，未来的研究应旨在确定老年患者继发性对侧髋部骨折的原因并降低其风险。
