Varieur Benjamin M, White Ryan C, Schmitt Daniel R, Brown Nicholas M
Loyola University Chicago Stritch School of Medicine, 2160 S 1st Ave, Maywood, IL, 60153, USA.
Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL, 60153, USA.
J Orthop. 2024 Oct 11;62:7-12. doi: 10.1016/j.jor.2024.10.016. eCollection 2025 Apr.
AIMS & OBJECTIVES: Hip fractures lead to significant morbidity, mortality, and healthcare costs, particularly in elderly populations. Understanding the mechanisms underlying these fractures is crucial for developing targeted prevention strategies and counseling patients.
The National Electronic Injury Surveillance System (NEISS) was utilized to identify a cohort of 25,068 hip fractures from 2013 to 2022. The inclusion criteria mandated classification as a lower trunk fracture and explicit mention of hip fracture in the narrative. Patient age, race, sex, incident location, the time of year, and associated consumer products were compared using 95% confidence intervals and Chi-Squared tests of independence.
A total of 25,068 hip fracture patients were included in this study. Females were more likely to fracture their hip (P < .001) representing 68.4% (95% CI 67.8%-69.0%) of all fractures. Patients were most likely to injure themselves at home (P < .001), accounting for 62.0 % (95% CI 61.4%-62.6%) of fractures. Falls to the floor represented 36.0 % (95% CI 35.4%-36.6%) of fractures, while fractures related to beds, stairs, and chairs emerged as other prevalent mechanisms at 11.2% (95% CI 10.8%-11.6%), 7.9% (95% CI 7.5%-8.2%), and 5.4% (95% CI 5.1%-5.7%), respectively. In the 50-60 age group, stairs present a prominent risk, representing 12.4% (95% CI 10.6%-14.5%) of fractures. Younger individuals suffered fractures most commonly due to high energy activities, such as falls from ladders, bicycles, and stairs (P < .001).
While falls remain the chief cause of hip fractures, many of these injuries stem from overlooked mechanisms. The heightened risk associated with falls from beds and chairs in the elderly, stair-related injuries in middle-aged individuals, and high-force modalities in younger people, highlights the necessity for tailored preventive measures. Providers should counsel their patients on risk reduction measures within the home, while Medicare and other insurers must work to expand coverage for these same measures.
髋部骨折会导致严重的发病情况、死亡率和医疗成本，尤其是在老年人群体中。了解这些骨折背后的机制对于制定针对性的预防策略和为患者提供咨询至关重要。
利用国家电子伤害监测系统（NEISS）确定了2013年至2022年期间的25068例髋部骨折病例队列。纳入标准要求分类为下躯干骨折且在叙述中明确提及髋部骨折。使用95%置信区间和卡方独立性检验对患者年龄、种族、性别、受伤地点、年份以及相关消费品进行比较。
本研究共纳入25068例髋部骨折患者。女性髋部骨折的可能性更大（P <.001），占所有骨折的68.4%（95%置信区间67.8% - 69.0%）。患者最有可能在家中受伤（P <.001），占骨折的62.0%（95%置信区间61.4% - 62.6%）。摔倒在地占骨折的36.0%（95%置信区间35.4% - 36.6%），而与床、楼梯和椅子相关的骨折分别占其他常见机制的11.2%（95%置信区间10.8% - 11.6%）、7.9%（95%置信区间7.5% - 8.2%）和5.4%（95%置信区间5.1% - 5.7%）。在50 - 60岁年龄组中，楼梯是一个突出的风险因素，占骨折的12.4%（95%置信区间10.6% - 14.5%）。较年轻的个体最常因高能量活动导致骨折，如从梯子、自行车和楼梯上摔倒（P <.001）。
虽然摔倒仍然是髋部骨折的主要原因，但许多此类损伤源于被忽视的机制。老年人从床和椅子上摔倒相关的风险增加、中年人与楼梯相关的损伤以及年轻人的高冲击力方式，凸显了采取针对性预防措施的必要性。医疗服务提供者应就家庭内的风险降低措施向患者提供咨询，而医疗保险和其他保险公司必须努力扩大对这些相同措施的覆盖范围。
