Epidemiology of hip fractures among the elderly. Risk factors for fracture type.

A study was undertaken in September 1988 of 169 patients who were > 50 years of age receiving care for hip fractures at 4 university-affiliated hospitals during a 2-year period. Demographics, medical history, cognitive function, mobility, and environmental factors surrounding the hip fractures were ascertained by patient or proxy interview and review of medical records. These were then related to the type and severity of hip fracture. Eighty-three (49%) patients had intertrochanteric fractures, 23 (14%) had subtrochanteric fractures, and 63 (37%) had intracapsular fractures. Walking versus standing, sitting, or getting up at the time of fracture (relative odds = 3.2, p = .041), and no mobility difficulty versus some mobility difficulty (relative odds = 5.2, p = .047) were associated with increased comminution in intertrochanteric or subtrochanteric fractures. The location of the fracture occurrence (indoor versus outdoors) was associated with greater displacement in intracapsular fractures (relative odds = 6.7, p = 0.021). Only 2 of 169 patients had spontaneous hip fractures, defined as hip pain that preceded the fall. Because spontaneous fractures are rare, efforts directed toward preventing falls would be expected to decrease the incidence of hip fractures. Future possibilities include the development of protective garments that can reduce impact loading to the hip during a fall.