Functional recovery following a second hip fracture.
OBJECTIVE
Patients who have a fracture of the hip, usually are considered at a risk of fracturing the contralateral hip. This risk, not sufficiently addressed to in literature, becomes increasingly important in the light of increasing longevity of the population. In this retrospective study, we present some of our epidemiological and post-operative data on limb function in a group of our patients.


METHODS
We examined the database of our patients over 50 years of age, admitted at our hospital in the last 9 years for fracture of the proximal third part of the femur bone. These patients did not have a history of neoplasms or severe multitrauma. The variables considered were: unilateral or bilateral fracture, age, sex, the level of physical activity before trauma (MET scale), the severity of the trauma, fracture site (cervical or trochanteric), the type of surgery and the level of functional autonomy (FIM scale) at time of discharge.


RESULTS
A total of 2 771 patients were identified. Bilateral fractures were present in 7.58% (n=210). Among bilateral fractures, the female to male ratio was 1 to 7.08 and the site of the contralateral fracture remained similar to the original site. In more than 48%, the second fracture occurred in patients over 85 years of age. The most common causes of both bilateral and mono lateral fractures, were either a moderate trauma or a fall in domestic premises. Cervical fractures were treated with cemented endoprothesis of the hip while for trochanteric fractures osteosyntesis with endomedullar nails were used. After the second fracture, the level of functional autonomy was found to be significantly reduced (FIM score mean difference +/-SD of 16.77+/-10.72) and the number of non deambulatory patients were tripled. Furthermore, these patients were found to be more sedentary, before the second fracture, as compared to the ones with only one fracture.


CONCLUSIONS
Bilateral fractures of the femur neck bone is still considered to be a rare event. The second fracture seems to be more frequent in sedentary women over 85 years of age. More often, the second fracture is caused by a simple domestic accident. Due the increasing age of the population, in future this event might become statistically relevant. The drastic decrease in post-operative functional autonomy in such patients might become a serious socio-economic and welfare policy problem. It is advisable to render domestic premises less hazardous and intense and prolonged postoperative physical rehabilitation treatment must be continued after discharge.
Rodaro
E
E
Physiotherapy Unit, Department of Rehabilitation, Santa Maria della Misericordia Hospital, Udine, Italy.
Pasqualini
M
M
Iona
L G
LG
Di Benedetto
P
P