Displaced intracapuslar hip fractures in the working age alcohol-abusing patient.
Management of alcohol-abusing patients presenting with intracapsular hip fractures is controversial. The aim of this study was to compare the management and outcome of working-age alcohol-abusing patients with similar-aged controls. Patients were identified from a prospectively collected database of trauma admissions. Full case notes were available for 78 patients under 65 of age presenting with a displaced intacapsular fracture at a teaching hospital between 1998 and 2002. Thirty seven patients had evidence of alcohol abuse. Alcohol-abusing patients presented to hospital later (p = 0.05), underwent surgery a median of 18 hours later (p = 0.011) and required a longer post operative stay (p = 0.003) compared to non-abusers. Despite this, the results of internal fixation were comparable. There was no significant difference between alcohol-abusers and non-abusers in rates of avascular necrosis (6.9% vs 9.7%; odds ratio 0.69, 0.11-4.47) or revision surgery (0.21 vs 0.10 procedures/ patient; odds ratio 1.49, 0.30-7.33). The high rates of alcohol abuse in this low-velocity trauma population suggest such patients are at increased risk of osteoporosis. Routine screening for osteoporosis should be considered in working-age alcohol abusers. After subcapital fracture, reduction and internal fixation is an acceptable treatment in this sub-group of patients.
Stearns
A T
AT
Directorate of Orthopaedics and Trauma, Glasgow Royal Infirmary, Castle Street, Glasgow G4 0SF.
Jaberoo
M C
MC
Ashraf
R
R
Wheelwright
E F
EF
Maclean
A D
AD
D000058:Accidental Falls / Q000706:statistics & numerical data; D000328:Adult; D000367:Age Factors; D000437:Alcoholism / Q000150:complications*; D015331:Cohort Studies; D005260:Female; D006617:Hip Dislocation / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006620:Hip Fractures / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors