title: Outcome after sequential hip fracture in the elderly.
abstract: BACKGROUND
  Hip fracture is a common cause of morbidity and mortality in the elderly. As the risk factors for hip fracture often persist after the original injury, patients remain at risk for sequential fractures. Our aim was to report the incidence, epidemiology, and outcome of sequential hip fracture in the elderly.
  
  
  METHODS
  Data were collected during the acute hospital stay and at 120 days after admission from twenty-two acute orthopaedic units across Scotland between January 1998 and December 2005. These data were analyzed according to two separate time periods: by six-month intervals up to eight years after the primary fracture and by twenty-day intervals for the first two years after the primary fracture.
  
  
  RESULTS
  The risk of sequential fracture was highest in the first twelve months, affecting 3% of surviving patients and decreasing to 2% per survival year thereafter. Survival to twelve months after sequential fracture was 63% compared with 68% for those with a single fracture (p = 0.03). Sequential hip fracture was also associated with greater loss of independent mobility and changes in residential status compared with single fractures.
  
  
  CONCLUSIONS
  Sequential hip fracture is a relatively rare injury. Individuals who sustain this injury combination have poorer outcomes both in terms of survival and functional status.
  
  
  METHODS
  Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Trauma & Orthopaedic Surgery, University Hospital Crosshouse, Kilmarnock Road, Kilmarnock, KA2 0BE, United Kingdom. graemeholt@btinternet.com
authors.forename: Graeme
authors.initials: G
authors.lastname: Holt
authors.forename: Rik
authors.initials: R
authors.lastname: Smith
authors.forename: Kathleen
authors.initials: K
authors.lastname: Duncan
authors.forename: James D
authors.initials: JD
authors.lastname: Hutchison
authors.forename: Alberto
authors.initials: A
authors.lastname: Gregori
authors.forename: Damien
authors.initials: D
authors.lastname: Reid
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods / Q000401:mortality*; D017102:Fracture Healing / Q000502:physiology; D015577:Geriatric Assessment / Q000379:methods; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis