title: Predictors of poor clinical outcome following hip fracture in middle aged-patients.
abstract: The aim of this study was to investigate morbidity and mortality following hip fractures in middle aged patients. In addition, we aimed to identify risk factors which could be used to predict postoperative complications. All patients aged 40-55 who sustained a hip fracture in Lothian from 2007 to 2008 were identified from a prospective trauma database. The main outcomes were complications and 5-year mortality. Thirty hip fractures were included in the study. Complications occurred in nine (30%) cases. Deep infection was seen in three cases (10%). Mortality was 20% at 5 years, 26 times higher than for the general population. All surviving patients were contacted for risk factor analysis (24). Low energy fractures, alcohol excess, smoking and history of previous fractures were significantly associated with complications (p<0.05). Complications only occurred amongst low energy fractures. Risk factors were further analysed using the WHO FRAX algorithm. No patient with a FRAX score of less than 10 suffered a complication, whereas 50% of patients who had a FRAX score of more than 10 suffered a complication. The results of our study suggest that low energy hip fractures in middle age are due to underlying morbidity and are associated with a high incidence of postoperative complications and mortality. The FRAX score could be used as a simple method of identifying patients in this age group who are at risk of a poor outcome.
authors.affiliation: Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. Electronic address: Robbie.ray@nhs.net.
authors.forename: Robbie I
authors.initials: RI
authors.lastname: Ray
authors.affiliation: Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Aitken
authors.affiliation: Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: McQueen
authors.affiliation: Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Court-Brown
authors.affiliation: Institute of Genetics and Molecular Medicine, University of Edinburgh, United Kingdom.
authors.forename: Stuart H
authors.initials: SH
authors.lastname: Ralston
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology*; D015519:Bone Density; D015897:Comorbidity; D005260:Female; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology
keywords: Complication; Hip fracture; Low energy fractures in middle age; Predictors of poor outcome