title: High Incidence of Undiagnosed Cervical Myelopathy in Patients With Hip Fracture Compared With Controls.
abstract: OBJECTIVE
  To identify the incidence of undiagnosed cervical myelopathy in patients who fall and develop hip fractures compared with age-matched controls.
  
  
  METHODS
  Prospective, case-control study.
  
  
  METHODS
  University level 1 Trauma Center.
  
  
  METHODS
  Consecutive patients who presented with hip fractures after a fall. A total of 159 patients were screened; 66 patients (38 arthroplasty, 28 fracture) were eligible for enrollment in the study. Exclusion criteria included cognitive impairment, known diagnosis of cervical myelopathy, previous cervical spine surgery, inability to comply with examination, or refusal to participate. The control group was age-matched elderly patients who underwent total hip arthroplasty (THA).
  
  
  METHODS
  Patient interview and physical examination for cervical myelopathy.
  
  
  METHODS
  Myelopathy was diagnosed by clinical history elements (Japanese Orthopaedic Association score ≤15) and pathologic reflexes. Comparison of the incidence of myelopathy in the study population with the control population was performed using Fisher exact test.
  
  
  RESULTS
  There were no statistically significant differences between the fracture and THA groups in mean patient age or male/female ratio. There was a statistically significant increased incidence of myelopathy in hip fracture patients (18%) compared with the THA group (0%, P = 0.01).
  
  
  CONCLUSIONS
  Hip fracture is a complex multifactorial process, and most patients (60%) were excluded due to known cognitive impairment. However, 18% of previously undiagnosed patients who were cognitively intact manifested clinical findings consistent with cervical spondylotic myelopathy. Consideration should be given to screening for undiagnosed myelopathy among patients with hip fracture to reduce the risk of subsequent fractures.
  
  
  METHODS
  Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Jefferson Medical College, Philadelphia, PA; †Department of Orthopaedic Surgery, Rothman Institute & Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; ‡Department of Orthopaedic Surgery, Sports Medicine, and Rehabilitation, Boonshoft School of Medicine, Wright State University, Dayton, OH; and §Department of Orthopaedic Surgery as Hospital for Special Surgery, New York, NY.
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Radcliff
authors.forename: Edward P
authors.initials: EP
authors.lastname: Curry
authors.forename: Roman
authors.initials: R
authors.lastname: Trimba
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Walker
authors.forename: James J
authors.initials: JJ
authors.lastname: Purtill
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Austin
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.forename: Alan S
authors.initials: AS
authors.lastname: Hilibrand
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Albert
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D058070:Asymptomatic Diseases / Q000453:epidemiology; D001259:Ataxia / Q000175:diagnosis / Q000453:epidemiology*; D016022:Case-Control Studies; D015984:Causality; D002574:Cervical Vertebrae; D015897:Comorbidity; D005260:Female; D006620:Hip Fractures / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D009820:Ohio / Q000453:epidemiology; D012016:Reference Values; D012307:Risk Factors; D055009:Spondylosis / Q000175:diagnosis* / Q000453:epidemiology*