Why is this important?
These data are essential for research and the clinical impact of new avenues for optimizing geriatric care in France.
Methodology
A team from a French department of orthopedic and traumatic surgery carried out this retrospective study between January 2011 and December 2019, aiming to describe the characteristics of a cohort > 75 years old hospitalized in a perioperative geriatric unit for iterative fracture and to identify possible risk factors for iterative fracture.
Principle results
Of the 3,207 patients hospitalized in the department of orthopedic and traumatic surgery, 292 had an iterative fracture, i.e. 9.1% of the population (average age 85.4 years).
The initial fractures were mainly intertrochanteric (43.2% of cases), femoral neck (32.9%), peri-implant (5.5%) or proximal humeral (5.5%) fractures.
New fractures were 29.5% intertrochanteric fractures, 28.8% peri-implant fractures and 26.7% femoral neck fractures.
Subjects hospitalized for proximal femoral fracture were 58.1% to have already made a fracture of the same type.
All fractures combined, the second fracture episode was contralateral in 58.6% of cases (and in 78% of situations, the iterative fracture was of the same type as the first fracture).
On the other hand, when the first fracture was not a proximal femoral fracture, the second was more often ipsilateral (61.4% versus 35.1%, p=0.0001).
The majority of new fractures occurred in the year following the last fracture (55.5%) with a median delay of 9.6 months. This period was shortened in the event of a peri-implant fracture or direct discharge home.
Analyzes showed that 21.9% of subjects were institutionalized when the first fracture occurred. Dementia (p=0.0002) and increased Charlson score (significant trend p=0.05) were the only two risk factors for institutionalization after a first episode of fracture highlighted by this study.
Women (10.2% versus 6.8%, p=0.003) and proximal femoral fractures (10.7% versus 6.8%, p=0.05) were risk factors for iterative fracture.
Age at first fracture, Charlson score, time to refracture did not appear to be associated with time to refracture.