I G N Paramartha Wijaya Putra, I Wayan Suryanto Dusak
ABSTRACT
Background: Problems surrounding the pelvis are usually associated with greater morbidity and mortality. The most common of such problem is hip fractures. Although fall is generally the main cause of fractures, the steep rise in hip fracture incidence rates with age (in older people) is not fully explained by an increase in the frequency of falls or by reduction in bone mineral density, suggesting that circumstances of falls may also affect the risk of hip fracture. The aim of our observational study is to evaluate, among patients with hip fragility fracture, fracture characteristics, gender, and treatment.
Methods: We conducted a descriptive retrospective study, which patient data obtained from Sanglah General Hospital. The data were obtained from patient’s medical record between April 2016 and April 2017, resulting from 162 patients. The variables obtained were sex, age, diagnosis, management, bone osteoporosis, mechanism of injury, and energy of the trauma. Then these data were analyzed using the SPSS 22.
Results: Among 162 patients who were reported having problems surrounding the hip, 84 patients (51.9%) were female and 48,1% were male. Eighteen patients (11.1%) sustained osteoarthritis hip joint, 5.6% had an AVN head femur, 8.0% implant loosening/infected/failure, 1.9% posterior wall acetabulum fracture, 0.6% posterior column acetabulum fracture, 0.6% anterior column acetabulum fracture, 3.7% perthrocanteric femoral fracture, 30.2% interthrocahanteric femoral fracture, 6.2% subtrochanteric femoral fracture, 19.1% neck femoral fracture, 3.1% basical neck femoral fracture, 5.6% posterior hip dislocation, and 4.3% sustained acetabulum fracture. From all of them, 1.2% undergoes hemiatrhroplasty, 17.9% hemiarthroplasty bipolar, 27.2% THR, 3.7% THR revision, 16.7% ORIF PS, 1.2% ORIF interlocking nail, 2.5% ORIF screwing cannulated, 13.0% ORIF cephalomedullary nailing, 5.6% ORIF DHS, 1.2% ORF ABP, 1.9% debridement, 1.2% debridement, remove implant, and spacer, 2.5% conservative, 1.2% osteotomy + debridement, 0.6% osteotomy + soft tissue release, 1.2% ORIF screwing, 0.6% implant removal, and 0.6% undergoes IM nailing. Only 21 patients (13%) has osteoporotic bone, while 87% are not osteoporotic. 35 patients are having non traumatic fracture (21.6%), while low energy trauma happens in 41.4% patients and high energy trauma in 37.0% patients. Lastly, only 27,2% of the injuries are due to non-traumatic mode-of-injury, while 72.8% are traumatic.
Discussion: The result corresponds with the previously reported study done by Iolascon et al. which state low impact falls as the most common cause of hip fractures in elderly. A meta-analysis by Deandrea et al. also showed that age and female sex were among the factors with greatest impact on fall risk and occurrence of future falls. Proper management of hip fractures will reduce the number of hip problems experienced by the elderly population.
Conclusion: This study showed that female is the one that sustained most of hip fracture, mostly without osteoporosis, and sustained intertrochanteric fracture. Traumatic Mode of Injury is the most common cause with low energy trauma as the most prevalent one. The most performed management of hip fractures at Sanglah General Hospital was Total Hip Replacement. A proper management of hip fractures will curb the number of hip incidence experienced by elderly population.
Keyword: hip, epidemiology, demographic profile, total hip replacement
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