Abstract
Background and Purpose Hip fracture is the most common cause of trauma admissions in the elderly. The incidence of contralateral hip fracture after hip fracture in the elderly is 10.8%, resulting in more disability, mortality, and increased medical cost. The study is to investigate the incidence of re-fracture in the elderly and possible related factors, including demographics, fracture types and treatments, osteoporosis parameters, lifestyle, body mass index, comorbidities, and clinical visits.
Methods This is a retrospective study. Data were collected from chart reviews of older adults who received hip fracture surgery at a hospital in Taiwan between 2018 and 2021. Data analysis was made by descriptive statistics, chi-square test, Mann-Whitney U test and logistic regression.
Results 407 patients were included. Among them, 277 were female. Their mean age was 81 years. Fractures occurred in the femoral neck and intertrochanteric region. Fracture types are displaced, comminuted and nondisplaced fractures. Surgical treaments included internal fixation and hemiarthroplasty. The median Frax score of hip fractures was 8.3%. The median Frax score of major osteoporotic fracture was 17%. The median T score was -3.2 . Median BMI was 22.3 kg/m2. Among them, 273 had hypertension, 140 had hyperlipidemia, 162 had diabetes and 19 had vision problems. The median number of clinical visits in one year was 6. Within a year, 135 patients suffered new fracture. The incidence of re-fracture was 33.2%. Median time to refracture was 5 months. Refractures occurred in the spine, contralateral femur and ipsilateral femur. Refracture types included nondisplaced, displaced, and comminuted. Treatments included medical therapy, internal fixation, spine surgery, and hemiarthroplasty. Logistic regression results showed that hypertension and the number of clinical visits were important predictors of re-fractures. The risk of further fractures was significantly higher in patients with hypertension (OR:1.81) and those with more clinical visits (OR:1.16).
Conclusion Our study showed high incidence of re-fracture after hip fracture surgery in the elderly. Spine is the most common site for new fractures. This suggests that it is key to care such patients to prevent them from further fractures. Among them, patients with hypertension and patients with high frequency of orthopedic clinical visits are at high-risk. Nurses should pay attention to this high-risk group to prevent further fractures.
Notes
References:
1.American Association 0f Orthopaedic Surgeons (2021).Management of Hip Fractures in Older Adults - Evidence-Based Clinical Practice Guideline
2.Guzon-Illescas, O., Perez Fernandez, E., Crespí Villarias, N., Quirós Donate, F. J., Peña, M., Alonso-Blas, C., García-Vadillo, A., & Mazzucchelli, R. (2019). Mortality after osteoporotic hip fracture: incidence, trends, and associated factors. Journal of orthopaedic surgery and research, 14(1), 203.
3.Ayers, C., Kansagara, D., Lazur, B., Fu, R., Kwon, A., & Harrod, C. (2023).Effectiveness and Safety of Treatments to Prevent Fractures in People With LowBone Mass or Primary Osteoporosis: A Living Systematic Review and Network Meta-analysis for the American College of Physicians. Annals of internal medicine, 176(2), 182–195.
4.Conley, R. B., Adib, G., Adler, R. A., Åkesson, K. E., Alexander, I. M., Amenta, K. C., Blank, R. D., Brox, W. T., Carmody, E. E., Chapman-Novakofski, K., Clarke, B. L., Cody, K. M., Cooper, C., Crandall, C. J., Dirschl, D. R., Eagen, T. J., Elderkin, A. L., Fujita, M., Greenspan, S. L., Halbout, P., … Kiel, D. P. (2020). Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition. Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research, 35(1), 36–52
5.Chen, X., He, B., Zhou, Y., Zhang, X., & Zhao, L. (2023). Investigating the effect of history of fractures and hypertension on the risk of all-cause death from osteoporosis: A retrospective cohort study. Medicine, 102(13), e33342
6.Dhibar, D. P., Gogate, Y., Aggarwal, S., Garg, S., Bhansali, A., & Bhadada, S. K. (2019). Predictors and Outcome of Fragility Hip Fracture: A Prospective Study from North India. Indian journal of endocrinology and metabolism, 23(3), 282–288.
7.Iconaru, L., Charles, A., Baleanu, F., Surquin, M., Benoit, F., Mugisha, A., Moreau, M.,Paesmans, M., Karmali, R., Rubinstein, M., Rozenberg, S., Body, J. J., & Bergmann, P. (2022). Prediction of an Imminent Fracture After an Index Fracture- Models Derived From the Frisbee Cohort. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 37(1),59–67
8.LeBlanc, K. E., Muncie, H. L., Jr, & LeBlanc, L. L. (2014). Hip fracture: diagnosis, treatment, and secondary prevention. American family physician, 89(12), 945–951
9.Mattisson, L., Bojan, A., & Enocson, A. (2018). Epidemiology, treatment and mortality of trochanteric and subtrochanteric hip fractures: data from the Swedish fracture register. BMC musculoskeletal disorders, 19(1), 369.
Sigma Membership
Non-member
Type
Poster
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Mixed/Multi Method Research
Keywords:
Primary Care, Acute Care, Sub-acute Care, Hip Fractures
Recommended Citation
Cheng, Shuwen and Wang, Tsae-Jyy, "Re-Fracture Within One Year After Hip Fracture Surgery in the Elderly and its Related Factor" (2025). International Nursing Research Congress (INRC). 32.
https://www.sigmarepository.org/inrc/2025/posters_2025/32
Conference Name
36th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Seattle, Washington, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Re-Fracture Within One Year After Hip Fracture Surgery in the Elderly and its Related Factor
Seattle, Washington, USA
Background and Purpose Hip fracture is the most common cause of trauma admissions in the elderly. The incidence of contralateral hip fracture after hip fracture in the elderly is 10.8%, resulting in more disability, mortality, and increased medical cost. The study is to investigate the incidence of re-fracture in the elderly and possible related factors, including demographics, fracture types and treatments, osteoporosis parameters, lifestyle, body mass index, comorbidities, and clinical visits.
Methods This is a retrospective study. Data were collected from chart reviews of older adults who received hip fracture surgery at a hospital in Taiwan between 2018 and 2021. Data analysis was made by descriptive statistics, chi-square test, Mann-Whitney U test and logistic regression.
Results 407 patients were included. Among them, 277 were female. Their mean age was 81 years. Fractures occurred in the femoral neck and intertrochanteric region. Fracture types are displaced, comminuted and nondisplaced fractures. Surgical treaments included internal fixation and hemiarthroplasty. The median Frax score of hip fractures was 8.3%. The median Frax score of major osteoporotic fracture was 17%. The median T score was -3.2 . Median BMI was 22.3 kg/m2. Among them, 273 had hypertension, 140 had hyperlipidemia, 162 had diabetes and 19 had vision problems. The median number of clinical visits in one year was 6. Within a year, 135 patients suffered new fracture. The incidence of re-fracture was 33.2%. Median time to refracture was 5 months. Refractures occurred in the spine, contralateral femur and ipsilateral femur. Refracture types included nondisplaced, displaced, and comminuted. Treatments included medical therapy, internal fixation, spine surgery, and hemiarthroplasty. Logistic regression results showed that hypertension and the number of clinical visits were important predictors of re-fractures. The risk of further fractures was significantly higher in patients with hypertension (OR:1.81) and those with more clinical visits (OR:1.16).
Conclusion Our study showed high incidence of re-fracture after hip fracture surgery in the elderly. Spine is the most common site for new fractures. This suggests that it is key to care such patients to prevent them from further fractures. Among them, patients with hypertension and patients with high frequency of orthopedic clinical visits are at high-risk. Nurses should pay attention to this high-risk group to prevent further fractures.
Description
Hip fractures of the elderly may cause morbidity and mortality. Disability following hip fractures is crucial to further falling and fracture. Our research aimed at factors resulting in repeated fractures. Our investigation revealed that hypertension was predisposing somatic factor of re-fracture in one year after the first hip fracture. Besides, frequency of returning to outpatient clinic was another significant difference in patients having re-fracture.