Late-in-Life Hip and Leg Fractures Need Medical Management

A study that compared geriatric patients with isolated fractures below the hip to those with isolated hip fractures found that lower extremity fractures can be more disabling than hip fractures because they necessitate weight-bearing restrictions.

When we think of fractures in elderly patient, we tend to envision broken hips, vertebrae and wrists. Orthopedic surgeons from the University of Missouri School of Medicine, Columbia, MO, have published a study comparing geriatric patients with isolated fractures below the hip to those with isolated hip fractures. Their results appeared in Geriatric Orthopaedic Surgery & Rehabilitation. They indicate that lower extremity fractures can be more disabling than hip fractures because they necessitate weight-bearing restrictions.

The researchers enrolled patients older than 59 years (N=346) who were admitted for surgical care of an isolated lower extremity fracture. Over the 3-year study period, they designated patients as either BTH (fracture below the subtrochanteric region of the femur, n=141) or HIP (proximal femoral fracture at subtrochanteric region or proximal, n=205). These number show that BTH is not as common as HIP, but occurs often.

BTH and HIP patients were very similar, with a few exceptions. HIP patients were on average 8 years older, tended to be thinner, and were more likely to have dementia or glaucoma. BTH patients were more likely to have peripheral neuropathy.

All other comorbidities were similar between the groups, as was the need for ambulation assistance.

At admission, HIP patients were more likely to be taking 2 types of medication: antiosteoporotic agents anticoagulants. They were also more likely to reside in an assisted living or long term care arrangement, and less likely to be discharged to home.

Previous studies have shown that geriatric patients with comorbidities who experience lower extremity fractures have elevated perioperative mortality rates. Heart failure, dementia, metastatic disease, and renal failure are particularly likely to be associated with morbidity and mortality.

This research highlights the medical similarities between geriatric patients with hip fracture and lower fractures. The researchers recommend that medical co-management protocols similar to those developed for geriatric patients with hip fracture need to be developed for geriatric patients with fractures below the hip.