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Number of acetabular fractures in geriatric patients continues to rise
Although researchers at the University of Pennsylvania discovered the number of hip fractures in geriatric patients have declined in the last 10 years, they found the incidence of acetabular fractures in this population has risen 58%.
“Our ability to prevent geriatric femoral neck and intertrochanteric [fractures] has improved dramatically over the past 2 decades,” Matthew P. Sullivan, MD, a resident at Penn Orthopaedics at the Hospital of the University of Pennsylvania, said during his presentation at the American Academy of Orthopaedic Surgeons Meeting. “On the other hand, geriatric acetabular fractures are rising rapidly. The reasons for this are unclear. More and more geriatric patients with acetabular fractures are being transferred from one facility to another for definitive management as compared to traditional hip fractures. This will have significant health and economic consequences that will only become more pronounced unless we address the issue of geriatric acetabular fractures head on.”
The researchers noted that bisphosphonate use in such patients might account for the recent decline in hip fractures.
“There is substantive literature documenting the recent decline in the rate of fragility fractures about the hip,” the researchers wrote in their abstract. “This is, in part, attributed to the wide use of bisphosphonates approved by the FDA in 1995.”
Sullivan and colleagues used the National Inpatient Sample (NIS) Database from the Agency for Healthcare Research and Quality to investigate the annual incidence of hip fractures between 1993 and 2010. Their study included Medicare patients, and the researchers used ICD-9 codes to identify closed femoral neck fractures, subtrochanteric fractures, acetabular fractures and pelvic fractures.
Overall, traditional geriatric hip fractures declined 25.7% between 1993 and 2010, but geriatric acetabular fractures rose 58% during the same time period, according to Sullivan.
“These trends demonstrate the decline of traditional hip fractures and the rise of acetabular fractures,” Sullivan said.
The researchers also examined the trends in transfers from acute care facilities to other institutions. They found transfers for traditional hip fractures declined from 5% to 3%, but transfers for geriatric acetabular fractures remained elevated at 6%.
“While clinicians are getting more comfortable with treating traditional hip fractures, they are less and less inclined to treat geriatric acetabular fractures,” Sullivan said. “The geriatric acetabular fracture in the area of orthopedic surgery has significant limitations in understanding. Moving forward, we want to focus our attention on morbidity and mortality, treatment options and the economic impact of these injuries.”
Sullivan said the reliability of the NIS data and coding may have limited the study.
“For example, over the course of the collection period, CT scanning became commonplace in emergency departments, which helped us increase our understanding of acetabular fractures and this no doubt affected the reliability of the National Inpatient Sample data over the course of the period that we studied,” he said.
Reference:
Sullivan M. Paper #196. Presented at: the American Academy of Orthopaedic Surgeons Meeting; March 19-23, 2013; Chicago.
Disclosure: Sullivan has no relevant financial disclosures.