Osteoporotic Pertrochanteric Hip Fractures

The incidence of hip fractures in the United States is 250,000 per year and is predicted to grow to 500,000 by 20401. The current cost is estimated to be ten billion dollars per year2,3. Nearly nine of ten hip fractures occur in patients older than sixty-five years of age, and about three of four occur in women (Fig. 1). Approximately half of these injuries are intertrochanteric fractures, occurring at an annual rate of sixty-three per 100,000 in elderly women and thirty-four per 100,000 in elderly men4. Fig. 1: Incidence of hip fractures as related to age and gender. (Reprinted, with permission, from: Baumgaertner MR, Chrostowsky JH, Levy RN. Skeletal trauma. Philadelphia: WB Saunders; 1998. p 1833. [Redrawn from: Apple DF Jr, Hayes WC, editors. Prevention of falls and hip fractures in the elderly. Rosemont, IL: American Academy of Orthopaedic Surgeons; 1993.]) The vast majority of these fractures occur after a simple fall, and hospitalized patients have an elevenfold increased frequency compared with aged-matched controls5-7. In 1996, Koval et al. found that positive predictors of independence after injury included an age of less than eighty-five years, three or more medical comorbidities, prefracture independence, and ambulatory status at discharge8. Furthermore, Koval et al. reported, in 1998, that fracture type is not a predictor of mortality or recovery of the ability to walk9, despite previous reports to the contrary10. Look for these related articles in Instructional Course Lectures , Volume 53, which will be published by the American Academy of Orthopaedic Surgeons in March 2004: Bone density has been noted to be predictive of intertrochanteric fractures, with these fractures …