In-hospital hip fractures: prevalence, risk factors and outcome

SIR—The incidence of hip fractures is increasing worldwide [1] and despite the advances in perioperative care during the last 20 years a decrease in mortality after surgical treatment has not been observed [2, 3]. Demographic studies from 1986 documented that the risk of a hip fracture was 11 times greater in hospitalised patients than for non-hospitalised persons of comparable age, and that 24% of all hip fractures occurred in elderly patients hospitalised for other reasons [4]. That in-hospital fractures still present a significant problem today is highlighted by Canadian data (2000–2003), where 0.9/1000 admissions of elderly patients suffered a hip fracture during hospitalisation [5]. These data, however, offer no description of preoperative characteristics, fall circumstances, preventive measures or outcome for these patients as opposed to the general hip fracture population. Therefore, the aims of the present study were four-fold: to establish the prevalence of in-hospital fractures among the total hip fracture population in a large urban general hospital with both acute and rehabilitation services, to determine the circumstances of the fall leading to the fracture, to describe the use of pre-fracture preventive measures undertaken and to examine how these patients differed in preoperative characteristics and postoperative outcome from the remaining hip fracture population.