Etiological factors and clinical outcomes in extracapsular and intracapsular hip fractures among older adults: A gender-specific analysis.

Abstract

Background: Compared to patients with intracapsular fractures (ICFs), those with extracapsular fractures (ECFs) had worse outcomes. However, most studies of risk factors for these fractures lacked relevant potential reasons, particularly nutritional status, and adjustment for confounding factors. Furthermore, less is known about their effects on clinical outcomes.

Objective: To conduct a gender-specific analysis of community-dwelling individuals admitted with hip fractures to examine the association of clinical risk factors and health care measures.

Design: Monocentric cross-sectional study.

Setting: Orthopedic trauma department.

Participants: A total of 787 women and 318 men of similar mean age (±SD): 83.1 years (±8.6) and 82.5 years (±9.0), respectively.

Main outcome measures: Multivariable logistic regression analyzed risk factors including age, gender, dementia, stroke, ischemic heart disease, diabetes, prefracture mobility, alcohol consumption, American Society of Anesthesiologists grades, drug history, and nutrition status for assessing risk factors and outcomes associated with ECFs and ICFs.

Results: Compared to ICFs, for each additional year of age, women had a 3% and men 4% greater association with ECFs. Among women only, ECFs were associated with risk of malnutrition: odds ratio [OR] = 1.70 (95% CI, 1.17-2.48) or malnourishment: OR = 1.93 (95% CI, 1.06-3.52), stroke: OR = 1.85 (95% CI, 1.16-2.97), and diabetes: OR = 1.92 (95% CI, 1.21-3.06). Women with ECFs were less likely to be discharged to their own homes: OR = 0.56 (95% CI, 0.38-0.83); but more likely to be discharged to a rehabilitation unit: OR = 1.81 (95% CI, 1.21-2.71) and readmitted to hospital within 30 days of discharge ≥1 time: OR: 2.39 (95% CI, 1.27-4.50) or ≥2 times: OR = 3.48 (95% CI, 1.05-11.57): they did not differ in discharge to residential or nursing care or in-hospital mortality. Among men, there were no differences in discharge destinations or readmissions between types of fractures.

Conclusions: Compared to ICFs, a greater number of risk factors associated with ECFs were identified more often in women than in men, and ECFs also have greater influences on clinical outcomes in women.