Causes and patterns of hip fractures among adult patients at Muhimbili Orthopaedic Institute from 2019 to 2020

Abstract

Background The population of older adults in sub-Saharan Africa has substantially increased (two times higher than in northern Europe) and is expected to grow rapidly than anywhere else by 2050. This is linked to increased rates of fracture in the hip region. However, there is a paucity of literature about causes and patterns among adult patients with hip fractures at Muhimbili Orthopaedic Institute (MOI) Aim/broad objective This study is aimed to determine the causes and patterns of hip fractures among patients aged 18 years and above admitted at MOI. Materials and methods A cross-sectional study was conducted from September 2019 to February 2020 on adult hip fracture patients admitted at MOI. Demographic information, mechanism of injury, associated injuries, and medical comorbidity were extracted from patient's files. A Singh index (SI) criteria determined osteoporosis on the anteroposterior plain radiographs of the pelvis in all patients aged 50 years and above who sustained a low-energy falls, whereby the score of ≤3 was graded as significant osteoporosis. A Statistical Package for the Social Sciences (SPSS version 25) for the analysis of data, and they were described as proportions (percentages) for categorical data and means for continuous. A Chi-square test was applied to check the association among the categorical/ordinal variables. A p-value that was found to be less than 0.05 was considered statistically significant. Results: The study included 178 hip fracture patients who met the criteria, of whom 60% (n=106) were males, and the rest were females. The mean age was 66 years, and more than half of patients (63%) were above 65 years of age. 138 patients (78%) sustained a low-energy injury, such as falls from standing height (FFSH) whereby the majority of them (94%) were aged 50 years and above with an almost equal ratio between both sexes (53% males versus 47% females). 40 patients (22%) sustained a high-energy trauma, mostly from motor traffic crash (MTC) (82%). Males were mostly involved in high-energy trauma (87%) compared to females (13%). Associated injuries were higher in the high-energy trauma (63%) than in the low-energy falls (1%). The trochanteric fractures were significantly higher in the low-energy injury (87%) compared to the femoral neck (81%) and subtrochanteric fractures (53%). In contrast, subtrochanteric fractures were almost equally distributed to both modes of injuries (i.e. high-energy and low-energy injury). Conclusion: The majority of hip fracture patients at MOI are low-energy fragility fractures mainly occur after 50 years of age. They are equally distributed between both genders and attributed to increasing age and osteoporosis. A few ones are due to high-energy trauma, mainly seen in young male patients aged less than 50 years, and are a result of MTC. The highest proportions of the trochanteric fractures occur in the low-energy falls, whereas half of the subtrochanteric fractures occur in high-energy trauma. Hence, the findings of the study may be used for the formulation and preparation of the management protocols of the hip fracture patients at MOI, for planning preventive measures, and encourage further researches on hip fractures.