Towards reducing diagnostic delay in endometriosis in primary care: a qualitative study.

BACKGROUND: Due to a heterogeneity of symptoms, a lack of an adequate diagnostic test and a lack of awareness, diagnostic delay in endometriosis in primary care on average amounts to 35 months. AIM: To determine which interventions are most feasible to reduce time to diagnosis in primary care, focusing on GPs' preferences, the intervention's content, design and implementation. DESIGN & SETTING: We conducted a qualitative study by performing focus groups with GPs and GP trainees between July and October 2021. METHOD: Data collection was continued until saturation was obtained. Focus groups were transcribed and openly encoded. Themes were formulated by three independent researchers. RESULTS: Divided over five focus groups 22 GPs and 13 GP trainees participated. Three themes were formulated: increasing awareness, combined intervention and reaching unaware GPs.Suggestions for a combined intervention strategy were adaptation of guidelines, a diagnostic support tool and compulsory education. To reach unaware GPs, participants felt that education should be offered in regional networks and education for GP trainees should be mandatory. A guideline on menstrual symptoms should be considered, and the term endometriosis should be added to the differential diagnosis paragraphs of existing guidelines. A diagnostic support tool should be linked to a guideline and consist of a flowchart with steps starting with the first presentation of symptoms leading to the diagnosis of endometriosis. CONCLUSION: According to GPs, a combined intervention strategy consisting of an adapted guideline, a diagnostic support tool and education might be successful interventions in reduction of diagnostic delay in endometriosis.

Role of Delay Between Injury and Surgery on the Outcomes of Rotator Cuff Repair: A Systematic Review and Meta-analysis.

BACKGROUND: Outcomes of rotator cuff repair (RCR) are influenced by several well-described factors, but the role of delay from injury to surgery on the outcomes is not clear. PURPOSE: To assess the role of delay to surgery on the outcomes of RCR in the literature. STUDY DESIGN: Systematic review with meta-analysis; Level of evidence, 4. METHODS: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. All studies assessing outcomes after RCR-either retear rates or patient-reported outcome measures (PROMs)-and reporting delay to surgery were identified through June 2021 in PubMed, Embase, and Cochrane. Inclusion criteria consisted of traumatic injuries, mean age <65 years, minimum 6-month follow-up, and assessment of retear rates with radiologic examination or reporting of PROMs. Random-effect models were used to assess outcomes, reported in odds ratio (OR) or mean difference (MD) with 95% CIs. RESULTS: A total of 8118 patients were included from 33 studies, with a mean age of 59 years (range, 53-64) and mean follow-up of 3.0 years (range, 0.5-8.2), among whom 53% were male and 74% had dominant-side injury. Patients undergoing surgery >3 months after injury did not have significantly higher retear rates (OR, 1.1 [95% CI, 0.5 to 3.1]; P = .700), lower Constant-Murley score (MD, -6.2 [95% CI, -16.4 to 4.1]; P = .240), or lower ASES score (American Shoulder and Elbow Surgeons; MD, -12.9 [95% CI, -26.0 to -0.2]; P = .050) compared with those having surgery within 3 months. Similarly, delaying surgery for 6 months did not result in higher retear rates (OR, 1.7 [95% CI, 0.8 to 3.7]; P = .190) or lower PROMs. Delaying surgery for 1 year, however, led to an increased likelihood of retear when compared with <1 year (OR, 2.9 [95% CI, 2.1 to 4.0]; P < .001), and this was similar for the 2-year cutoff (OR, 5.9 [95% CI, 1.1 to 32.1]; P = .040). It was also noted that patients with an intact cuff at follow-up had a mean 3.9 months' shorter time from injury to surgery than patients with retear (95% CI, 1.0-6.8 months; P = .009). CONCLUSION: This systematic review with meta-analysis found that delaying rotator cuff surgery for 3 to 6 months did not lead to higher retear rates or inferior PROMs as compared with undergoing earlier surgery. However, delaying surgery for ≥1 year clearly resulted in higher retear rates after RCR. This study is limited by relying on retrospective studies, and larger prospective studies are needed to confirm these findings. REGISTRATION: CRD42021240720 (PROSPERO).

Common peroneal nerve palsy after TKA in valgus deformities; a systematic review.

PURPOSE: The aim of this systematic review is to investigate the prevalence of Common Peroneal Nerve Palsy after total knee arthroplasty in valgus deformities. Furthermore, the effectiveness of a peroneal nerve release prior to arthroplasty to prevent the palsy will be investigated. METHODS: PubMed and Google Scholar were searched. Search terms regarding valgus deformity and total knee arthroplasty were used. Data analysis and extraction were performed using the web application 'Rayyan QCRI' according to PRISMA guidelines and screened according to the inclusion and exclusion criteria. RESULTS: Twenty-seven studies were included, representing 1397 valgus knees. Knee balancing was performed in 19 studies with lateral soft tissue releases (1164 knees) and 8 studies (233 knees) with an additional osteotomy. Two studies (41 knees) in the lateral soft tissue release group conducted a peroneal nerve release simultaneous to arthroplasty. Common peroneal nerve palsies occurred in 26 cases (1.9%). Overall, no significant difference in palsy ratio between studies was found by using a peroneal nerve release (p = 0.90), between lateral soft tissue releases and osteotomies (p = 0.11) or between releases of specific ligaments. CONCLUSION: Common peroneal nerve palsies occur in 1.9% of the cases after total knee arthroplasty in valgus deformities. No difference in the number of palsies was seen when using a peroneal nerve release or using different balancing techniques. However, literature about peroneal nerve releases was very limited, therefore, the effectiveness of a peroneal nerve release remains unclear. LEVEL OF EVIDENCE: LEVEL III: Systematic review.

No common peroneal nerve palsies found after a peroneal nerve release prior to TKA in fixed valgus deformities (a retrospective cohort study).

PURPOSE: The main purpose of this study was to analyse the incidence of Common Peroneal Nerve Palsy (CPNP) after Total Knee Arthroplasty (TKA) for all alignments. Secondarily, the efficiency and safety of a Peroneal Nerve Release (PNR) prior to TKA in preoperative severe fixed valgus deformities were evaluated to prevent a CPNP. METHODS: Overall, 7612 TKAs were performed in the institution from 2009 to 2021. 1913 TKAs were performed by three surgeons, who consistently performed a PNR in case of a fixed valgus deformity of (1) more than 15°, or (2) more than 10° but in combination with a flexion contracture of more than 15°. Patients with fixed valgus deformities of more than 10° were identified (81 knees) and a comparison was made between the patients who received a PNR (26 knees) and those who did not receive a PNR (55 knees). Data for the analysis were collected from patient medical files and were compared with the Chi2-test or Fisher Exact test. RESULTS: A CPNP incidence of 0.2% (16/7612) was found after TKA for all alignments together. No CPNP cases (0%) were developed in the PNR-group, compared to five (9%) in the non-PNR group (p = NS). A larger preoperative valgus angle (17° vs 13°, p < 0.001) and flexion contracture (10° vs 3°, p < 0.001) was present in the PNR group compared with the non-PNR group. No PNR-related complications were reported. CONCLUSION: The CPNP incidence in this study is consistent with the previous literature. Furthermore, although not significant, the group that received a PNR procedure developed fewer CPNPs compared to the group without PNR. LEVEL OF EVIDENCE: Retrospective cohort study, III.

Risk Factors for Musculoskeletal Complaints in Female Musicians: A Systematic Review and Exploration for Future Studies.

BACKGROUND: Female musicians are prone to the development of musculoskeletal complaints (MSC). The etiology of this increased risk is poorly understood. As the number of professional female musicians increases, so does the importance of understanding female-specific risk factors for MSC in musicians. OBJECTIVE: To provide an overview of current literature of proven and possible risk factors/etiology of MSC in female musicians, and to identify topics for future studies. METHODS: Systematic review performed according to international guidelines. A database search was performed in MEDLINE (PubMed), Embase, CINAHL, Cochrane, PsycINFO, clinicaltrials.gov, and gray literature. Studies were independently selected and rated by two reviewers. QUIPS and STROBE guidelines were used for assessing quality and risk of bias. Risk factors were categorized by means of the theoretical framework of the International Classification of Functioning (ICF) and evaluated using the Bradford Hill criteria for causality. RESULTS: Out of 1,924 records, 10 eligible studies were included. A low to moderate level of methodological quality was present in the studies. Fifteen risk factors could be identified from the included studies, which were positioned in the ICF model. The two most frequently mentioned female-specific risk factors were hand size and joint laxity. None of the risk factors fulfilled Bradford Hill's criteria for causality. Many other risk factors were suggested, while a number of expected causes were not encountered. CONCLUSION: At this moment, no evidence-based deductions can be made about female-specific risk factors for MSC in musicians. There is a lack of high-quality studies in this field and a need for studies with a different focus and a prospective study design.

How to Treat Musicians with Frozen Shoulder: A Narrative Review.

Musicians comprise a specific occupational group with high musculoskeletal loads as well as demands. A frozen shoulder, or adhesive capsulitis, is a common musculoskeletal condition characterized by pain and loss of function of the glenohumeral joint. Despite being described as a generally self-limiting condition, the clinical course of the disease is unclear. A frozen shoulder can be a career-threatening diagnosis for musicians who need a wide range of motion of the shoulder to play their instruments. The aim of this narrative review is to provide healthcare providers and musicians with an overview of treatment principles for instrumental musicians with frozen shoulder. In this review, both general treatment principles as well as instrument-specific ergonomic tools are discussed. The aim is to provide an overview of the available tools to preserve a musician's playing capabilities and to enable early return to playing the instrument.

Use of a Shoulder Rest for Playing the Violin Revisited: An Analysis of the Effect of Shoulder Rest Height on Muscle Activity, Violin Fixation Force, and Player Comfort.

AIMS: For violinists, the shoulder rest is an ergonomic adaptation to reduce musculoskeletal load. In this study, we aimed to evaluate how the height of the shoulder rest affects the violin fixation force and electromyographic (EMG) activity of the superficial neck and shoulder muscles. METHODS: In professional violinists, four different shoulder rest heights during five playing conditions were evaluated. Outcome variables included the jaw-shoulder violin fixation force and bilateral surface EMG of the upper trapezius (mTP), sternocleidomastoid (mSCM), and left anterior part of the left deltoid muscle (mDTA). Playing comfort was subjectively rated on a visual analogue scale (VAS). Linear regression models were estimated to investigate the influence of the shoulder rest height on muscle activity and violin fixation force as well as the muscle activity of the five evaluated muscles on violin fixation force. RESULTS: 20 professional violinists (4 males, 16 females, mean age 29.4 yrs) participated in this study. The shoulder rest condition had a significant effect on playing comfort (p<0.001), with higher shoulder rest conditions associated with decreased subjective playing comfort. The mean violin fixation force for each shoulder rest condition ranged between 2.92 and 3.39 N; higher shoulder rests were related to a higher violin fixation force (p<0.001). CONCLUSION: In this study, violin fixation force and muscle activity of the left mDTA increased while playing with an increasing height of the shoulder rest. As the shoulder rest influences muscle activity patterns and violin fixation force, adjustment of the shoulder rest and positioning of the violin need to be carefully optimized.

Differences in violin fixation force and muscle activity among violinists with and without complaints of the neck shoulder region.

PURPOSE: The aim of this study is to determine the relationship between complaints of the neck and shoulder region, the jaw-shoulder violin fixation force, and the activity of the neck and shoulder muscles in violinists. METHODS: In this case-control study twenty professional violinists were included, of which ten with current complaints of the neck shoulder region and ten without these complaints. A questionnaire including the DASH and NDI was used; violin fixation force and activity of the superficial neck muscles were evaluated in five playing conditions. RESULTS: Each group consisted of eight female and two male violists with a mean age of 29 years. Violinists with complaints had more muscle activity of all evaluated muscles compared to violinists without complaints; complaints were significantly associated with the muscle activity of all evaluated muscles. Complaints were not significantly associated with the violin fixation force. The playing condition significantly predicted the violin fixation force and the activity of all muscles except the left mTP. CONCLUSIONS: Violinists with complaints have more muscle activity of some superficial neck and shoulder muscles. Co-contraction is thought to play a relevant role in violinists with these complaints.

The high prevalence of playing-related musculoskeletal disorders (PRMDs) and its associated factors in amateur musicians playing in student orchestras: A cross-sectional study.

OBJECTIVE: Despite the high number of amateur musicians in the general population, little is known about the musculoskeletal health of amateur musicians. Playing a musical instrument is supposed to be a risk factor for the development of musculoskeletal complaints. This study aimed to evaluate playing-related musculoskeletal disorders (PRMDs) among amateur musicians playing in student orchestras. DESIGN: A cross-sectional study. PARTICIPANTS: 357 members of eleven Dutch student orchestras across the Netherlands were included in this study. INTERVENTION: A paper-based questionnaire on PRMDs was used. OUTCOME MEASURES: Sociodemographic characteristics and PRMDs were evaluated using an adaptation of the Nordic Musculoskeletal Questionnaire (NMQ) and the music module of the Disabilities of Shoulder and Hand (DASH) questionnaire. RESULTS: The year prevalence of PRMDs among amateur musicians was 67.8%. Female gender, younger age, higher BMI and playing a string instrument were independently associated with a higher prevalence of PRMDs. The left shoulder was affected more frequently in violinists and violists, whereas the right hand and wrist were more frequently affected in woodwind instrumentalists. Of the subjects with PRMDs during the last week, the score of the music module of the DASH was 18.8 (6.3-31.2). DISCUSSION: This study is the first to report on PRMDs and its associated factors in a large group of amateur musicians. The prevalence of PRMDs in amateur musicians is high, however the DASH scores reflect a confined impact of these PRMDs on their functioning as a musician. Preventive measures are needed aiming at reducing PRMDs among amateur musicians.

Association of Arm Position and Playing Time with Prevalence of Complaints of the Arm, Neck, and/or Shoulder (CANS) in Amateur Musicians: A Cross-Sectional Pilot Study Among University Students.

OBJECTIVE: In addition to known risk factors for musculoskeletal complaints in the general population, playing a musical instrument is an additional risk factor. In this pilot study, the prevalence of musculoskeletal complaints in student amateur musicians and their relation with playing posture and playing time were evaluated. METHODS: A cross-sectional web-based survey among amateur musicians studying at a Dutch university. RESULTS: 162 amateur musicians were included in this pilot study (response rate 17.6%). 46.9% of these amateur musicians played with an elevated arm position. Presence of complaints of the arm, neck and/or shoulder (CANS) was not statistically significantly related to arm position, except for complaints in the left shoulder with an elevated left arm position compared to neutral left arm position (OR 6.7, CI 95% 2.2-20.8) The number of hours playing per week did not significantly contribute to CANS (OR 1.0, CI 95% 0.95-1.17). CONCLUSIONS: In this pilot study among student amateur musicians, the occurrence of CANS was not significantly related to arm position, except for musicians playing with an elevated left arm position, which was associated with complaints of the left shoulder (OR 6.7). The number of hours playing per week did not significantly contribute to CANS in this group of musicians.

The Influence of a Sudden Increase in Playing Time on Playing-Related Musculoskeletal Complaints in High-Level Amateur Musicians in a Longitudinal Cohort Study.

BACKGROUND: Several studies in the domain of professional musicians describe the relation between playing time and the occurrence of musculoskeletal complaints in professional musicians. To date, no longitudinal cohort study into this relationship has been performed and no amateur musicians were studied. Therefore, the aim of this study is to examine the causal relationship between a sudden increase in playing time among amateur musicians on the occurrence of musculoskeletal complaints in a prospective cohort study. METHODS: All members of two national Dutch Students Orchestras were asked to participate in the study. These project-based orchestras, consisting of high-level amateurs, followed a nine-hour rehearsing schedule for ten consecutive days. On the first day (t0) and after one week (t1) the subjects were asked to complete a paper-based questionnaire including sociodemographic characteristics, music-related questions, questions regarding playing-related musculoskeletal complaints and the music module of the disabilities of arm, shoulder and hand questionnaire. RESULTS: The NSO consisted of 85 and the NESKO of 41 members during the study period. 59 subjects completed the questionnaire at both timepoints (response rate 47%). 9 subjects were excluded for being a music academy student, leaving 50 subjects (mean age 22.1, 72% female) suitable for analysis. During the rehearsal week, the prevalence of at least one playing-related musculoskeletal complaint increased from 28% to 80%. The most frequently affected areas were the neck, upper and lower back, hand/and or wrists and shoulders. The DASH music module score increased from 14 at t0 to 23 at t1. CONCLUSION: A point prevalence of 28% at the start of the study that increased remarkably to 80% within a one-week period. Future research should evaluate other risk factors for musculoskeletal complaints in amateur musicians. These risk factors should be the base for the development of preventive measures.

The occurrence of musculoskeletal complaints among professional musicians: a systematic review.

PURPOSE: This study gives a systematic overview of the literature on the occurrence of musculoskeletal complaints in professional instrumental musicians. METHODS: A systematic review. Nine literature databases were searched without time limits on June 25, 2015, also the complete index of the journal Medical Problems of Performing Artists (MPPA) until June 2015 (30;2) was searched, and citation tracking and reference checking of the selected articles were performed. The search consisted of the combination of three groups of keywords: musician (e.g., musician, violin, music student, instrument player) AND musculoskeletal (e.g., musculoskeletal, tendon, shoulder, arthritis) AND epidemiology (e.g., prevalence, incidence, occurrence). RESULTS: The initial literature search strategy resulted in 1258 potentially relevant articles. Finally, 21 articles describing 5424 musicians were included in this review. Point prevalences of musculoskeletal complaints in professional musicians range between 9 and 68 %; 12-month prevalences range between 41 and 93 %; and lifetime prevalences range between 62 and 93 %. Ten out of 12 studies show a higher prevalence of musculoskeletal complaints among women. Brass instrumentalists are reported to have the lowest prevalence rates of musculoskeletal complaints. The neck and shoulders are the anatomic areas most affected; the elbows are least affected. Although some information is reported concerning age, the high risk of bias in and between these studies makes it impossible to present reliable statements with respect to this. CONCLUSION: Musculoskeletal symptoms are highly prevalent among musicians, especially among women instrumentalists. Future research concerning the epidemiology of musculoskeletal complaints among musicians should focus on associated risk factors and follow the current guidelines to optimize scientific quality.

Prevalence and Consequences of Arm, Neck, and/or Shoulder Complaints Among Music Academy Students: A Comparative Study.

OBJECTIVE: CANS (complaints of arm, neck, and/or shoulder not caused by a systemic disease or acute trauma) are a recognized problem in specific occupational groups such as musicians. This study aimed to compare the prevalence, characteristics, and consequences of CANS between music academy students and a control group of peer-age medical students. METHODS: A cross-sectional study among music academy students and medical students. Data were collected using a web-based questionnaire on musculoskeletal conditions of the upper extremity in the two cohorts. RESULTS: Students of three music academies (n=345) and one medical university (n=2,870) received the questionnaire, of which 25% (n=87) and 18% (n=503) responded, respectively. The 12-month prevalence of CANS was nearly twice as high among music academy students as the control group (80.7% vs 41.5%, p<0.001). Music academy students reported 2.6 times the point prevalence as medical students (47.0% vs 18.2%, p<0.001). Chronic CANS was present in 36.1% of the music students, compared to 10.3% of the medical students (p<0.001). Music academy students presented more complaints per anatomic localization and a higher number of involved anatomic localizations. Music students rated the influence of CANS on daily functioning as more severe (5.0 vs 3.1, p<0.001). Of all subjects with CANS during the last year, more music academy students (46.3%) visited a healthcare professional compared to medical students (29.8%, p=0.013). CONCLUSION: The prevalence of CANS is high in music academy students compared to medical students. This emphasizes the necessity of effective (preventive) interventions in these high-demanding professionals.

Musicians' illness perceptions of musculoskeletal complaints.

The purpose of this study is to know the views of people about their illness, i.e., illness perceptions, determine coping strategies, and outcome. Previous research suggests a higher prevalence and a different perception of musculoskeletal complaints between musicians and nonmusicians. The aim of this study is to compare illness perceptions related to musculoskeletal complaints between musicians and nonmusicians. In this cross-sectional study, students from three music academies (n = 345) and one university medical center (n = 2,870) in the Netherlands received an electronic questionnaire concerning questions on sociodemographic characteristics, use of musical instruments, occurrence and characteristics of musculoskeletal complaints in the past year, and the Brief Illness Perception Questionnaire (B-IPQ). Baseline and B-IPQ scores were compared between the samples by means of t tests, chi-square tests, and regression models to adjust for differences in sociodemographic characteristics. Eighty-three music academy students and 494 medical students completed the questionnaire (response rates, 25.5 and 17.6 %, respectively). Seventy-four (89 %) persons in the musician group and 382 (78 %) persons in the nonmusician group reported occurrence of musculoskeletal complaints during the last 12 months. Adjusted for sociodemographic characteristics, the B-IPQ scores of the domains consequences (my illness is a serious condition), concern (I am extremely concerned about my illness), and emotions (my illness makes me scared) were significantly higher among musicians, whereas personal control (there is little I can do to improve my illness), identity (number of symptoms patient sees as part of illness) were not significantly different. Music academy students had a significant more positive score on treatment control. Music academy students report more negative perceptions of their musculoskeletal complaints compared to medical students. Although some selection bias is present, this is supposed to have a minor effect on the outcomes of this study. Addressing illness perceptions in musicians with musculoskeletal complaints could have beneficial effects on physical and functional outcomes.

A comparative study on the prevalence of musculoskeletal complaints among musicians and non-musicians.

BACKGROUND: Research comparing the frequency of musculoskeletal complaints between musicians and non-musicians is scarce. The aim of this study was to compare the prevalence of musculoskeletal complaints between musicians and non-musicians. METHODS: A cross-sectional study in 3215 students from three music academies (n = 345) and one medical school (n = 2870) in The Netherlands was performed, using an electronic questionnaire. The questionnaire included socio-demographic characteristics, use of music instruments and the occurrence of musculoskeletal complaints in six body regions. Questions were related to musculoskeletal complaints over the last twelve months and at the time of the questionnaire. Chi-square, t-tests and Kruskal-Wallis tests were used for comparison between the two groups. The association between musculoskeletal complaints and possible predictors was analyzed using a logistic and Poisson regression. RESULTS: Eighty-seven music academy students and 503 medical students returned the questionnaire, of which respectively eighty-three and 494 were included in the study. Seventy-four music academy students (89.2%) reported one or more musculoskeletal complaints during the last twelve months, compared to 384 (77.9%) medical students (p = 0.019). Moreover 52 music academy students (62.7%) and 211 medical students (42.7%) reported current musculoskeletal complaints (p = 0.001). The odds ratio (OR) for the development of musculoskeletal complaints during the last twelve months in music academy students versus medical students is 2.33 (95% CI 1.61-3.05, p = 0.022). The OR at the time of the questionnaire is 2.25 (95% CI 1.77-2.73, p = 0.001). The total number of complaints have been modeled by employing a Poisson regression; the results show that non-musicians have on average less complaints than musicians (p = 0.01). The adjusted means are 2.90 (95% CI 2.18-3.63) and 1.83 (95% CI 1.63-2.04) respectively for musicians and non-musicians. Regarding the localization of complaints, music academy students reported more complaints concerning the right hand, wrists, left elbow, shoulders, neck, jaw and mouth in contrast to medical students. CONCLUSIONS: Musculoskeletal complaints are significantly more common among musicians compared to non-musicians, mainly due to a higher number of upper extremity complaints.

[Bilateral Achilles tendon rupture following levofloxacin and glucocorticoid use]. / Bilaterale achillespeesruptuur bij gebruik van levofloxacine en glucocorticoïden.

The combination of fluorquinolones and glucocorticoids leads to a high risk of tendon rupture. Especially the Achilles tendon is at risk. We present a report of a 65-year-old woman with a bilateral Achilles tendon rupture following use of levofloxacin and corticosteroids for pneumonia. Symptoms of the tendons in patients using glucocorticoids and fluorquinolones should be evaluated. The physician should be aware of the high risk of an Achilles tendon rupture, particularly in older patients using this combination.

A retrospective analysis of bilateral fractures over sixteen years: localisation and variation in treatment of second hip fractures.

The aim of this study was the evaluation of contralateral hip fractures after a previous hip fracture. For this retrospective analysis patients were selected from the database of the LUMC, a teaching hospital in the south-west of the Netherlands. We analyzed all patients with a second fracture of a hip between 1992 and 2007. The exclusion criteria were high impact trauma and patients with diseases or medication known to have a negative effect on bone metabolism. A total of 1,604 hip fractures were identified. The possible predictive factors for the second fracture and descriptive statistics related to surgery (Hb and HT before and after the operation, total amount of intra- and postoperative blood loss, type of osteosynthesis, complications, time of death after the last fracture, time between arrival in the hospital and operation and hospital stay for both fractures) were recorded. A total of 32 second hip fractures were identified (2%) at a mean of 27.5 (SD 28.9) months after the initial hip fracture. The mean age at the first fracture was 77.2 years (SD 11.7), and 27 of 32 patients were female. Of these 32 patients (64 bilateral hip fractures), 32 fractures were intracapsular (1 femoral neck, 31 subcapital) and 32 were extracapsular fractures (6 subtrochanteric, 26 transtrochanteric). Although 24 of the 32 patients had identical first and second hip fractures, only eight out of 32 hips were treated with the same implants. There was a significant difference in Singh index between both hips at the time of the first fracture. There was also a significant difference in Singh index between the hip which was not fractured compared with its subsequent index when it was broken. All other studied patient and fracture characteristics were not significantly different. In this population the percentage of second hip fractures was relatively low compared to other studies. The choice of implants in this study shows that implants were chosen randomly. Because there is a significant difference in the Singh index during first and second hip fracture, osteoporosis medication might help reduce the incidence of second hip fractures.