Fracturas de cadera intra- y extracapsulares en mayores: ¿dos enfermedades distintas? / Intra- and extra-capsular hip fractures in the elderly: two different pathologies?

Objetivos. Comparar las fracturas de cadera (FC) intra- y extracapsulares (FIC y FEC) en pacientes mayores para determinar si son patologías diferentes. Sujetos/método. Diseño prospectivo longitudinal, observacional, descriptivo y analítico. Muestra no probabilística. Muestreo de colección completa. Seiscientos cuarenta y siete sujetos (ambos sexos), 60 o más años, ingresados con FC desde el Servicio de Ortopedia y Traumatología del Hospital (1 de enero de 2010 al 31 de diciembre de 2012). Seguimiento de un año pos-FC. Se comparan variables sociodemográficas, etiológicas, evolutivas, terapéuticas y pronósticas. Resultados. Es la primera investigación sobre este tema realizada con población latinoamericana. La incidencia de FEC fue superior a FIC, al contrario de lo publicado en población europea/estadounidense. Existen diferencias significativas en las variables etiológicas (χ2 = 6,34, p < 0,042), siendo la etiología traumática en FEC y no traumática en FIC. También hay diferencias en las intervenciones terapéuticas realizadas (osteosíntesis para FEC, artroplastia para FIC); y la decisión de no operar es menor en FIC (ambos p < 0,0000). Las variables asociadas con la decisión de no intervención quirúrgica son edad, diagnósticos causales y mortalidad postoperatoria. Discusión. Los resultados son similares a otros trabajos, añadiendo la asociación FIC y origen no traumático, especialmente la tendencia de asociación FIC y enfermedad no osteoporótica primaria (neoplasias, osteodistrofia renal, osteoporosis secundaria a hiperparatiroidismo primario). Debemos profundizar en las diferencias entre poblaciones latinoamericana y europea/estadounidense en la incidencia de uno u otro tipo de FC. Existen diferencias importantes, etiológicas y terapéuticas, entre FIC y FEC, por lo que sería conveniente considerarlas como entidades nosológicas distintas (AU)

Objectives. To compare intracapsular (IC) and extracapsular (EC) hip fractures (HIF) in elderly patients in order to determine if they are different pathologies. Subjects and methods. Longitudinal, observational, descriptive, analytical prospective design, using a non-probabilistic sample from a full sample collection with 647 subjects (male and female), of 60 or more years old, admitted with HIF to the Department of Orthopedics and Traumatology of the Hospital, between January 1, 2010 and December 31, 2012. Follow-up was for 1 year post HIF. Socio-demographic, etiological, developmental, therapeutic and prognostic variables are compared. Results. This is the first study on this subject with Latin American population. EC HIF incidence was superior to IC, contrary to that published in European/American populations. There are significant differences in etiological variables (χ2 = 6.34, p<0.042), with traumatic etiology in EC and non-traumatic in IC. There are also differences in therapeutic interventions performed (osteosynthesis for EC, arthroplasty for IC), with the decision on not to operate being lower in IC (both p<0.0000). The variables associated with the decision on not to perform surgery are age, etiology and postoperative mortality. Discussion. The results are similar to other studies, adding the IC association with non-traumatic origin, in particular the trend of statistical association between IC and non-primary osteoporotic pathology (neoplasms, renal osteodystrophy, primary hyperparathyroidism). A further analysis was performed on the differences between Latin American and European/American populations in the incidence of either type of HIF. There are important etiological and therapeutic differences between IC and EC HIF; therefore it would be advisable to consider them as distinct disease entities (AU)

Intra- and extra-capsular hip fractures in the elderly: Two different pathologies?

OBJECTIVES: To compare intracapsular (IC) and extracapsular (EC) hip fractures (HIF) in elderly patients in order to determine if they are different pathologies. SUBJECTS AND METHODS: Longitudinal, observational, descriptive, analytical prospective design, using a non-probabilistic sample from a full sample collection with 647 subjects (male and female), of 60 or more years old, admitted with HIF to the Department of Orthopedics and Traumatology of the Hospital, between January 1, 2010 and December 31, 2012. Follow-up was for 1 year post HIF. Socio-demographic, etiological, developmental, therapeutic and prognostic variables are compared. RESULTS: This is the first study on this subject with Latin American population. EC HIF incidence was superior to IC, contrary to that published in European/American populations. There are significant differences in etiological variables (χ(2)=6.34, p<0.042), with traumatic etiology in EC and non-traumatic in IC. There are also differences in therapeutic interventions performed (osteosynthesis for EC, arthroplasty for IC), with the decision on not to operate being lower in IC (both p<0.0000). The variables associated with the decision on not to perform surgery are age, etiology and postoperative mortality. DISCUSSION: The results are similar to other studies, adding the IC association with non-traumatic origin, in particular the trend of statistical association between IC and non-primary osteoporotic pathology (neoplasms, renal osteodystrophy, primary hyperparathyroidism). A further analysis was performed on the differences between Latin American and European/American populations in the incidence of either type of HIF. There are important etiological and therapeutic differences between IC and EC HIF; therefore it would be advisable to consider them as distinct disease entities.