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Outcome After Sequential Hip Fracture in the Elderly
Graeme Holt, MBChB, FRCS(Tr&Orth)1; Rik Smith, PhD2; Kathleen Duncan, MSc, BA2; James D. Hutchison, PhD, FRCSEd, FRCSE, FRCSGlas3; Alberto Gregori, MBChB, FRCS(Tr&Orth)4; Damien Reid, MBChB, MRCP4
1 Department of Trauma & Orthopaedic Surgery, University Hospital Crosshouse, Kilmarnock Road, Kilmarnock, KA2 0BE, United Kingdom. E-mail address: graemeholt@btinternet.com
2 Scottish Hip Fracture Audit, Quality Improvement Program, Healthcare Information Group, Information Services Division Scotland, Area 143c, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, United Kingdom
3 Department of Surgery and Orthopaedics, University of Aberdeen Medical School, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, United Kingdom
4 Department of Orthopaedic and Trauma Surgery (A.G.) and Department of Medicine for the Elderly (D.R.), Hairmyres Hospital, Eaglesham Road, East Kilbride G75 8RG, United Kingdom
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Investigation performed at University Hospital Crosshouse, Kilmarnock; Hairmyres Hospital, East Kilbride; Information Services Division Scotland, Edinburgh; and University of Aberdeen Medical School, Aberdeen, United Kingdom

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Oct 03;94(19):1801-1808. doi: 10.2106/JBJS.J.01539
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Hip fracture is a common cause of morbidity and mortality in the elderly. As the risk factors for hip fracture often persist after the original injury, patients remain at risk for sequential fractures. Our aim was to report the incidence, epidemiology, and outcome of sequential hip fracture in the elderly.


Data were collected during the acute hospital stay and at 120 days after admission from twenty-two acute orthopaedic units across Scotland between January 1998 and December 2005. These data were analyzed according to two separate time periods: by six-month intervals up to eight years after the primary fracture and by twenty-day intervals for the first two years after the primary fracture.


The risk of sequential fracture was highest in the first twelve months, affecting 3% of surviving patients and decreasing to 2% per survival year thereafter. Survival to twelve months after sequential fracture was 63% compared with 68% for those with a single fracture (p = 0.03). Sequential hip fracture was also associated with greater loss of independent mobility and changes in residential status compared with single fractures.


Sequential hip fracture is a relatively rare injury. Individuals who sustain this injury combination have poorer outcomes both in terms of survival and functional status.

Level of Evidence: 

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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