OBJECTIVES: Osteoporotic hip fractures are associated with high mortality in the older population. Few population studies have reported the long-term trends of incidence and mortality rate of hip fracture among the older in Korea. This study assessed the incidence and mortality rate within 1 year after hip fracture from 2006 to 2015 in South Korea. METHODS: The National Health Information Database was used to identify adults aged 60 years and older with a diagnosis of hip fracture and died within 1 year from hip fracture. Regression analyses were performed to estimate the change of the incidence of hip fracture and the related mortality rate. RESULTS: The events causing hip fracture increased 1.85 times (1.91 times in women and 1.71 times in men), and the incidence of hip fracture increased 1.23 times (1.30 times in women and 1.11 times in men) from 2006 to 2015. The mortality rate after hip fracture decreased by 10% in women; however, it increased by 13% in men. These trends were more prominent in the older population. CONCLUSIONS: Although the mortality rate after hip fracture in women decreased, other parameters associated with hip fracture have worsened during the last decade. Nationwide programs were urgently needed to reduce the future socioeconomic burdens of hip fractures.
Adult ; Cohort Studies ; Diagnosis ; Female ; Hip Fractures ; Hip ; Humans ; Incidence ; Korea ; Male ; Mortality ; Osteoporosis

Periprosthetic acetabular fracture (PAF) is an uncommon complication following hip arthroplasty. However, as the number of people needing hip prostheses continues to rise, the absolute number of PAF is expected to increase as well. These fractures may occur either intraoperatively or postoperatively. Postoperative fractures can be caused by traumatic events or by pathologic conditions related to periacetabular osteolysis. The management of PAF usually depends on the degree of displacement and the stability of the acetabular component. While most of non-displaced fractures can be managed nonoperatively by protected weight bearing, displaced fractures with unstable implants require surgical intervention, which is often technically challenging. This review summarized the latest findings on the epidemiology, the diagnosis, the classification, and the treatment of PAF.
Acetabulum ; Arthroplasty ; Classification ; Diagnosis ; Epidemiology ; Hip Prosthesis ; Hip ; Osteolysis ; Periprosthetic Fractures ; Weight-Bearing

BACKGROUND: We determined the prevalence of sarcopenia according to fracture site and evaluated the associated risk factors in female patients with osteoporotic fractures. METHODS: A total of 108 patients aged 50 years or older with an osteoporotic fracture (hip, spine, or wrist) were enrolled in this retrospective observational study. A diagnosis of sarcopenia was confirmed using whole-body densitometry for skeletal muscle mass measurement. Logistic regression analysis was used to analyze the risk factors for sarcopenia. RESULTS: Of 108 female patients treated for osteoporotic fractures between January 2016 and June 2017, sarcopenia was diagnosed in 39 (36.1%). Of these, 41.5% (17/41) had hip fractures, 35% (14/40) had spine fractures, and 29.6% (8/27) had distal radius fractures. Body mass index (BMI; P=0.036) and prevalence of chronic kidney disease (CKD; P=0.046) and rheumatoid arthritis (P=0.051) were significantly different between the groups. In multivariable analysis, BMI (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.55–1.05, P=0.098) and CKD (OR 2.51; 95% CI, 0.38–16.2; P=0.233) were associated with an increased risk of sarcopenia; however, this was not statistically significant. CONCLUSIONS: This study evaluated the prevalence of sarcopenia according to the fracture site and identified associated risk factors in patients with osteoporotic fractures. A longterm, observational study with a larger population is needed to validate our results.
Arthritis, Rheumatoid ; Body Mass Index ; Densitometry ; Diagnosis ; Female ; Hip Fractures ; Humans ; Logistic Models ; Muscle, Skeletal ; Observational Study ; Osteoporosis ; Osteoporotic Fractures ; Prevalence ; Radius Fractures ; Renal Insufficiency, Chronic ; Retrospective Studies ; Risk Factors ; Sarcopenia ; Spine

BACKGROUND: The authors had earlier conducted a retrospective cohort study from 2008 to 2011 in Jeju Island, among 945 hip fracture patients above 50 years of age. Of these 945 patients, 344 patients (36.4%) underwent a bone mineral density test and 218 patients (23.1%) received treatment for osteoporosis. The purpose of this study was to determine whether a patient education program could improve osteoporosis management after hip fracture. The data of the previous study was used for comparison. METHODS: From November 1, 2014 to September 30, 2015, 190 patients above 50 years of age who were admitted for hip fractures at six different hospitals, were enrolled in the present study. During the hospitalization period, patients underwent education sessions and were provided brochures. Patients were evaluated for diagnosis and treatment of osteoporosis at six months after discharge and were followed-up for at least a year. RESULTS: Of the 222 patients with hip fractures, 190 patients (37 men, 153 women) were enrolled at six hospitals in 2015. Dual energy X-ray absorptiometry was performed on 115 patients (60.5%) and 92 patients (48.4%) were prescribed medication for osteoporosis at the time of discharge. A total of 43.7% and 40.2% of the patients were found to be compliant with osteoporosis medication at 6 months and 12 months follow-up respectively. CONCLUSIONS: This interventional multicenter study demonstrated that a patient education program in patients with hip fractures can improve compliance to osteoporosis medication up to 12 months of follow-up.
Absorptiometry, Photon ; Bone Density ; Cohort Studies ; Compliance ; Diagnosis ; Education ; Follow-Up Studies ; Hip Fractures ; Hip* ; Hospitalization ; Humans ; Male ; Osteoporosis* ; Pamphlets ; Patient Education as Topic ; Prospective Studies* ; Retrospective Studies

BACKGROUND: Bone mineral density (BMD) is the indicator of bone quality in at-risk individuals. Along with the fracture risk assessment tool (FRAX), a quick assessment of BMD from routine radiographs may be useful in the case of lacking X-ray absorptiometry data. This study aimed to investigate the correlation of cortical thickness index (CTI) and canal flare index (CFI) with BMD and FRAX and to evaluate their ability to predict femoral neck BMD (nBMD) and FRAX in the general elderly population. METHODS: A total of 560 volunteers (age ≥ 50 years) who underwent hip-spine X-ray, BMD scanning and FRAX calculation were retrospectively reviewed. CTI and CFI were measured on anteroposterior radiographs and analyzed for their correlation with BMD and FRAX and for their ability to predict nBMD. The ability of CTI to predict osteoporosis status (OPS) and fracture risk status (FRS) was also investigated and the threshold values were calculated. All the analyses were performed separately on male and female subjects. RESULTS: Significant differences in CTI, CFI, nBMD and FRAX between males and females were observed. CTI and CFI demonstrated significant positive correlation with nBMD and FRAX (all p < 0.001) in both males and females. CTI, height, and weight significantly predicted nBMD. CTI statistically predicted OPS and FRS, and the values of 0.56 and 0.62 were computed as CTI thresholds for males and females, respectively. CONCLUSIONS: CTI was significantly correlated with nBMD and it predicted nBMD at good prediction levels. Therefore, CTI may be used as a supportive tool in the assessment of OPS and FRS besides BMD and FRAX in clinical practice.
Absorptiometry, Photon ; Aged ; Bone Density* ; Diagnosis ; Female ; Femur Neck ; Femur* ; Hip Fractures ; Humans ; Male ; Osteoporosis* ; Retrospective Studies ; Risk Assessment ; Volunteers

Schwannomas are benign nerve sheath tumors that are typically located in soft tissue. Occasionally, schwannomas involve osseous structures. These intraosseous schwannomas are generally benign neoplasms that account for less than 0.2% of primary bone tumors. Schwannomas are very rarely observed in long bones. We present a case of a schwannoma affecting the proximal femur with a coincident subchondral fracture of the femoral head. A 38-year-old-male presented with left hip pain without deteriorating locomotor function. Plain film radiographs displayed a lobulating contoured lesion within the intertrochanteric portion of the femur. The magnetic resonance imaging (MRI) scans showed a tumor occupying the intertrochanteric region. Diffuse bone marrow edema, especially in the subchondral and head portions of the femur that was possibly due to the subchondral insufficiency fracture was also noted. The lesion was surgically excised and bone grafting was performed. Histologically, there was diffuse infiltrative growth of the elongated, wavy, and tapered cells with collagen fibers, which are findings that are characteristic of intraosseous schwannoma. Although very rare, intraosseous schwannoma should be included in the differential diagnosis of radiographically benign-appearing, non-aggressive lesions arising in the femur. The concomitant subchondral fracture of the femoral head confounded the correct diagnosis of intraosseous schwannoma in this case.
Bone Marrow ; Bone Transplantation ; Collagen ; Diagnosis ; Diagnosis, Differential ; Edema ; Femur ; Fractures, Stress ; Head* ; Hip ; Magnetic Resonance Imaging ; Nerve Sheath Neoplasms ; Neurilemmoma*

Venous thromboembolism (VTE) is a potentially fatal complication that is relatively common after hip surgery. Since patients with a hip fracture have a higher risk of preoperative VTE due to an inability to ambulate after injury and aggravation of underlying age-related conditions, it may be difficult to effectively prevent VTE using only conventional approaches. Very few studies have been published reporting on the prevalence and prevention of VTE in patients with a hip fracture compared to those with hip arthroplasty. For this reason, we aimed to share recent updates on the diagnosis and prevention of VTE in patients with a hip fracture. Preoperative screening tests to diagnose VTE need to be performed more actively following hip fracture and indirect multidetector computed tomography venography is considered the most effective test for this purpose. As the risk of VTE appears to increase with time following a hip fracture, preventive measures should be taken as soon as possible in patients with a hip fracture. A wide variety of mechanical and pharmacological options are available for prophylaxis. When considering patient compliance and preventive impact, intermittent pneumatic compression devices and foot pumps are recommended as mechanical modalities. Of the available preventive medications for patients with a hip fracture, low molecular weight heparin seems to be the most appropriate option because of its short half-life and fast onset of action. Surgery should be performed as soon as possible in patients with hip fractures, and we recommend mechanical and pharmacological methods as active interventions immediately after injury to prevent VTE.
Arthroplasty ; Diagnosis* ; Foot ; Half-Life ; Heparin, Low-Molecular-Weight ; Hip Fractures ; Hip* ; Humans ; Intermittent Pneumatic Compression Devices ; Mass Screening ; Multidetector Computed Tomography ; Patient Compliance ; Phlebography ; Prevalence ; Venous Thromboembolism*

A femoral neck stress fracture in child is rare, particularly in bilateral case. It is easy to miss initially or may be misdiagnosed. The authors experienced a case of bilateral femoral neck stress fracture in a 10-year-old boy with bilateral hip. The patient was successfully healed by conservative treatment. We report this rare case with a review of the literature. A femoral neck stress fracture should be included in the differential diagnosis in children who present with sustained hip or groin pain.
Child* ; Diagnosis, Differential ; Femur Neck* ; Fractures, Stress* ; Groin ; Hip ; Humans ; Male

Recently, we experienced a case where the diagnosis and management of a deep femoral artery rupture was delayed. This vascular complication occurred during the insertion of a distal interlocking screw of a proximal femoral nail for the fixation of an intertrochanteric femur fracture. A 79-year-old male patient was diagnosed with a right intertrochanteric fracture after a fall. We fixed the fracture with a proximal femoral nail (Zimmer® Natural Nail™ System). One day after the procedure, the patient complained of pain and swelling on the anteromedial side of his middle thigh followed by hypotension, anemia and prolonged thigh swelling. Computed tomography angiography was performed 7 days after the procedure. We found a pseudoaneurysm of the perforating artery caused by injury to the deep femoral artery and an intramuscular hematoma in the anterior thigh muscle. We successfully treated the pseudoaneurysm using coil embolization. Throughout the management of intertrochanteric femoral fractures, it is important to be aware and monitor signs and symptoms related to the possibility of blood vessel damage. When a patient presents with swelling and pain on the middle thigh and/or unexplained anemia postoperatively, the possibility that these symptoms are caused by an injury to the femoral artery must be considered.
Aged ; Anemia ; Aneurysm, False ; Angiography ; Arteries ; Blood Vessels ; Diagnosis ; Embolization, Therapeutic ; Femoral Artery* ; Femoral Fractures ; Femur ; Hematoma ; Hip Fractures ; Humans ; Hypotension ; Male ; Rupture* ; Thigh

One of the severe complications of osteoporosis is hip fracture, which can occur even with minimal trauma. This burdensome complication is closely associated with an increased risk of mortality, impairment, and decreased quality of life, resulting in enormous health care costs. Hip fracture is significantly related to a previous history of fracture, and its risk can be determined by bone strength and type of trauma-with falls posing an especially high risk. The first step to prevent osteoporotic fracture is the detection of osteoporosis, relying on the quantification of bone density via imaging techniques such as dual-energy X-ray absorptiometry and quantitative computed tomography. In addition, various preventive strategies have been introduced. Above all, proper supplementation of vitamin D, protein, milk, calcium, folic acid, vitamin B12, and vitamin K is beneficial for prevention of osteoporotic fracture for elderly patients who are susceptible to nutrition imbalance. For elderly patients, rehabilitation is considered to be crucial for increasing function and improving patients' activities of daily living as well. A fall-preventive intervention program has been known to be the effective and useful way for elderly patients to reduce fall risk, which can be assessed with the 'timed up and go' test. A home hazard modification program such as wearing anti-slip shoe devices has been proven to decrease fall risk in community-living elderly. Therefore, diagnosis of osteoporosis, proper supplementation of nutrients, rehabilitation, and a fall-preventive intervention program are essential components in the prevention of hip fracture.
Absorptiometry, Photon ; Accidental Falls ; Activities of Daily Living ; Aged* ; Bone Density ; Calcium ; Diagnosis ; Folic Acid ; Health Care Costs ; Hip Fractures ; Hip* ; Humans ; Milk Proteins ; Mortality ; Osteoporosis ; Osteoporotic Fractures ; Quality of Life ; Rehabilitation ; Shoes ; Vitamin B 12 ; Vitamin D ; Vitamin K