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OBJECTIVES: The aim of this study is to investigate the incidence of second hip fractures after a previous hip fracture and subsequent mortality in Chinese men and women. METHODS: Data of patients aged 65 years or above with operatively treated hip fracture in the years 2000-2011 in Hong Kong were retrieved from Hospital Authority clinical database. During the follow-up period, second contralateral operatively treated hip fractures were identified. The incidence of a second fracture was determined using survival analysis. RESULTS: A total of 2399 second hip fractures were identified. The cumulative incidence of a second fracture was 1.24% at 1 year and 4.42% at 5 years with 60% of second fractures occurring within 4 years after the initial fracture. In cox regression model, a higher incidence was observed as age increased (hazard ratio [HR], 1.08; P < 0.001). The cumulative mortality at 1 and 5 years after a second fracture was 16.9% and 54.8%, respectively. The median survival after single fracture was 4.9 years, while after a second fracture it was 3.8 years (P < 0.05). Lower survival was observed after the second fracture (HR, 5.44; P < 0.05), in men (HR, 1.91; P < 0.05) and older patients (HR, 1.061; P < 0.05). CONCLUSIONS: Patients with history of hip fracture are at high risk to develop a second fracture. Initiation of treatment and fragility fracture prevention program after primary hip fracture should be started in order to reduce second fracture incidence and related mortality.

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BACKGROUND: The purpose of this registry-based retrospective study was to investigate the risk factors related to one-year mortality in displaced intracapsular fragility hip fracture patients. METHODS: Patients were screened from the Fragility Fracture Registry. Inclusion criterion was displaced intracapsular hip fracture patients with atypical or pathological fractures excluded. One-year mortality was investigated against risk factors including age, gender, past medical history, pre-fracture mobility (PFM), pre-operation ASA grade, delayed surgery over 48 h, post-surgical complications, and length of stay at acute orthopedic ward (LOS). RESULTS: A total of 1050 patients were included for further analysis. Gross one-year mortality was 14.9%. One-year mortality was significantly higher in patients who received non-operative treatment and those who received surgery but delayed over 48 h after admission (both p <  0.001). Male gender (OR = 2.708), advanced age (OR = 1.359), higher risk ASA grades (III to V) (OR = 1.990), past history of gastrointestinal disease (OR = 1.671), and renal impairment (OR = 1.984) were related to higher one-year mortality. The mortality of patients in PFM grade 3 and LOS group 3 was significantly higher (OR = 2.240 and 1.722, respectively). CONCLUSIONS: Higher age, male gender, past gastrointestinal disease and renal impairment, ASA grade over 3, indoor confined pre-fracture ambulatory, and stay at hospital over 15 days were risk factors related to higher one-year mortality in surgically treated displaced intracapsular hip fracture patients. A multi-disciplinary approach is advised to patients identified with these risks factors and co-managed by orthopedic surgeons, geriatricians, and fracture liaison nurses.

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PURPOSE: To compare anatomic lower limb features of anterior cruciate ligament (ACL)-deficient versus -intact knees in Chinese subjects. METHODS: Anatomic lower limb features (mechanical axis, tibiofemoral angle, posterior tibial slope, notch width index, and hip neck-shaft angle) of 25 men and 3 women aged 18 to 39 (mean, 26) years with ACL-deficient knees, and 16 men and 4 women aged 24 to 31 (mean, 28) years with ACL-intact knees were compared using radiography. RESULTS: The notch width index (0.26 vs. 0.29, p=0.02) was significantly smaller in ACL-deficient than ACL-intact knees. CONCLUSION: Small notch width was associated with a thin ACL and can be regarded as an anatomic intrinsic risk factor for ACL injuries.

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