To analyze the risk factors for contralateral hip fracture after surgery for primary femoral intertrochanteric fracture in senile patients.

Clinical data of the senior patients (≥ 65 years of age) were reviewed who had been treated for femoral intertrochanteric fracture between December 2008 and February 2014 in our hospital. They were 89 males and 185 females, 65 to 100 years of age (average, 80.0 years). The left side was involved in 133 cases and the right 141. By AO classification, 70 cases were type 31-A1, 192 type 31-A2 and 12 type 31-A3. The patients who had suffered from contralateral hip fracture were put into group A while those who had not into group B. The 2 groups were compared in terms of general clinical data, postoperative rate of positive Trendelenburg sign, Singh index, Harris score at 6 months postoperation, and iliopsoas strength. Binary logistic regression was conducted for factors with P<0.05.

Of all the patients, 274 obtained follow-up from 6 to 66 months (average, 30.1 months). Contralateral hip fracture occurred in 15 cases (6.2%). There were no significant differences between groups A (n=15) and B (n=226) regarding gender, age, laterality, fracture type, concomitant neural disorder, time from injury to surgery, internal fixation method, operative time, blood transfusion, time for hospital stay, postoperative rate of positive Trendelenburg sign, or Harris score at 6 months postoperation (P>0.05), but there were significant differences between the 2 groups regarding intraoperative blood loss, Singh index and iliopsoas strength (P<0.05). Binary logistic regression analysis showed Singh index (OR=0.325, P=0.026) and iliopsoas strength (OR=0.584, P=0.046) were risk factors for contralateral hip fracture after surgery for primary femoral intertrochanteric fracture in senile patients.

Osteoporosis is the pathologic basis for contralateral hip fracture after surgery for primary femoral intertrochanteric fracture in senile patients. The main cause for falling after surgery of intertrochanteric fracture is weakened hip function, the weakened strength of iliopsoas in particular. Therefore, anti-osteoporosis and rehabilitation of the strength of muscles around the hip, especially the iliopsoas, are essential to prevention of contralateral hip fracture following surgery for primary femoral intertrochanteric fracture in senile patients.

Hip fractures; Osteoporosis; Fracture fixation, internal; Strength of muscle