Geriatric trauma: Initial evaluation and management

Background: Fractures of the proximal femur constitute a major public health problem, with an annual incidence in Spain of 7.6 cases per 1000 inhabitants over 65 years of age. Hip fractures are frequent in elderly patients, related to osteoporosis and with low energy trauma, which means that they can be considered a geriatric syndrome. Simultaneous ipsilateral extraand intra-articular hip fractures are considered as very rare are, and generally speaking, classified as extraor intra-capsular fractures. Moreover, there is no consensus with regard to treatment of these concomitant fractures. Aim: To estimate the incidence of concomitant ipsilateral extraand intracapsular fractures of the proximal femur, and to describe the diagnostic process and the clinical characteristics of these concomitant fractures. Patients and methods: Retrospective cohort study of patients with hip fractures. The incidence of combined extraand intra-capsular fractures was estimated, a confidence interval of 95% (95%CI) was calculated and a descriptive analysis was drawn up. Results: Between May 2010 (the date on which the Orthopaedic and Trauma Surgery Department of our new Hospital began the surgical activity) and December 2016, 33 (median age, 86 years-old) of the 2625 hip fractures were classified as simultaneous extraand intra-capsular ipsilateral fractures. The overall cumulative incidence was of 1.3% (95%CI:0.9-1.8%). In 32 (97%) of the patients, the fracture was a consequence of a low energy trauma (ground level fall), while the remainder was due to a medium energy trauma (skating). In all cases the two fracture lines seem to be independent of each other, which suggests different mechanisms of injury from that of isolated subcapital or intrertrochanteric fracture. Conclusion: The incidence of concomitant ipsilateral extraand intra-capsular fractures of the proximal femur must be taken into account in patients over 65 years of age. It is clinically relevant to identify these concomitant fractures in order to arrive at a correct diagnosis, which will facilitate preoperative planning and the choice of the best treatment to