Epidemiology hip fracture

 Epidemiology hip fracture

Hip fracture
Incidence For women, the incidence of hipfracturesincreased fromtwo per1,000 for65-69year oldsto 28per 1,000for womenaged 85 andolder.

For men in the same age groups, the incidence increased from one to 16 per 1,000.1,2
The incidence in the Netherlands is comparable to that in other countries of Western Europe.3,4  In 1999 there were 15,286 hospital admissions in the Netherlands for hip fractures in persons aged 55 or older, of which 3,637 in men and 11,649 in women.2

Sex Female > Male = 3:1 1,2
Age The incidence of hip fractures, both women and men, increases with age.1 The incidence is higher at all ages in women than in men.1,2
Pain location Hip joint
Risk factors For case-findings the main risk factors are:6
– Fracture after the age of 50;
– Existing vertebral fracture;
– Positive family history (especially maternal hip fracture);
– Low body weight;
– Severe immobility;
– Use of corticosteroids prednisolone equivalent ≥ 7.5 mg per day.
Prognosis With an average stay of 24 days after a hip fracture, this pathology takes up 3% of the total number of hospital days in the Netherlands.5
  1. De Laet CE, Van Hout BA, Pols HA. Osteoporosis in the Netherlands; A burden of Illness study. Institute for Medical Technology Assessment, Rotterdam 1996.
  2. Prismant (voorheen Stichting Informatiecentrum voor de gezondheidszorg), Maliebaan 50, 3508 SC Utrecht.
  3. European Commission. Report on Osteoporosis in the European Community – Action for prevention, Brussels 1998.
  4. Elffors I, Allander E, Kanis JA, Gullberg B, Johnell O, Dequeker J, et al. The variable incidence of hip fracture in Southern Europe: the MEDOS Study. Osteoporosis Int 1994; 4(5): 253-63.
  5. Polder JJ, Meerding WJ, Koopmanschap MA, Bonneux L, van der Maas PJ. Kosten van ziekten in Nederland 1994. Rotterdam: Erasmus Universiteit, instituut Maatschappelijke Gezondheidszorg/instituut voor Medische Technology Assessment, 1997
  6. https://www.cebp.nl/media/m1138.pdf


Physical Examination

Test for hip or femur fracture
  1. The patient lieson his back.
  2. The therapist places the stethoscope on the pubic symphysis of the patient.
  3. The therapist taps the patella of the patient and report the noise.
  4. Therapist repeats the process on the other side and listens to difference.
  5. A positive test means a different sound compared to the other leg, a negative test is no difference between the two legs.


Evidence Based Practice

Patellar-Pubic Percussion Test Utility 1
Study Sensitivity (show) Specificity (exclude) QUADAS Score 0-14
Tiru et al.4 96 86 8
Adams & Yarnold1 94 95 9
Bache & Cross2 91 82 8
Misurya et al.3 89 NT 5
Comments: Although the studies are not optimal, this test is diagnostic value as a screening test.
  1. Adams S, Yarnold P. Clinical use of the patellar-pubic percussion sign in hip trauma. Am J Emerg Med. 1997;15:173-175
  2. Bache JB, Cross AB. The Barford test: a useful diagnostic sign in fractures of the femoral neck. Practitioner. 1984;228(1389):305-308
  3. Misurya RK, Khare A, Mallick A, Sural A, Vishwakarma GK. Use of tuning fork in diagnostic auscultation of fractures. Injury. 1987;18(1):63-64
  4. Tiru M, Goh S, Low B. Use of percussion as a screening tool in the diagnosis of occult hip fractures. Signapore Med J. 2002;43:467-469


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