Etiological factors and clinical outcomes in extracapsular and intracapsular hip fractures among older adults:  A gender‐specific analysis

Radcliffe Lisk; Keefai Yeong; David Fluck; Jonathan Robin; Christopher H. Fry; Thang S. Han

doi:10.1002/pmrj.13326

Etiological factors and clinical outcomes in extracapsular and intracapsular hip fractures among older adults: A gender‐specific analysis

Radcliffe Lisk
, Keefai Yeong
, David Fluck
, Jonathan Robin
, Christopher H. Fry
, Thang S. Han^*

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

1 Citation (Scopus)

Abstract

Background
Compared to patients with intracapsular fractures (ICFs), those with extracapsular fractures (ECFs) had worse outcomes. However, most studies of risk factors for these fractures lacked relevant potential reasons, particularly nutritional status, and adjustment for confounding factors. Furthermore, less is known about their effects on clinical outcomes.

Objective
To conduct a gender-specific analysis of community-dwelling individuals admitted with hip fractures to examine the association of clinical risk factors and health care measures.

Design
Monocentric cross-sectional study.

Setting
Orthopedic trauma department.

Participants
A total of 787 women and 318 men of similar mean age (±SD): 83.1 years (±8.6) and 82.5 years (±9.0), respectively.

Main Outcome Measures
Multivariable logistic regression analyzed risk factors including age, gender, dementia, stroke, ischemic heart disease, diabetes, prefracture mobility, alcohol consumption, American Society of Anesthesiologists grades, drug history, and nutrition status for assessing risk factors and outcomes associated with ECFs and ICFs.

Results
Compared to ICFs, for each additional year of age, women had a 3% and men 4% greater association with ECFs. Among women only, ECFs were associated with risk of malnutrition: odds ratio [OR] = 1.70 (95% CI, 1.17–2.48) or malnourishment: OR = 1.93 (95% CI, 1.06–3.52), stroke: OR = 1.85 (95% CI, 1.16–2.97), and diabetes: OR = 1.92 (95% CI, 1.21–3.06). Women with ECFs were less likely to be discharged to their own homes: OR = 0.56 (95% CI, 0.38–0.83); but more likely to be discharged to a rehabilitation unit: OR = 1.81 (95% CI, 1.21–2.71) and readmitted to hospital within 30 days of discharge ≥1 time: OR: 2.39 (95% CI, 1.27–4.50) or ≥2 times: OR = 3.48 (95% CI, 1.05–11.57): they did not differ in discharge to residential or nursing care or in-hospital mortality. Among men, there were no differences in discharge destinations or readmissions between types of fractures.

Conclusions
Compared to ICFs, a greater number of risk factors associated with ECFs were identified more often in women than in men, and ECFs also have greater influences on clinical outcomes in women.

Original language	English
Pages (from-to)	793-803
Number of pages	11
Journal	PM&R
Volume	17
Issue number	7
Early online date	5 Feb 2025
DOIs	https://doi.org/10.1002/pmrj.13326
Publication status	E-pub ahead of print - 5 Feb 2025

Bibliographical note

Publisher Copyright:
© 2025 The Author(s). PM&R published by Wiley Periodicals LLC on behalf of American Academy of Physical Medicine and Rehabilitation.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Access to Document

10.1002/pmrj.13326Licence: CC BY

Handle.net

Persistent link

Cite this

@article{41bee31d48e548db8f76834fc1808c6d,

title = "Etiological factors and clinical outcomes in extracapsular and intracapsular hip fractures among older adults: A gender‐specific analysis",

abstract = "Background Compared to patients with intracapsular fractures (ICFs), those with extracapsular fractures (ECFs) had worse outcomes. However, most studies of risk factors for these fractures lacked relevant potential reasons, particularly nutritional status, and adjustment for confounding factors. Furthermore, less is known about their effects on clinical outcomes. Objective To conduct a gender-specific analysis of community-dwelling individuals admitted with hip fractures to examine the association of clinical risk factors and health care measures. Design Monocentric cross-sectional study. Setting Orthopedic trauma department. Participants A total of 787 women and 318 men of similar mean age (±SD): 83.1 years (±8.6) and 82.5 years (±9.0), respectively. Main Outcome Measures Multivariable logistic regression analyzed risk factors including age, gender, dementia, stroke, ischemic heart disease, diabetes, prefracture mobility, alcohol consumption, American Society of Anesthesiologists grades, drug history, and nutrition status for assessing risk factors and outcomes associated with ECFs and ICFs. Results Compared to ICFs, for each additional year of age, women had a 3\% and men 4\% greater association with ECFs. Among women only, ECFs were associated with risk of malnutrition: odds ratio [OR] = 1.70 (95\% CI, 1.17{\textendash}2.48) or malnourishment: OR = 1.93 (95\% CI, 1.06{\textendash}3.52), stroke: OR = 1.85 (95\% CI, 1.16{\textendash}2.97), and diabetes: OR = 1.92 (95\% CI, 1.21{\textendash}3.06). Women with ECFs were less likely to be discharged to their own homes: OR = 0.56 (95\% CI, 0.38{\textendash}0.83); but more likely to be discharged to a rehabilitation unit: OR = 1.81 (95\% CI, 1.21{\textendash}2.71) and readmitted to hospital within 30 days of discharge ≥1 time: OR: 2.39 (95\% CI, 1.27{\textendash}4.50) or ≥2 times: OR = 3.48 (95\% CI, 1.05{\textendash}11.57): they did not differ in discharge to residential or nursing care or in-hospital mortality. Among men, there were no differences in discharge destinations or readmissions between types of fractures. Conclusions Compared to ICFs, a greater number of risk factors associated with ECFs were identified more often in women than in men, and ECFs also have greater influences on clinical outcomes in women.",

author = "Radcliffe Lisk and Keefai Yeong and David Fluck and Jonathan Robin and Fry, \{Christopher H.\} and Han, \{Thang S.\}",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s). PM\&R published by Wiley Periodicals LLC on behalf of American Academy of Physical Medicine and Rehabilitation.",

year = "2025",

month = feb,

day = "5",

doi = "10.1002/pmrj.13326",

language = "English",

volume = "17",

pages = "793--803",

journal = "PM\&R",

issn = "1934-1482",

publisher = "Elsevier Inc.",

number = "7",

}

TY - JOUR

T1 - Etiological factors and clinical outcomes in extracapsular and intracapsular hip fractures among older adults

T2 - A gender‐specific analysis

AU - Lisk, Radcliffe

AU - Yeong, Keefai

AU - Fluck, David

AU - Robin, Jonathan

AU - Fry, Christopher H.

AU - Han, Thang S.

PY - 2025/2/5

Y1 - 2025/2/5

N2 - Background Compared to patients with intracapsular fractures (ICFs), those with extracapsular fractures (ECFs) had worse outcomes. However, most studies of risk factors for these fractures lacked relevant potential reasons, particularly nutritional status, and adjustment for confounding factors. Furthermore, less is known about their effects on clinical outcomes. Objective To conduct a gender-specific analysis of community-dwelling individuals admitted with hip fractures to examine the association of clinical risk factors and health care measures. Design Monocentric cross-sectional study. Setting Orthopedic trauma department. Participants A total of 787 women and 318 men of similar mean age (±SD): 83.1 years (±8.6) and 82.5 years (±9.0), respectively. Main Outcome Measures Multivariable logistic regression analyzed risk factors including age, gender, dementia, stroke, ischemic heart disease, diabetes, prefracture mobility, alcohol consumption, American Society of Anesthesiologists grades, drug history, and nutrition status for assessing risk factors and outcomes associated with ECFs and ICFs. Results Compared to ICFs, for each additional year of age, women had a 3% and men 4% greater association with ECFs. Among women only, ECFs were associated with risk of malnutrition: odds ratio [OR] = 1.70 (95% CI, 1.17–2.48) or malnourishment: OR = 1.93 (95% CI, 1.06–3.52), stroke: OR = 1.85 (95% CI, 1.16–2.97), and diabetes: OR = 1.92 (95% CI, 1.21–3.06). Women with ECFs were less likely to be discharged to their own homes: OR = 0.56 (95% CI, 0.38–0.83); but more likely to be discharged to a rehabilitation unit: OR = 1.81 (95% CI, 1.21–2.71) and readmitted to hospital within 30 days of discharge ≥1 time: OR: 2.39 (95% CI, 1.27–4.50) or ≥2 times: OR = 3.48 (95% CI, 1.05–11.57): they did not differ in discharge to residential or nursing care or in-hospital mortality. Among men, there were no differences in discharge destinations or readmissions between types of fractures. Conclusions Compared to ICFs, a greater number of risk factors associated with ECFs were identified more often in women than in men, and ECFs also have greater influences on clinical outcomes in women.

AB - Background Compared to patients with intracapsular fractures (ICFs), those with extracapsular fractures (ECFs) had worse outcomes. However, most studies of risk factors for these fractures lacked relevant potential reasons, particularly nutritional status, and adjustment for confounding factors. Furthermore, less is known about their effects on clinical outcomes. Objective To conduct a gender-specific analysis of community-dwelling individuals admitted with hip fractures to examine the association of clinical risk factors and health care measures. Design Monocentric cross-sectional study. Setting Orthopedic trauma department. Participants A total of 787 women and 318 men of similar mean age (±SD): 83.1 years (±8.6) and 82.5 years (±9.0), respectively. Main Outcome Measures Multivariable logistic regression analyzed risk factors including age, gender, dementia, stroke, ischemic heart disease, diabetes, prefracture mobility, alcohol consumption, American Society of Anesthesiologists grades, drug history, and nutrition status for assessing risk factors and outcomes associated with ECFs and ICFs. Results Compared to ICFs, for each additional year of age, women had a 3% and men 4% greater association with ECFs. Among women only, ECFs were associated with risk of malnutrition: odds ratio [OR] = 1.70 (95% CI, 1.17–2.48) or malnourishment: OR = 1.93 (95% CI, 1.06–3.52), stroke: OR = 1.85 (95% CI, 1.16–2.97), and diabetes: OR = 1.92 (95% CI, 1.21–3.06). Women with ECFs were less likely to be discharged to their own homes: OR = 0.56 (95% CI, 0.38–0.83); but more likely to be discharged to a rehabilitation unit: OR = 1.81 (95% CI, 1.21–2.71) and readmitted to hospital within 30 days of discharge ≥1 time: OR: 2.39 (95% CI, 1.27–4.50) or ≥2 times: OR = 3.48 (95% CI, 1.05–11.57): they did not differ in discharge to residential or nursing care or in-hospital mortality. Among men, there were no differences in discharge destinations or readmissions between types of fractures. Conclusions Compared to ICFs, a greater number of risk factors associated with ECFs were identified more often in women than in men, and ECFs also have greater influences on clinical outcomes in women.

U2 - 10.1002/pmrj.13326

DO - 10.1002/pmrj.13326

M3 - Article (Academic Journal)

C2 - 39907419

SN - 1934-1482

VL - 17

SP - 793

EP - 803

JO - PM&R

JF - PM&R

IS - 7

ER -