Background: Hip fractures contribute to increased morbidity and mortality in the elderly, with published standards of care to guide optimal management. In comparison, there is limited data examining hip fractures in young adults, including comorbidities and outcomes.
Aim: To characterise risk factors and follow-up of hip fractures in young adults.
Methods: Medical records of patients aged 15-49 years with hip fractures were identified using ICD-10 codes from 2009-2015 at Monash Health. Fractures were classified as high-impact (HIF) or minimal-trauma (MTF).
Results: 2,512 patients presented with hip fractures, with 2.5% (n=62) aged 15-49. Mean age was 40 years (±9.0) and 56% were male. MTF occurred in 43 individuals (51% male) and HIF in 10 (70% male). Mechanism of injury was unspecified in 7 patients; 2 pathological fractures were excluded.
Young adults with MTF hip fractures had significantly higher American Society of Anesthesiologists Physical Status Classification System values compared to those with HIF (MTF 2.44±0.9; HIF 1.43±0.5) (p=0.025). Comorbidities were common in the MTF group, including endocrine disorders (MTF 35%; HIF 0%; p=0.046) (hypogonadism, thyroid disorders, type 1/2 diabetes mellitus, parathyroid disease). Other comorbidities included neurological disease (MTF 36%; HIF 10%) and chronic renal disease (9%; 0%).
In the MTF group, Osteoporosis Clinic follow-up was arranged for 35% (15/43), with no osteoporosis follow-up in ~50 % of patients (data not available in 15%). Further fractures occurred in 5/43 MTF patients (12%) during the study period, with a mean time to re-fracture of 315 days post-initial fracture.
Conclusions: Young adults with MTF of the hip have significantly higher ASA scores and rates of endocrine disease compared to those with HIF, with complex co-morbidities including neurological and renal disease. Development of a systematic medical referral pathway is needed to address management of osteoporosis and comorbidities in these young adults.