Injury Characteristics and Frailty Patterns in Older Patients Admitted with Hip Fractures in an Irish Hospital

Abstract Background The Irish Hip Fracture Database (IHFD) has played a crucial role in improving hip fracture care over the last ten years. However, the IHFD does not include detailed data on the nature of the injury leading to hip fracture. In this study we examined the characteristics of the injuries leading to hip fractures and their relationship with frailty. Methods We conducted a retrospective chart review of all hip fracture patients aged over 60 years old admitted to an acute orthopaedic floor in a tertiary hospital from May 2023 to May 2024. Patients under 60 years old, and those with periprosthetic fractures were excluded. Delirium was based on a composite of clinical diagnosis and/or a 4AT score ≥ 4. Frailty was quantified using the IFHD Frailty Index. The relationships between various injury characteristics were examined with Student T test and χ square. Results The study included 168 patients, 73.8% female, mean age was 80.1±11.2 years. Of these, 91.1 % were fragility fractures and 4.8% were atraumatic. Indoor falls accounted for 67.9% of cases. Assault led to hip fracture in 5.4% (n=9) of all fractures and 17.0% (n=8) of outdoor fractures. Frailty Index was higher in those with fragility fracture vs. non fragility fracture (0.19 vs. 0.10, p<0.003), as well as in those with indoor vs. outdoor fractures (0.21 vs 0.16, p<0.001). Indoor fractures were significantly associated with delirium (p=0.012), frailty index (p<0.001), and age (p=0.016). Conclusion The great majority of hip fractures were fragility fractures occurring indoors. Patients who suffer hip fractures indoors are frailer and more likely to develop delirium. These findings underscore the importance of targeted falls prevention strategies for frail older adults, including optimizing the home environment and reducing hazards within the home. The number of hip fractures due to assault deserves further examination.