Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: A prospective controlled hip fracture study with 206 consecutive patients

The objectives of this study were to learn how hip fracture patients fall, and to compare the mechanics of their falls with those falls that did not r esult in hip fracture. In this way we sought to obtain reliable insight int o the etiology and pathogenesis of hip fracture and fracture prevention. A total of 206 consecutive patients with fresh hip fracture and 100 controls were interviewed and examined between October 1994 and May 1996. The only i nclusion criterion was that the fracture had occurred within 24 hours of ho spital admittance. The control subjects were admitted from the same communi ty after an accidental fall that did not result in hip fracture. The charac teristics of the accident were determined by personal interview and examina tion of the patients within 24 hours of the event. In 98% of the hip fractu re patients, the fracture was a result of a fall. The majority of the patie nts (76%) reported that they had fallen directly to the side. Forty-eight f racture cases had one or more eyewitnesses and their reports supported this observation. In 56% of the hip fracture patients, a fresh subcutaneous hem atoma was seen on the greater trochanter of the proximal femur; such a hema toma was rare in the controls (6%) (P < 0.001), and this gave evidence for the direct impact of the greater trochanter during the fall of the hip frac ture subjects. Most of the elderly fallers who fractured a hip did not mana ge to break the fall, e.g., with an outstretched arm. In conclusion, our re sults suggest that a typical hip fracture is the result of a fall and a sub sequent impact on the greater trochanter of the proximal femur. The clinica l implication of this finding is that effective prevention of hip fractures could be achieved by the diminution of the number and severity of falls of the elderly. We suggest that the severity of the falls (impacts on the gre ater trochanter) could be decreased by an external hip protector.