• Users Online: 1971
  • Print this page
  • Email this page

Table of Contents
Year : 2017  |  Volume : 6  |  Issue : 5  |  Page : 210-213

Emergency treatment of proximal femural fracture within 48h: The Umbria Region experience

University of Perugia, Perugia, Italy

Date of Submission19-Jun-2017
Date of Decision10-Jul-2017
Date of Acceptance18-Jul-2017
Date of Web Publication7-Dec-2017

Correspondence Address:
Pellegrino Ferrara
Division of Orthopedics and Trauma Surgery, University of Perugia, S. Maria della Misericordia Hospital, Perugia
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2221-6189.219614

Rights and Permissions

Objective: To study the main aspects of osteoporotic emergency fracture of the hip in the Umbria Region in the years 2006-2011. Methods: The study was conducted from January 1 of 2006 to December 31 of 2011, and included only patients over 49 years of age. Patients who did not habitually reside in the region were excluded. They were collected in each based on the following data: age, sex, place of residence (urban or rural), time of the year, fractured side, type of trauma, history of fracture contralateral and perioperative mortality. Results: From 2006 to 2011, a progressive increase in the number of femoral fracture admissions in regional hospitals was observed, equal to 4.73% per annum. The incidence went from 6.8 to 8.1 for 1.000 ultra-65th residents. The most affected age groups are those between 75-84 years and 85- 94 years. Conclusions: The epidemiology of osteoporotic hip fracture in the Umbria Region follows a pattern similar to that of other Italian regions. The in-hospital mortality of these patients is partly determined by age and number of complications they suffer during admission. The impact of economic resources on patients who break the osteoporotic hip justifies the implementation of programs for the prevention of osteoporosis and fractures.

Keywords: Eslicarbazepine acetate, Partial-onset seizures, Epilepsy, Antiepileptic drugs, Drug interactions

How to cite this article:
Ferrara P, El Jaouni LK, Talesa GR, Parmeggiani S. Emergency treatment of proximal femural fracture within 48h: The Umbria Region experience. J Acute Dis 2017;6:210-3

How to cite this URL:
Ferrara P, El Jaouni LK, Talesa GR, Parmeggiani S. Emergency treatment of proximal femural fracture within 48h: The Umbria Region experience. J Acute Dis [serial online] 2017 [cited 2022 May 16];6:210-3. Available from: https://www.jadweb.org/text.asp?2017/6/5/210/219614

  1. Introduction Top

The proximal fracture of the femur[1] is the most serious complication of osteoporosis, due to its high mortality and morbidity, as well as to the important social, economic and welfare cost that it generates. Its incidence varies markedly from one country to another and even within from one country, from one region to another. In Italy, proximal femoral fractures generate acute hospitalization and direct costs comparable to those of myocardial infarction and are characterized by a higher incidence of age-related increases[2]. They are burdened with high mortality rates, 5%-8% in the acute phase and 25%-30% within the year, compared to a one-year mortality rate for the same age group no more than 10%, as well as permanent disability: only 20% of patients undergoing surgery for proximal femoral fracture recover the previous level of independence or functional autonomy.

  2. Materials and Methods Top

The histories of all patients have been reviewed with proximal femur fracture treated in the Umbria Region between the 1st of January 2006 and the 31st of December of 2011. Its identification was made by verification of the diagnoses of hospitalization, as well as through the diagnosis of the units of traumatology of the care centers to acute patients of the Umbria Region.

All operated patients had been identified in the verification of the diagnosis of admission and high (in particular they accounted for 97% of the total the same). The following data were collected from each patient: age, sex, place of residence (medium rural or urban), time of year, type of fracture, fractured side, type of trauma, history of contralateral proximal femoral fracture and mortality perioperative. In no case was there a bone lesion focal area underlying the fracture, such as metastasis, of Paget or others[3],[4],[5]. The analysis included only patients over 49 years.

The patients with non-resident hip fractures habitual in Umbria were not included in the study. Fractures were classified as cervical and trochanteric. The mortality perioperative period was defined as that produced during the period of hospitalization. Information on the population of Umbria is obtained from the National Institute of Statistics. The statistical analysis was performed with computer support (Sigma and Horus Hardware)[6],[7],[8]. The results are expressed in the form of Mean±SE. For the assessment of differences Student's t-test was used, comparing percentages, analysis of variance and test of c2, depending on the number and characteristics of the variable to be studied. They are considered significant P-values less than 0.05.

  3. Results Top

From 2006 to 2011, there was a progressive increase in the number of femoral fractures in regional hospitals, which is 4.73% per annum. The incidence went from 6.8 to 8.1 for 1.000 ultra-65th residents. Ultraphytes account for 93% of femoral fractures. The most affected age groups are those between 75-84 years and 85-94 years [Figure 1]. In 2011, 1 699 patients aged 65 years or older (hospitalization rate of 200 cases per 100 000), mainly women (75.3% of cases) with a median age of 84 years, were hospitalized for femoral fracture. In 2011, 91.9% (n = 1 562) of fractured females residing in ultrafood was surgically treated: 204 (13%) within 24 hours, 520 (33%) within 48 hours, the remaining 838 cases in a time between 3 and 20 days from hospitalization [Figure 2]. The treatment or conservative was reserved for 8% of the females fractured[9],[10].
Figure 1: Distribution by age groups of resident patients and hospitalized in regional hospital fractures by femoral fracture, from 2006 to early 2011.

Click here to view
Figure 2: Patients undergoing surgical intervention within two days of entry into the hospital due to femoral fracture (compared to the total number of those who underwent surgery).

Click here to view

The waiting time for access to surgery remained basically stable over the period 2006-2011, which corresponded to 3.47 days and 3.88 days [Figure 3].
Figure 3: Progress in waiting times for surgery for the period 2006-2011.

Click here to view

In the same period, the average duration of hospital stay has increased steadily, from 10.86 days in 2006 to 11.60 days in 2011, while intraospedal mortality (total and postoperative) remained substantially overlapping, respectively 2.5% and 1.7%, in the same period [Figure 4].
Figure 4: Total and post-operative intra-hospital mortality after femoral fracture in the ultra-65-year-olds from 2006-2011.

Click here to view

There were no significant differences between the incidence of fractures in the rural and in the urban environment.

The most frequent type of fracture corresponded to trochanterism (60% in women and 55% in men). The side that fractured most frequency was the left (61% in the women and 58% in males).

  5. Conclusion Top

Surgery should be performed quickly in clinically stable subjects in order to reduce the preoperative waiting within 24-48 hours. In ensuring timely access to the intervention, it is recommended to examine the organizational factors related to this specific process and outcome. The possibility of early intervention requires the availability of operating rooms, surgical and anesthesiologic staff, separate paths between traumatology and election interventions. The hospital organizational model, prepared by companies in agreement with the multidisciplinary team, should be aimed at minimizing cases of delayed intervention for non-clinical reasons.

Fracture surgical stabilization represents the procedural standard for femoral fracture in the elderly[11],[12]. The aim of the surgery is to achieve a stable fracture synthesis to allow a rapid recovery of the ability to walk with load or to return to levels of autonomy and quality of life pre-existing to the traumatic event. Orthogeriatric evaluation and clinical patient stabilization are paramount and should facilitate access to surgery within 24-48 hours[12].

The rapid recovery of mobility after surgery is a pivotal point of the elder patient's pathway with femoral fracture. Practically 90% of all fractures of hip seen in a hospital are attributable to osteoporosis. Osteoporotic hip fracture is a process related to aging and, in large part of published studies to date, it has been communicated an exponential increase in incidence of this fracture with age5-9,27. In the present study has been proven which doubles the incidence for each age group (5 years) from the age of 75 years13. The incidence of hip fracture in Umbria is similar to that of other Italian regions[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24].

Within the world geography, the incidence of osteoporotic hip fracture in this region and in general in Italy25-34, is well below the reported for the countries of northern Europe and Anglo-Saxons, and approach to that presented by other countries European countries.

Regarding sex, the hip fracture is more frequent in women than in males. There are very few populations in which an inverse relationship is observed[35],[36],[37],[38],[39],[40],[41],[42],[43],[44],[45].

The epidemiology of osteoporotic hip fracture in the Umbria Region follows a pattern similar to that of other Italian regions. The in-hospital mortality of these patients is partly determined by age and number of complications they suffer during admission. The impact of economic resources on patients who break the osteoporotic hip justifies the implementation of programs for the prevention of osteoporosis and fractures.

Conflict of interest statement

The authors report no conflict of interest.

  References Top

Melton LJ III, Ilstrup DM, Riggs BL, BeckerbaughRD. Fifty-year trend in hip fracture incidence. Clin Orthop 1982; 162: 144-149.  Back to cited text no. 1
Della Torre P, Petini P, Mancini GB. The epidemiologyof fractures of the proximal end of the femur. Change in the incidence among the population at risk in the city of Perugia, Italy between the periods 1975-77 and 1986-88. Ital J Orthop Traumatol 1991; 17: 555-562.  Back to cited text no. 2
Lizaur-Utrilla A, Puchades A, Sánchez F, Anta, J, Gutiérrez P. Epidemiology of trochanteric fractures of the femur in Alicante, Spain, 1974- 1982. Clin Orthop 1987; 218: 24-31.  Back to cited text no. 3
Boereboom FTJ, Raymakers JA, de Groot RRM, Duursma SA. Epidemiology of hip fractures in The Netherlands: women compared with men. Osteoporosis Int 1992; 2: 279-284.  Back to cited text no. 4
Zetterberg C, Elmerson S, Andersson GBJ. Epidemiology of hip fractures in Göteborg, Sweden, 1940-1983. Clin Orthop 1984; 191: 43-52.  Back to cited text no. 5
Obrant KJ, Bengnr H, Johnell O, Nilsonn BE, Sernbo l. lncreasing age- adjusted risk of fragility fractures: a sign of increasing osteporosis in sucessive generations? Calcif Tissue lnt 1980; 44: 157-167.  Back to cited text no. 6
Stewart IM. Fractures of the neck of femur: incidence and implications. Br Med J 1955; 1: 698- 701.  Back to cited text no. 7
Nagant de Deuschaisnes C, Devogelaer JP. Endocrinologic status of postmenopausal osteoporosis. Clin Rheum Dis 1986; 12: 559-635.  Back to cited text no. 8
Nydegger V, Rizzoli R, Rapin CH, Vasey H, Bonjour JPh. Epidemiology of fractures of the proximal femur in Geneva: lncidence, clinical and social aspects. Osteoporosis lnt 1991; 2: 42-47.  Back to cited text no. 9
Lewinnek GE, Kelsey J, White AA, Kreiger NJ. The significance and comparative analysis of the epidemiology of hip fractures. Clin Orthop Rel Res 1980; 152: 35-44.  Back to cited text no. 10
Sosa Henriquez M, Segarra Sánchez M.C, Limifiana Canal J.M, Priego López M, Betancor León P. Fractura osteoporótica de la extremidad proximal del fémur. Relación con el hábitat y diferencias hospitalarias. Rev Esp Enf Metab Oseas 1993;2:114-117.  Back to cited text no. 11
Marini C, Paparelli F, Barberini L. DGR n. 1411 del 30/11/2015 - Regione Umbria [Online]. Avaliable at: http://www.regione.umbria.it/ documents/18/3914146/DGR+1411_30_11_2015_frattura_femore. pdf/78ed4d27-4e0f-46c7-8124-17367064596c.[Accessed on 10 June 2017].  Back to cited text no. 12
González Domínguez J, Martinez Concha D, Caracuel MA, González Pérez, Gines Martinez F, Gala M, et al. The influence of playing surface on injury risk in italian elite rugby players. Muscles Ligaments Tendons J 2017;7(1):180-185.  Back to cited text no. 13
De Carli A, Fabbri M, Lanzetti RM, Ciompi A, Gaj E, Beccarini G, Vetrano M, Ferretti A. Functional treatment in rotator cuff tears: is it safe and effective? A retrospective comparison with surgical treatment. Muscles Ligaments Tendons J 2017;7(1):40-45.  Back to cited text no. 14
Monaco E, Mazza D, Redler A, Lupariello D, Lanzetti R, Guzzini M, Ferretti A. Segond's fracture: a biomechanical cadaveric study using navigation. J Orthop Traumatol 2017; doi: 10.1007/s10195-017-0460-0.  Back to cited text no. 15
Monaco E, Fabbri M, Lanzetti RM, Del Duca A, Labianca L, Ferretti A. Biomechanical comparison of four coupled fixation systems for ACL reconstruction with bone socket or full-tunnel on the tibial side. Knee 2017;24(4):705-710.  Back to cited text no. 16
Lanzetti RM, Lupariello D, De Carli A, Monaco E, Guzzini M, Fabbri M, Vadalà A, Ferretti A. Can the outside-in half-tunnel technique reduce femoral tunnel widening in anterior cruciate ligament reconstruction? A CT study. Eur J Orthop Surg Traumatol 2017;27(5):659-664.  Back to cited text no. 17
Monaco E, Lanzetti RM, Fabbri M, Redler A, De Carli A, Ferretti A. Anterolateral ligament reconstruction with autologous grafting: A biomechanical study. Clin Biomech (Bristol, Avon) 2017;44:99-103.  Back to cited text no. 18
Guzzini M, Lanzetti RM, Lupariello D, Morelli F, Princi G, Perugia D, et al. Comparison between carbon-peek plate and conventional stainless steal plate in ankle fractures. A prospective study of two years follow up. Injury 2017;48(6):1249-1252.  Back to cited text no. 19
Guzzini M, Lanzetti RM, Proietti L, Mazza D, Fabbri M, Monaco E, et al. Interlocking horizontal mattress suture versus Kakiuchi technique in repair of Achilles tendon rupture: a biomechanical study. J Orthop Traumatol 2017; doi: 10.1007/s10195-017-0455-x.  Back to cited text no. 20
Guzzini M, Vadalà A, Agro A, Di Sanzo V, Pironi D, Redler A, et al. Nonsurgical treatment of Mason type II radial head fractures in athletes. A retrospective study. G Chir 2017;37(5):200-205.  Back to cited text no. 21
Guzzini M, Mazza D, Fabbri M, Lanzetti R, Redler A, Iorio C, Monaco E, Ferretti A. Extra-articular tenodesis combined with an anterior cruciate ligament reconstruction in acute anterior cruciate ligament tear in elite female football players. Int Orthop 2016;40(10):2091-2096.  Back to cited text no. 22
Fabbri M, Monaco E, Lanzetti RM, Perugia D, Guzzini M, Labianca L, et al. Single harvesting in the all-inside graft-link technique: is the graft length crucial for success? A biomechanical study. J Orthop Traumatol 2017;18(1):17-22.  Back to cited text no. 23
Fabbri M, Ciompi A, Lanzetti RM, Vadalà A, Lupariello D, Iorio C, et al. Muscle atrophy and fatty infiltration in rotator cuff tears: Can surgery stop muscular degenerative changes? J Orthop Sci 2016;21(5):614-618.  Back to cited text no. 24
Lanzetti RM, Monaco E, De Carli A, Grasso A, Ciompi A, Sigillo R, et al. Can an adjustable-loop length suspensory fixation device reduce femoral tunnel enlargement in anterior cruciate ligament reconstruction? A prospective computer tomography study. Knee 2016;23(5):837-841.  Back to cited text no. 25
Godenèche A, Freychet B, Lanzetti RM, Clechet J, Carrillon Y, Saffarini M. Should massive rotator cuff tears be reconstructed even when only partially repairable? Knee Surg Sports Traumatol Arthrosc 2017;25(7):2164-2173.  Back to cited text no. 26
Lanzetti RM, Ciompi A, Lupariello D, Guzzini M, De Carli A, Ferretti A. Safety of third-generation artificial turf in male elite professional soccer players in Italian major league. Scand J Med Sci Sports 2017;27(4):435- 439.  Back to cited text no. 27
De Carli A, Lanzetti RM, Ciompi A, Lupariello D, Vadalà A, Argento G, et al. Can platelet-rich plasma have a role in Achilles tendon surgical repair? Knee Surg Sports Traumatol Arthrosc 2016;24(7):2231-2237.  Back to cited text no. 28
De Carli A, Lanzetti RM, Monaco E, Labianca L, Mossa L, Ferretti A. The failure mode of two reabsorbable fixation systems: Swivelock with Fibertape versus Bio-Corkscrew with Fiberwire in bovine rotator cuff. J Orthop Sci 2012;17(6):789-795.  Back to cited text no. 29
Lanzetti RM, Vadalà A, Morelli F, Iorio R, Ciompi A, Vetrano M, et al. Bilateral quadriceps rupture: results with and without platelet-rich plasma. Orthopedics 2013;36(11):e1474-478.  Back to cited text no. 30
Vadalà A, Lanzetti RM, Ciompi A, Rossi C, Lupariello D, Ferretti A. Functional evaluation of professional athletes treated with a mini-open technique for achilles tendon rupture. Muscles Ligaments Tendons J 2014;4(2):177-181.  Back to cited text no. 31
De Carli A, Lanzetti RM, Ciompi A, Lupariello D, Rota P, Ferretti A. Acromioclavicular third degree dislocation: surgical treatment in acute cases. J Orthop Surg Res 2015;10:13.  Back to cited text no. 32
Bisaccia M, Manni M, Colleluori G. et al. The management of pin- care in external fixation technique: povidone-iodine versus sodium hypochlorite 0,05% (amukina-med®) medications. Euro-Mediterranean Biomed J 2016;11 (10):81-87.  Back to cited text no. 33
Maiettini D, Bisaccia M, Caraffa A, Rinonapoli G, Piscitelli L, Bisaccia O, et al. Feasibility and value of radiographic union score hip fracture after treatment with intramedullary nail of stable hip fractures. Acta Inform Med 2016; 24(6): 394-396.  Back to cited text no. 34
Bisaccia M, Rinonapoli G, Bisaccia O, Meccariello L, Ibáňez Vicente C, Ceccarini P, et al. Articular fractures of distal radius: comparison of treatment and clinical and radiological outcomes with volar plate versus hoffmann bridging external fixator. Euro-Mediterranean Biomed J 2017;12(06) 023-028.  Back to cited text no. 35
Bisaccia M, Meccariello L, Rinonapoli G, Rollo G, Pellegrino M, Schiavone A, et al. Comparison of plate, nail and external fixation in the management of diaphyseal fractures of the humerus. Med Arch 2017;71(2): 97-102.  Back to cited text no. 36
Petruccelli R, Bisaccia M, Rinonapoli G, Rollo G, Meccariello L, falzarano G, et al. Tubular vs. Profile plate in peroneal or bimalleolar fractures: Is there a real difference in skin complication? A retrospective study in three level I trauma center. Med Arch 2017; 71(4): 265-269.  Back to cited text no. 37
Pellegrino M, Trinchese E, Bisaccia M, Rinonapoli G, Meccariello L, Falzarano G, et al. Long-term outcome of grade III and IV chondral injuries of the knee treated with Steadman microfracture technique. Clin Cases Miner Bone Metab 2016;13(3): 237-240.  Back to cited text no. 38
Falzarano G, Piscopo A, Grubor P, Rollo G, Medici A, Pipola V, et al. Use of Common inflammatory markers in the long-term screening of total hip arthroprosthesis infections: Our experience. Adv Orthop 2017; Article ID: 9679470, 7 pages. doi: 10.1155/2017/9679470.  Back to cited text no. 39
Rollo G, Pellegrino M, Filipponi M, Falzarano G, Medici A, Meccariello L, et al. A case of the management of Heterotopic ossification as the result of acetabular fracture in a patient with traumatic brain injury. Int J Surg Open 1 2015;30-34. doi: 10.1016/j.ijso.2016.03.001.  Back to cited text no. 40
Di Giacomo LM, Khan MS, Piscitelli L, Bisaccia M, Caraffa A. Management of cyclops syndrome: A case report. J Pak Med Assoc 2016;66(10):1330-1333.  Back to cited text no. 41
Ceccarini P, Rinonapoli G, Gambaracci G, Bisaccia M, Ceccarini A, Caraffa A. The arthroereisis procedure in adult flexible flatfoot grade IIA due to insufficiency of posterior tibial tendon. Foot & Ankle Surg 2016. doi: 10.1016/j.fas.2017.04.003 (article in press)  Back to cited text no. 42
Mercurio U, Troiano G, Manfreda F, Piscitelli L, Schiavone A, Bisaccia M. Tertiary prevention in athletes' diseases: new challenges for the clinical medicine and the public health. Ann Ig 2017;29(4):336-337.  Back to cited text no. 43
Ceccarini P, Rinonapoli G, Nardi A, Nardi A, Bisaccia M, Ceccarini A, Caraffa A. 2017 Foot and Ankle Specialist DOI: 10.1177/1938640016679696  Back to cited text no. 44
Falzarano G, Piscopo A, Rollo G, Medici A, Grubor P, Bisaccia M, et al. Tantalum in type IV and V paprosky periprosthetic acetabular fractures surgery in Paprosky type IV and V periprosthetic acetabular fractures surgery. Musculoskelet Surg 2017;30:doi: 10.1007/s12306-017-0503-y.  Back to cited text no. 45


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  2. Materials and...
  In this article
1. Introduction
3. Results
5. Conclusion
Article Figures

 Article Access Statistics
    PDF Downloaded179    
    Comments [Add]    

Recommend this journal