L..THWIN1, S.E.TAN1, W.L.HO1
Tan Tock Seng Hospital1
Given limited evidence to guide clinicians on the management of occult hip fracture, this study aims to determine the radiological and functional outcomes of conservatively treated occult hip fractures in the elderly.
Retrospective cohort study of patients aged 65 and above who presented with isolated, non pathological occult hip fractures from January 2012 to December 2013. Functional outcome using Modified Barthel’s Index (MBI) and radiological outcomes of surgically treated and conservatively treated occult hip fractures were compared.
60 patients (5.6%) were diagnosed with occult hip fracture on MRI (37 occult neck of femur (NOF) fractures and 24 occult intertrochanteric (IT) fractures). 100% of the occult IT fractures healed while 2 out of 6 occult NOF fractures had fracture displacement and non-union. Surgically treated occult hip fractures showed better absolute MBI scores at 6 months and 1 years as well as interval change in MBI scores at all time points. Surgically treated occult hip fractures have significantly shorter LOS than the conservatively treated group (44 vs 11 days, p=0.03) but there was no significant difference in complications and 1-year mortality. A sub- group analysis showed that there was no significant difference in absolute MBI scores and interval change in MBI scores between conservatively and surgically treated IT fractures.
For patients who are fit for surgery, surgical treatment should be considered for occult hip fractures given the benefits of better functional outcomes and shorter length of stay.