On hip fractures in adults under the age of 60

Sammanfattning: The understanding of patients under the age of 60 with hip fractures have been influenced by preconceptions that fractures are due to high-energy trauma and the risk of osteoporosis is low. The patients’ perspectives have seldomly been presented and the surgical results were insufficiently described. This thesis project was developed in response to the relative lack of research on this patient group.In a prospective, multicenter, mixed general population-based cohort study, Paper I collected detailed information on the injury, demographics, epidemiology, lifestyle factors, comorbidity and general health, and DXA was performed at the time of the fracture. Paper II described the fracture classification, and analyzed whether trauma mechanism and osteoporosis determined the fracture pattern. In a qualitative interview study, Paper III illuminated the lived experience of recovery after a hip fracture. Paper IV analyzed national register data to describe the rate of conversion to secondary arthroplasty after internal fixation of displaced and undisplaced femoral neck fractures. Adults under the age of 60 constituted approximately 5% of the total hip fracture population. More than half of the fractures occurred in men and most were aged 50-59. Two thirds of the fractures were displaced or unstable and intracapsular fractures were most common. Two thirds suffered their fractures after low-energy trauma, two thirds had previous disease(s), and half had a previous fracture. On DXA, we found a high prevalence of osteopenia (57%) and osteoporosis (31%). Trauma mechanism and bone mineral density did not explain different hip fracture patterns. The recovery after a hip fracture was a protracted process with lingering pain, functional, and psychosocial challenges and support of rehabilitation was inadequate. After initial internal fixation, a secondary arthroplasty was performed in 25% of displaced and 8% of undisplaced femoral neck fractures at five years.Existing preconceptions should be traded for a nuanced understanding of patients under the age of 60 with hip fractures. A thorough health investigation and DXA assessment is warranted in all patients, regardless of age and trauma mechanism. A long term follow up is justified considering lingering challenges in recovery and the risk of a need for conversion to secondary arthroplasty after internal fixation of femoral neck fractures. Rehabilitation should be diversified and meet the demands of younger patients suffering hip fractures.