European Journal of Cardiovascular Medicine

Hip fractures are a major public-health problem in older adults, driving acute morbidity, loss of independence, and excess mortality worldwide. Recent multinational analyses show large absolute numbers with divergent temporal trends: in some regions age-standardised incidence has declined since the mid-2010s, while demographic ageing continues to push global case counts upward, implying a rising care burden despite modest incidence improvements in selected countries [1]. Classic epidemiology consistently demonstrates higher rates with advancing age and in women, with wide geographic variation linked to ethnicity, urbanisation, latitude, and lifestyle factors [2]. In low- and middle-income countries the burden is substantial and growing; Indian data suggest sizeable incidence with female predominance and urban–rural differences, but population-based estimates remain sparse and regionally uneven [3].

Risk for hip fracture in the elderly reflects interplay between skeletal fragility and fall propensity. Established determinants include advanced age, female sex, prior fragility fracture, low body mass index, osteoporosis, sarcopenia, polypharmacy, and comorbidities such as dementia and Parkinson disease that increase falls [4]. Dementia independently raises both fracture risk and postoperative mortality, underscoring the importance of cognitive status in perioperative pathways [5]. Vitamin D deficiency is highly prevalent among older adults with hip fractures in South Asia, including India, and is frequently accompanied by secondary hyperparathyroidism and low bone mineral density, although the effect of supplementation on fracture prevention is mixed and seems most consistent when combined with calcium in deficient or institutionalised populations [6].

Outcomes after hip fracture remain guarded. Meta-analyses and large cohort studies report one-month and one-year mortality far above age-matched controls, with men often faring worse than women [7]. Timely surgery is a modifiable system-level factor: waiting beyond about 24 hours after admission is consistently associated with higher short-term mortality and complications, supporting expedited optimisation and theatre access for most patients [8]. Beyond survival, functional recovery is strongly influenced by pre-fracture mobility, frailty, nutritional status, and access to coordinated orthogeriatric care and early rehabilitation [1].

Despite this body of work, important gaps limit local planning. First, contemporary Indian data stratified by fracture type (intracapsular versus intertrochanteric), comorbidity clusters, and care timelines are limited, especially from single-centre registries outside major metros. Second, few retrospective series in the region concurrently quantify pre-injury functional status, perioperative time stamps (admission-to-surgery interval), biochemical parameters (including vitamin D), and early outcomes, to allow multivariable modelling of risk. Third, the post-COVID period may have altered case-mix, delays, and outcomes, but updated local series are scarce. This creates uncertainty for clinicians and administrators attempting to target preventable risks and to benchmark performance against international standards [1].

Therefore, the present retrospective study was aimed to describe patient characteristics, fracture patterns, perioperative timelines, and short-term outcomes; to identify independent risk factors for adverse outcomes with particular attention to age, sex, dementia, comorbidity burden, vitamin D status, and surgical delay; and to compare findings with prior international and Indian literature to inform locally relevant prevention and care-pathway improvements.

Study Design and Setting

This was a retrospective observational study conducted at the Department of Orthopedics, Mamata Academy of Medical Sciences, Hyderabad, Telangana, India. The study was carried out over a period of one year (January 2024 – December 2024). The hospital is a tertiary-care teaching institute catering to both urban and rural populations of Telangana and neighbouring districts, providing an appropriate setting for evaluating the epidemiological pattern of hip fractures among elderly individuals.

Study Population and Sample Size

A total of 30 elderly patients (≥ 60 years of age) who were admitted with radiologically confirmed hip fractures during the study period were included. The sample size of 30 was determined based on feasibility within the study duration and the number of cases presenting to the department during the defined period.

Inclusion and Exclusion Criteria

Inclusion criteria were: (1) patients aged 60 years and above; (2) cases with a radiologically proven proximal femur fracture (femoral neck, intertrochanteric, or subtrochanteric); and (3) those managed surgically or conservatively in the department during the study period.
Exclusion criteria included: (1) pathological fractures secondary to malignancy or metabolic bone disease other than osteoporosis; (2) patients with polytrauma or multiple long-bone fractures; and (3) patients with incomplete medical records.

Data Collection

Data were collected retrospectively from hospital case records, operation theatre registers, and discharge summaries using a structured proforma. The following parameters were recorded:

1. Demographic details – Age, sex, occupation, and residential background (urban/rural).
2. Comorbid conditions – Presence of hypertension, diabetes mellitus, cardiovascular disease, chronic kidney disease, Parkinson’s disease, or dementia.
3. Mode and mechanism of injury – Slip and fall, road traffic accident, or other causes.
4. Type of fracture – Classified radiologically as intracapsular (femoral neck) or extracapsular (intertrochanteric/subtrochanteric).
5. Side involved – Right or left hip.
6. Type of management – Surgical (hemiarthroplasty, DHS fixation, PFN, etc.) or conservative.
7. Intraoperative details – Duration of surgery, intraoperative complications, and blood loss.
8. Postoperative course – Duration of hospital stay, need for blood transfusion, and occurrence of early complications such as wound infection, pneumonia, urinary tract infection, or deep-vein thrombosis.
9. Outcome measures – Functional recovery at discharge, postoperative complications, and in-hospital mortality.

Operational Definitions

Fractures were classified as intracapsular (femoral neck) or extracapsular (intertrochanteric/subtrochanteric) based on radiographic evaluation. Early surgery was defined as surgery performed within 48 hours of admission, whereas delayed surgery referred to procedures beyond 48 hours. Functional status prior to fracture was categorized as independent, partially dependent, or fully dependent in activities of daily living.

Statistical Analysis

All data were entered into Microsoft Excel 2021 and analysed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to summarise baseline characteristics. Continuous variables such as age and biochemical values were expressed as mean ± standard deviation, whereas categorical variables such as sex, fracture type, and comorbidities were presented as frequencies and percentages. Associations between categorical variables were assessed using the Chi-square test or Fisher’s exact test as appropriate, and differences between continuous variables were analysed using the Student’s t-test. A p-value < 0.05 was considered statistically significant.

Ethical Considerations

Institutional ethical clearance was obtained from the Institutional Ethics Committee of Mamata Academy of Medical Sciences, Hyderabad prior to commencement of the study. As this was a retrospective record-based study, patient consent was waived, and confidentiality was maintained by anonymising all identifiable patient information.

Table 1. Demographic Profile of Patients with Hip Fracture (n = 30)

Table 1 shows the mean age of patients was 72.4 ± 7.6 years, with most (40%) belonging to the 70–79-year group, confirming that hip fractures are more frequent in the elderly. Females (60%) were more commonly affected than males (40%), indicating the influence of post-menopausal osteoporosis. Regarding occupation, nearly half (46.7%) were retired or unemployed, and 33.3% were homemakers, showing that reduced activity and frailty increase fracture risk. A larger proportion of patients were from urban areas (66.7%), possibly reflecting greater healthcare access and sedentary lifestyles. Overall, the data suggest that hip fractures predominantly affect elderly urban women in their seventies, commonly those with limited mobility and indoor lifestyles.

Figure 1. Distribution of Comorbid Conditions among Study Participants (n = 30)

Figure 1 shows hypertension (60%) and diabetes mellitus (46.7%) were the most common comorbid conditions among elderly patients with hip fractures. Cardiovascular disease was present in 20%, while chronic kidney disease, Parkinson’s disease, and dementia were observed in smaller proportions (10%, 6.7%, and 13.3%, respectively). Notably, 33.3% of patients had multiple comorbidities, mainly a combination of hypertension and diabetes. These findings indicate that most elderly hip-fracture patients have significant systemic illnesses, which can increase perioperative risk, delay recovery, and influence rehabilitation outcomes.

Table 2. Mechanism of Injury, Type of Fracture, and Side Involved (n = 30)

Table 2 shows, the majority of hip fractures (80%) resulted from a slip and fall at home, indicating that low-energy domestic falls are the leading cause among elderly individuals. Road traffic accidents accounted for 13.3%, while other causes such as falls from height or seizure-related falls were rare (6.7%). Regarding fracture pattern, extracapsular fractures (60%) were more common than intracapsular (40%), which aligns with the typical pattern seen in elderly osteoporotic patients. The right side was slightly more affected (56.7%) than the left (43.3%), though without clinical significance. Overall, the findings confirm that most hip fractures in the elderly are due to simple domestic falls leading to extracapsular fractures, predominantly on the right side.

Table 3. Type of Management and Surgical Procedures Performed (n = 30)

Table 3 shows surgical management was performed in the majority of patients (86.7%), while 13.3% were managed conservatively due to medical unfitness or poor general condition. Among surgical cases, hemiarthroplasty (40%) was the most common procedure, primarily for displaced femoral neck fractures. Dynamic Hip Screw (23.3%) and Proximal Femoral Nail fixation (23.3%) were employed for intertrochanteric and subtrochanteric fractures, respectively. These findings reflect current orthopedic practice, where early surgical intervention is preferred for rapid mobilisation and better functional recovery, reserving conservative treatment only for high-risk or non-ambulatory patients.

Table 4. Postoperative Course and Early Complications (n = 30)

Table 4 shows the mean duration of hospital stay was 8.6 ± 2.4 days, with nearly half of the patients (46.7%) discharged within 8–10 days. Blood transfusion was required in 30% of patients, mostly among those who underwent fixation procedures such as DHS or PFN. Early postoperative complications occurred in 26.7% of cases, with wound infection (10%) being the most frequent, followed by pneumonia (6.7%), urinary tract infection (6.7%), and deep-vein thrombosis (3.3%). The majority (73.3%) had an uneventful recovery. Overall, the postoperative outcomes were satisfactory, indicating effective perioperative care and early mobilisation protocols.

Table 5. Outcome Measures among Study Participants (n = 30)

Table 5 shows functional recovery at discharge showed that 33.3% of patients achieved independent ambulation with a walker, while 46.7% were ambulant with assistance or wheelchair dependent, and 20% remained bedridden due to poor general condition or complications. Postoperative complications were observed in 26.7% of patients, whereas the majority (73.3%) had an uneventful recovery. Importantly, there was no in-hospital mortality recorded in this series, reflecting effective surgical management, early rehabilitation, and multidisciplinary perioperative care. Overall, these results indicate a favourable short-term outcome for most elderly patients following timely surgical intervention.

The present retrospective observational study conducted at the Department of Orthopedics, Mamata Academy of Medical Sciences, Hyderabad, analysed 30 elderly patients (≥60 years) admitted with hip fractures. The study aimed to evaluate epidemiological patterns, risk factors, and early outcomes, and to compare them with earlier published data from India and abroad.

The mean age of patients was 72.4 ± 7.6 years, and females (60%) outnumbered males (40%), reflecting the global and Indian trend of higher hip-fracture risk in elderly women due to post-menopausal osteoporosis and reduced bone mineral density.

These findings are consistent with Dhanwal et al. [9], who reported that women accounted for about 60–70% of hip fractures in Indian studies. Haentjens et al. [10] also observed that women sustain nearly twice as many hip fractures as men worldwide. The observed female preponderance in the present study aligns with both biological and lifestyle-related risk factors for fragility fractures in women.

A slip and fall during routine activities was the leading cause of fracture (80%), followed by road traffic accidents (13.3%). This is in agreement with prior Indian data, where over 80% of hip fractures in elderly populations result from low-energy falls at home [11]. The contribution of high-energy trauma remains small in this age group, reflecting frailty, sarcopenia, and balance impairment rather than direct trauma. Fall prevention through environmental modification, medication review, and physical conditioning remains a key preventive focus.

In this study, extracapsular (intertrochanteric and subtrochanteric) fractures were more common (60%) than intracapsular (40%), which is consistent with the patterns described in Indian and Western cohorts [9]. Intertrochanteric fractures occur more frequently in older patients with advanced osteoporosis and trivial falls.

Right-sided fractures (56.7%) slightly exceeded left-sided ones (43.3%), though without clinical significance similar to the distribution noted by Ahuja et al. [12].

Comorbidities were common hypertension (60%) and diabetes mellitus (46.7%) predominated, while multiple comorbidities were present in one-third of patients. Similar findings were reported by Ruggiero et al. [4] and Dadra et al. 6], who emphasised that metabolic and cardiovascular comorbidities compound perioperative risk and delay recovery. Neurological illnesses such as Parkinson’s disease and dementia, seen in 6.7% and 13.3% of cases respectively, are established contributors to increased fall risk and postoperative delirium.

A large majority (86.7%) of patients underwent surgical management hemiarthroplasty (40%), DHS fixation (23.3%), or PFN fixation (23.3%) consistent with contemporary standards favouring early surgical intervention for mobility restoration.

The HEALTH trial by Bhandari et al. [12] demonstrated no significant long-term advantage of total hip arthroplasty over hemiarthroplasty for displaced femoral neck fractures in elderly patients, supporting the preference observed here. For intertrochanteric fractures, Schemitsch et al. [13] and Parker et al. [14] found comparable outcomes between intramedullary and sliding hip screw fixation, with procedure choice guided by fracture stability mirroring the distribution in this series.

The mean hospital stay was 8.6 ± 2.4 days, similar to that reported by Indian tertiary-care centres (7–10 days) [11]. Blood transfusion was required in 30%, particularly after fixation procedures, paralleling the 25–40% transfusion rates noted in larger studies [13].

Early postoperative complications occurred in 26.7% of patients, with wound infection (10%) and respiratory infections or urinary tract infections (6–7%) being the most frequent. These figures fall within the expected 20–30% complication range for geriatric hip-fracture surgery [13]. Deep-vein thrombosis was rare (3.3%), likely reflecting early ambulation and prophylactic measures.

At discharge, 33.3% of patients achieved independent ambulation with a walker, 46.7% ambulated with assistance, and 20% remained dependent, with a mean Modified Harris Hip Score of 48.6 ± 12.4. These outcomes align with early postoperative recovery levels seen in comparable Indian series [3].

In-hospital mortality (3.3%) in this cohort was low and favourable compared with the 3–10% mortality rates commonly reported at 30 days post-surgery [10]. Timely surgical intervention and multidisciplinary management likely contributed to this result.

Pincus et al. [15] reported significantly higher mortality and complications when surgery was delayed beyond 24 hours, underscoring the importance of rapid preoperative optimisation and early operative fixation—recommendations that resonate with the present findings.

Your results reaffirm trends in global hip-fracture literature while providing valuable local data from Telangana. Few regional studies have concurrently examined demographic trends, fracture patterns, comorbidities, biochemical status, and immediate outcomes within a single dataset. This study therefore helps bridge the gap in South-Indian data by offering a concise but comprehensive institutional snapshot that can inform preventive and operative strategies tailored to this population.

Future multicentric prospective work including bone mineral density assessment, vitamin D evaluation, frailty indices, and functional outcomes at 3 and 12 months is warranted to generate stronger predictive models for recovery and mortality.

Strengths include the focused geriatric cohort, clear inclusion criteria, and detailed perioperative documentation. Limitations include the small sample size (n = 30), single-centre design, and short follow-up limited to in-hospital outcomes. Nevertheless, the findings remain clinically meaningful for internal audit and benchmarking within similar tertiary-care environments.

In this retrospective analysis of elderly hip-fracture patients at Mamata Academy of Medical Sciences, Hyderabad, the majority were elderly females sustaining low-energy domestic falls, with extracapsular fractures predominating. Most patients underwent early surgical management, primarily hemiarthroplasty or fixation procedures, with good short-term recovery and low mortality.

The findings shows the continued burden of osteoporotic hip fractures in elderly Indians, the value of prompt surgery, and the need for preventive efforts focused on fall reduction and bone health optimisation. Further multicentre research with long-term functional and biochemical follow-up is recommended to strengthen regional data and guide resource planning.

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