Prefracture syndrome of the hip fracture: a case control study

Background. Hip fractures result from both bone fragility and trauma, more often a sideways fall. Spontaneous hip fractures have been described; in such cases, patients reported pain ("prefracture" syndrome) in the hip region for weeks before the fracture. Objectives. To identify the proportion of patients who had a pain in the hip region before a hip fracture, to compare this proportion to the one observed in controls and to describe the characteristics of this pain. Patients and methods. For a period of 6 months, each subject (>65 years) treated for hip fracture was prospectively recruited in an orthopaedic surgery department. Exclusion criteria were: alterations of cognitive functions (defined by a mini mental state <20), refusal, and fractures related to bone metastasis or multiple myeloma. Subjects were compared to sex-matched controls consulting in an acute care geriatrics unit. They were asked about the occurrence of pain in hip region before the fracture and its characteristics. Results. Thirty-eight patients (31 women, 7 men, mean age 83.1 [+/-7.6]) were included and were compared to 38 sex-matched controls (31 women, 7 men, mean age 82.7 [+/-6.9]). Among the 38 patients with hip fracture, 10 (26.3%) reported a pain in the hip region, compared with 2 (5.3%) in the control group (p=0.01). Conclusion. A better recognition of "prefracture" pain in the elderly may allow adequate management and treatment of patients, in order to avoid a proportion of hip fractures.