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Background The aims of this study were to review and update previous projections of the number of proximal femoral fractures in the Northern Ireland population and to ascertain if the trend of increasing age-specific fracture incidence was continuing. Methods Data from 1985 to 1997 was obtained from hospital theatre records to ascertain the number of surgical procedures for proximal femoral fracture. Data for the years 2005 and 2010 was obtained from Northern Ireland's Fracture Outcomes Research Database (FORD) and locally held records in one region not then using FORD. Demographic details were obtained from data published by the Northern Ireland Statistics and Research Agency. Age-specific fracture rates were calculated for males and females in 5 year age brackets and for populations aged 50+ and 65+. Updated projections for the number of proximal femoral fractures by 2020 were made assuming the continuation of the same age-specific fracture rates observed in 2010. Results From 1997 to 2010 the age-specific fracture incidence has fallen or plateaued across most observed age and sex subgroups. Over the period 2010 to 2020, male and female fracture numbers are projected to increase by 23% and 21% respectively which equates to approximately 400 extra proximal femoral fractures. Conclusion Over the next decade there will be an increasing burden on Northern Irish healthcare resources attributed to a rise in the number of proximal femoral fractures. The age-specific fracture rates in this population are no longer rising and hence the expected increase in healthcare costs is primarily a consequence of the anticipated changing demographic trends.

Objective To study the outcome following treatment for proximal femoral fracture in elderly people. Methods All consecutive males and females admitted to the acute fracture service at the Royal Victoria Hospital and the Belfast City Hospital for the 3 years from 1999 to 2001 were studied. The data was collected by trained research nurses. Variables gathered included age, sex, marital status, mental state, pre-injury Barthel score and the American Society of Anaesthesiology (ASA) physical status grading. The information was gathered on admission to hospital and at four, six and 12 months after the injury. Results The total number of patients studied between January 1999 to December 2001 was 2834 of whom 77% were female and 23% were male. The mean (median) length of stay in the acute fracture service was 10.7 (9 days). The mean (median) length of stay in the rehabilitation ward was 35.3 (24 days). The 30-day mortality was 6.9%, the four-month mortality 15.6 % and one year mortality 22.3 %. Of those subjects living at home at the time of fracture 68% remained at home at one year. Factors predicting successful return home were higher mental test score, younger age, female sex, higher Barthel score, better pre-injury mobility and better ASA score. Of those able to walk independently outdoors before injury 40% regained this ability by 12 months. Factors predicting return of pre-injury mobility were poorer pre-injury mobility, younger age, higher mental test score, better ASA category, higher Barthel score, and previous residence at home. The proportion admitted from their own home and discharged by 56 days was 56%. Conclusion The standardised measurement of outcome in hip fracture subjects enables comparison between units and facilitates improvement in standards of care available to the increasing number of elderly patients presenting with proximal femoral fracture.