Beyond the Hip: Comparing the Burden of Injury between Cervical Spine Fractures and Neck of Femur Fractures in the Elderly

Introduction

Fractures of the cervical spine and neck of femur (NOF) represent a high burden of injury and mortality in the elderly population. Disability adjusted life years lost (DALY) is a measure of how many years of full health are lost across a population due to an injury.

Methods

Retrospectively 51 patients aged 65 or over that had sustained a cervical spine fracture were identified through ED coding between January 2023 and December 2023. Outcome data on 551 patients aged 65 or over that had sustained a NOF fracture was collected via the National Hip Fracture database for 2023. Local population demographic data was collected from the 2021 census.

Results

The DALY rate in over 65s in Sheffield for cervical fractures was 99.6 per 100,000 compared to NOF fracture DALY rate of 448.5 per 100,000. When adjusted to per injury sustained this translates to 1.8 DALYs per cervical fracture and 0.8 DALYs per NOF fracture. Crude 30-day mortality rate for cervical fractures was 21% compared to 6.1% in NOF fractures.

Burden of injury in NOF showed female DALYs at 249.7 per 100,000 compared with males at 170.3 per 100,000. When adjusted to per injury sustained, males generated 1.14 DALYs per NOF compared with females generating 0.68 DALYs per NOF.

Burden of injury in cervical spine fractures showed female DALYs at 74.2 per 100,000 compared with males at 130.3 per 100,000. When adjusted to per injury sustained, both males and females generated 1.8 DALYs per cervical spine fracture.

Conclusion

At a population level overall burden in cervical fractures is lower than that of neck of femur fractures, however an individual cervical fracture is associated with more than double the burden of injury than that of a neck of femur fracture. 30-day mortality rate was also higher in cervical fractures when compared with NOFs.