Text 1 Journal Abstract - NSW Study of Hip Fracture Admissions

Objective: To examine trends in hospital admission for hip fracture in New South
Wales between July 1990 and June 2000.
Setting: Public and private acute-care hospitals in NSW.
Participants: Admissions of patients aged 50 years and over with a primary diagnosis
of fracture of the neck of femur.
Results: Between July 1990 and June 2000, the number of admissions to NSW acute-
care hospitals for hip fracture increased by 41.9% in men (from 1059 to 1503 per
year) and by 31.2% in women (from 3160 to 4145 per year). However, age-specific
and age-adjusted rates remained practically unchanged. The average length of stay
for admissions for hip fracture decreased significantly from 19.2 days in 1990–
1991 to 14.2 days in 1999–2000. No significant change was observed in the overall
inpatient death rates per 1000 admissions.
Conclusions: The findings support recent reports that the increase in hip fracture
rates during most of the past century may have ended. However, the number of
admissions for hip fracture is still rising. Preventive measures to reduce the burden of
this condition on the healthcare system and community need to be pursued and
strengthened.

Text 2 Hip fracture incidence

United States
In the United States, hip fracture occurs in approximately 80 per 100,000 persons, or
approximately 250,000 persons each year. The rate of hip fracture increases with age,
doubling each decade after age 50 years. Nearly half of all hip fractures occur in
adults older than 80 years. Hip fracture at a young age is rare and is usually the result
of a high-velocity injury or, rarely, secondary to bone pathology.

International
The US frequency of hip fracture, when age and sex are adjusted, ranks the highest in
the world. Western Europe and New Zealand also have reported high rates, with the
lowest rates occurring in the South African Bantu people and in East Asian countries,
where the incidence of osteoporosis is low.

Text 3 Symptoms of Hip Fracture

Hip fractures almost always cause pain, weakness in the affected leg, or both.
Pain occurs partly because the ends of the broken bone move around,
injuring the surrounding tissue. Most people with a displaced hip fracture
cannot walk or stand. When they are lying on their back, the affected leg may
appear shorter than the other leg, and the foot of the affected leg turns out
(rather than pointing straight up). Some people with an impacted hip fracture
can walk, although with pain.
The stress of having a hip fracture can lead to other problems. Pain due to a
hip fracture, the drugs used to control pain, and the experience of
hospitalization and surgery may cause an older person to become confused,
disoriented, forgetful, and anxious. A change in living arrangements, if
needed, can be upsetting. A person may become depressed, especially if a
fracture disrupts normal activities and requires a lot of time and adjustments
while healing.

Text 4 Mortality/Morbidity of Hip Fractures

 The reported overall mortality rate of hip fractures is 15-20%, yet in older
persons this can increase to 36% over the year following hip fracture. Rate of
mortality is greatest in the first few months following injury but remains high
for up to 1 year. It then returns to the same rate for age- and sex-matched
people without hip fracture.
 Morbidity associated with hip fracture is staggering, especially in older
persons. Morbidity from immobilization includes development of deep vein
thrombosis, pulmonary embolism, pneumonia, and muscular deconditioning.
Morbidity from surgical procedures includes complications of anaesthesia,
postoperative infection, loss of fixation, malunion or non-union, as well as the
complications associated with immobilization as outlined above.

Reading – Subtest A Level III (four texts)

Hip Fracture
Complete the following summary using the
information in the texts provided. You do
not need to read each text from beginning to
end to complete the task. You should scan
the texts to find the information you need.
Gaps may require 1, 2 or 3 words. You
should write your answers next to the
appropriate number in the right hand
column. Use correct grammar and spelling –
marks will be lost if there is incorrect
spelling. Please write legibly.

Summary Task

10

11

12

13

Hip (1) is a major health issue around the world, with (2) figures showing
250,000 cases per (3) in that country alone. It is a condition of older people,
with (4) the sufferers being over 80. Most Western countries have comparable
rates, but figures from the South African (5) people and (6) communities are
lower, due to the incidence of (7) being lower.
Although the (8) features of this condition have been well described, being
pain, shortening, usually the inability to (9) and the turning outwards of the
(10) on the affected side, there are other features that are sometimes
overlooked. (11) due to pain, drugs or the experience of (12) or surgery can
be a problem, and the disruption of normal activities can lead to (13).

14

15

17

18

19

20

21

22

23

24

25

26

27

The cost to the (14) system of this condition is considerable, although the
length of time (15) has reduced in recent years. NSW figures show a
reduction from 19.2 days to (16) over the 10 year period up to the year 2000,
with the inpatient death rates being (17) over this time.
However, the overall mortality and (18) statistics of hip fracture remain very
high, and the death rate may be (19) in older people in the year after a
fracture. Morbidity factors include (20), leading to thromboembolic disease,
(21) and muscular deconditioning, and surgical complications, including (22)
complications, post-operative (23), loss of fixation, (24) and non-union. There
is no doubt that (25) to reduce the burden of this condition on the health care
system
and the (26) need pursuing and (27).

Hip fracture is a major health issue around the world, with US figures
showing 250,000 cases per year in that country alone. It is a condition of
older people, with nearly half the sufferers being over 80. Most Western
countries have comparable rates, but figures from the South African Bantu
people and East Asian communities are lower, due to the incidence of
osteoporosis being lower.
Although the clinical / main/ common features of this condition have been
well described, being pain, shortening, usually (but not always) the inability to
walk / weight bear and the turning outwards of the foot on the affected side,
there are other features that are sometimes overlooked. Confusion due to
pain, drugs or the experience of hospitalisation or surgery can be a problem,
and the disruption of normal activities can lead to depression.
The cost to the health system of this condition is considerable, although the
length of time in hospital has reduced in recent years. NSW figures show a
reduction from 19.2 days to 14.2 days over the 10 year period up to the year
2000, with the inpatient death rates being unchanged over this time.
However, the overall mortality and morbidity statistics of hip fracture remain
very high, and the death rate may be 36% in older people in the year after a
fracture. Morbidity factors include immobilisation, leading to thromboembolic
disease, pneumonia and muscular deconditioning, and surgical
complications, including anaesthetic complications, post-operative infection,
loss of fixation, malunion and non-union. There is no doubt that preventive /
preventative measures to reduce the burden of this condition on the health
care system and the community need pursuing and strengthening.