Polytrauma, defined as multiple traumatic injuries involving at least two body regions or organ systems, often presents as a complex clinical scenario with high morbidity and mortality. Among the various injuries sustained in polytrauma, musculoskeletal trauma remains a leading contributor to long-term disability and hospital stay. Hip fractures, in particular, represent a significant subset of musculoskeletal injuries encountered in such patients, due to their association with high-energy mechanisms like road traffic accidents (RTAs), falls from height, and crush injuries [1]. The incidence of hip fractures in polytrauma patients is frequently underreported, largely because life-threatening injuries often demand immediate clinical attention, potentially

overshadowing orthopedic injuries until later stages [2].

Hip fractures are broadly classified into femoral neck, intertrochanteric, and subtrochanteric types. These fractures are especially concerning in the context of polytrauma due to the risk of hemodynamic instability, delayed surgical fixation, and prolonged immobilization, all of which may significantly impact patient outcomes [3]. While isolated hip fractures have been extensively studied, there is a relative paucity of literature focusing on their prevalence in polytrauma settings, particularly in developing countries where trauma care systems may be overburdened or inconsistently standardized [4]. Furthermore, tertiary care centers in such regions often serve as referral hubs, receiving patients from multiple districts and rural areas, making them ideal for retrospective epidemiological studies.

In the global context, the burden of hip fractures is expected to rise dramatically due to increasing life expectancy and urbanization, which in turn contributes to higher rates of traffic accidents and falls [5]. The World Health Organization (WHO) recognizes trauma as a major cause of death and disability in the 15–45 age group, with hip fractures contributing significantly to the disability-adjusted life years (DALYs) [6]. In India, trauma is the leading cause of hospitalization, and yet there remains limited regional data to guide preventive and rehabilitative policies tailored to fracture epidemiology in polytrauma patients [7]. Understanding the true incidence and prevalence of hip fractures within polytrauma cases is crucial not only for resource allocation but also for the development of standardized trauma protocols and early orthopedic intervention strategies.

In addition to incidence and prevalence, it is important to explore the demographic and etiological patterns associated with hip fractures in polytrauma. Younger patients tend to sustain such injuries due to high-velocity trauma, whereas in elderly populations, even minor falls may lead to significant fracture patterns due to osteoporosis and frailty [8]. The interplay between age, sex, mechanism of injury, and pre-existing comorbidities can influence both the type of hip fracture and clinical outcomes [9]. Moreover, the timing of orthopedic intervention in polytrauma cases is critical, as delayed fixation has been shown to increase the risk of complications such as deep vein thrombosis, pulmonary embolism, pressure ulcers, and prolonged rehabilitation [10].

This retrospective study aims to determine the incidence and prevalence of hip fractures in polytrauma cases managed at a tertiary care center, examining demographic trends, injury mechanisms, and associated morbidity. The findings are expected to contribute to a better understanding of injury patterns and help optimize trauma management protocols to ensure early diagnosis and timely orthopedic care.

Study Design and Setting

This study was designed as a retrospective observational analysis conducted at the Department of Orthopedics and Trauma, a tertiary care teaching hospital that functions as a referral center for multiple districts in the region. The study was approved by the Institutional Ethics Committee (IEC No. ___________), and the guidelines outlined in the Declaration of Helsinki were followed.

Study Period and Population

Data were collected for a period of five years, from January 2019 to December 2023. All patients admitted with polytrauma (defined as injury to two or more body systems with an Injury Severity Score [ISS] ≥16) were identified through the hospital's trauma registry and electronic medical records.

Inclusion Criteria

• Patients of all age groups and genders diagnosed with polytrauma.
• Documented evidence of hip fracture confirmed through radiological imaging (X-ray, CT scan).
• Admitted to the emergency or trauma care unit and subsequently treated (conservatively or operatively) at the center.

Exclusion Criteria

• Isolated hip fractures without polytrauma.
• Incomplete medical records or missing radiographic evidence.
• Referred cases who were transferred out before definitive orthopedic evaluation.
• Periprosthetic hip fractures and pathological fractures secondary to malignancy.

Data Collection Procedure

Medical records, radiographic archives, and trauma registry entries were reviewed. Patient demographics (age, sex), mechanism of injury, type and side of hip fracture, associated injuries (head, thoracic, abdominal, spinal, or extremity injuries), ISS, time to diagnosis, time to surgical intervention, duration of hospital stay, and immediate complications were extracted. A standardized proforma was used for data abstraction by two independent reviewers to minimize bias.

Hip fractures were categorized into femoral neck, intertrochanteric, and subtrochanteric types. Associated injuries were classified by anatomical region and severity. The delay in diagnosis or treatment, if any, was noted. Operative versus conservative management was also recorded.

Statistical Analysis

All collected data were entered into Microsoft Excel and analyzed using IBM SPSS Statistics version 26. Descriptive statistics such as frequencies, means, medians, and standard deviations were calculated. Categorical variables were expressed as percentages, and continuous variables were presented as mean ± standard deviation. The incidence and prevalence rates of hip fractures among polytrauma cases were calculated. Chi-square test and independent t-tests were used to compare categorical and continuous variables respectively. A p-value of <0.05 was considered statistically significant.

The study analyzed 1,132 polytrauma cases over a five-year period, identifying 147 patients (13.0%) with hip fractures. Table 1 summarizes demographic and etiological data. The mean age of patients with hip fractures was 54.8 ± 18.3 years, with a slight male predominance (56.5%). Road traffic accidents were the leading cause (74.1%), followed by falls from height (23.8%) and crush injuries (2.1%), highlighting the role of high-energy trauma in hip fracture occurrence among polytrauma patients.

Table 2 details the fracture types and laterality. Intertrochanteric fractures were the most common (46.9%), followed by femoral neck (34.7%) and subtrochanteric fractures (18.4%). Right-sided fractures (55.1%) were slightly more frequent than left-sided ones (44.9%), though the difference was not statistically significant.

Table 3 explores the correlation between age groups and fracture types. A statistically significant association (p=0.034) was noted, with intertrochanteric fractures predominantly seen in patients aged above 60 years. Femoral neck and subtrochanteric fractures had a more even age distribution, suggesting fracture patterns may be influenced by age-related bone quality.

Table 4 presents outcome comparisons between hip fracture and non-hip fracture polytrauma patients. Hip fractures were associated with significantly higher ICU admissions (62.6% vs. 47.0%, p=0.002), longer hospital stays (10.4 vs. 7.1 days, p<0.001), increased need for surgical intervention (83.7% vs. 30.3%, p<0.001), and higher 30-day mortality (14.3% vs. 6.0%, p=0.001), emphasizing the adverse clinical implications of hip fractures in polytrauma patients.

 Table 1: Demographic Characteristics of Hip Fracture Patients (n = 147)

Table 2: Type of Hip Fracture and Side Involvement

Table 3: Association of Hip Fracture Type with Age Group

             *Chi-square test; *p < 0.05 significant

Table 4: Outcome and Complication Analysis in Hip Fracture Group

            *Chi-square or independent t-test used as appropriate; *p < 0.05 significant

The present study aimed to evaluate the incidence and prevalence of hip fractures among polytrauma cases admitted to a tertiary care center over a five-year period. Our findings revealed a hip fracture prevalence of 13.0% among polytrauma patients, with an average annual incidence of 29.4 cases. These results underline the significance of hip injuries within the broader spectrum of polytrauma and highlight the need for early orthopedic evaluation in such patients.

The demographic distribution indicated a male predominance (56.5%), which aligns with previous literature suggesting higher trauma exposure among men, primarily due to greater involvement in high-risk activities and occupations [9]. The mean age of 54.8 years observed in our study further confirms that both younger and older adults are susceptible, although the mechanism of injury tends to differ with age. In our cohort, road traffic accidents were the most common cause (74.1%), consistent with studies conducted in low- and middle-income countries where RTAs are a leading cause of polytrauma [10].

The most frequent type of hip fracture was intertrochanteric (46.9%), followed by femoral neck (34.7%) and subtrochanteric fractures (18.4%). This distribution has clinical significance as intertrochanteric fractures are typically more stable and may be easier to manage surgically compared to femoral neck fractures, which have a higher risk of complications such as avascular necrosis [11]. Interestingly, we found that right-sided fractures were slightly more common than left-sided ones

(55.1% vs. 44.9%), although this difference was not statistically significant.

Age-stratified analysis demonstrated a statistically significant association between fracture type and age group (p = 0.034). Intertrochanteric fractures were more common in patients over 60 years of age, likely due to the increased prevalence of osteoporosis in this population. Conversely, femoral neck fractures appeared more evenly distributed across age groups. These findings are in concordance with literature suggesting that bone quality, fall dynamics, and muscle mass play significant roles in determining fracture patterns in trauma settings [12].

The presence of hip fractures in polytrauma patients was also associated with worse outcomes. ICU admissions, length of hospital stay, need for surgical intervention, and 30-day mortality rates were significantly higher in the hip fracture group. These findings echo previous research demonstrating that orthopedic injuries, although often not immediately life-threatening, contribute substantially to morbidity and delayed recovery in polytrauma scenarios [13]. The increased length of hospital stay (10.4 ± 4.8 days vs. 7.1 ± 3.6 days; p < 0.001) and higher ICU admission rates (62.6% vs. 47.0%; p = 0.002) in our study can be attributed to the complex management of concurrent injuries, the need for surgical fixation, and the risk of complications such as fat embolism, infections, and pressure ulcers.

Notably, the 30-day mortality rate in hip fracture patients was 14.3%, significantly higher than that in polytrauma patients without hip fractures (6.0%). This reinforces the view that hip fractures, particularly in the elderly or those with pre-existing comorbidities, may serve as a prognostic indicator in trauma patients. Delayed surgical intervention due to concurrent injuries or systemic instability may further contribute to the elevated mortality observed [14].

From a clinical perspective, the study highlights the necessity of a multidisciplinary trauma team that includes orthopedic surgeons for early assessment of musculoskeletal injuries. In many trauma centers, life-threatening conditions take priority, and orthopedic assessments may be delayed. However, our findings suggest that early identification and stabilization of hip fractures could potentially improve outcomes, reduce complications, and decrease hospitalization time.

Moreover, this study underscores the need for enhanced preventive measures. Given that RTAs were the predominant mechanism of injury, efforts toward stricter traffic regulations, helmet and seatbelt enforcement, and improved road infrastructure could help reduce the incidence of such injuries. In elderly populations, screening for osteoporosis and fall prevention programs could mitigate the risk of fractures resulting from minor trauma.

A limitation of this study includes its retrospective design, which may be subject to documentation bias. Additionally, we did not evaluate long-term functional outcomes post-discharge, which would provide valuable insights into recovery trajectories. However, the relatively large sample size and use of standardized data abstraction tools strengthen the validity of our findings.

Future prospective studies incorporating long-term follow-up and patient-reported outcome measures are warranted. These could provide a deeper understanding of the socioeconomic and rehabilitative burden imposed by hip fractures in polytrauma patients. Furthermore, cost-effectiveness analysis of early orthopedic intervention in trauma settings would be beneficial to guide healthcare resource planning.

This retrospective study demonstrates a significant prevalence of hip fractures in polytrauma cases, particularly among middle-aged and elderly patients involved in road traffic accidents. Intertrochanteric fractures were the most common, and the presence of a hip fracture was associated with increased ICU admissions, longer hospital stays, and higher short-term mortality. The findings emphasize the importance of prompt orthopedic assessment and integrated trauma care to optimize outcomes. Preventive strategies targeting traffic safety and elderly fall reduction should also be prioritized. Further prospective research is needed to evaluate long-term outcomes and cost-effectiveness of early orthopedic interventions in polytrauma patients [15].

1. Giannoudis PV, Pape HC, Roberts CS. Practical Procedures in Orthopaedic Trauma Surgery. Springer; 2006.
2. Pape HC, Giannoudis PV, Krettek C. The timing of fracture treatment in polytrauma patients: relevance of damage control orthopedic surgery. Am J Surg. 2002;183(6):622–629.
3. Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch EH, DeBeer J, et al. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ. 2010;182(15):1609–1616.
4. Rohella D, Swathy APJ, Ajmeera R, Das P, Tiwari RV, Tiwari HD. Comparison of Quality of Life in Patients Operated for Knee Surgery via Conventional Method and Arthroscopy: An Original Research. J Pharm Bioallied Sci. 2023 Jul;15(Suppl 1):S293–S298. doi:10.4103/jpbs.jpbs_498_22.
5. Balu PRS, Syed AK, Kotian T, Padala HSS, Gupta S, Tiwari R, Kamboj S. Efficacy of Different Triage Protocols in Reducing Waiting Times in Emergency Settings: A Randomized Controlled Trial. J Pharm Bioallied Sci. 2025 Feb 28. doi:10.4103/jpbs.jpbs_1481_24.
6. Ganaraj S, Tiwari RVC, Dixit Tiwari H, Dutta P, Jaiswal A, Kalmee Syed A. Role of Saliva in Conservative Dentistry. Int J Early Child Spec Educ (INT-JECSE). 2022;14(1):3697–3703.
7. Arun Patyal, Dr. Rahul VC Tiwari, Dr. Heena Dixit Tiwari, Dr. Praveen Kumar Varma, Dr. Afroz Kalmee Syed, Dr. Akriti Mahajan. Comparative Evaluation of Root Resorption Associated with Maxillary Canine in OPG versus CBCT: An Original Research. J Cardiovasc Dis Res. 2022;13(4):782–786.
8. Viral BM, Rashmi D, Afroz KS, Akriti M, Priyanjali D, Alice, Jeevana MSS. Comparative Study of Various Methods for Estimation of Amount of Blood Loss in Postpartum Hemorrhage: An Original Research. Turkish J Physiother Rehabil. 2021;32(3):45222–45228.
9. Chen YH, Ho ML, Hsu YH, Wang CJ. The epidemiology and mortality risk factors of hip fracture in Taiwan: a population-based study. Bone. 2008;42(3):566–573.
10. Mock C, Quansah R, Krishnan R, Arreola-Risa C, Rivara F. Strengthening the prevention and care of injuries worldwide. Lancet. 2004;363(9427):2172–2179.
11. Parker MJ, Gurusamy K. Internal fixation implants for intracapsular proximal femoral fractures in adults. Cochrane Database Syst Rev. 2006;(4):CD001467.
12. Bhandari M, Swiontkowski MF. Management of acute hip fracture. N Engl J Med. 2017;377(21):2053–2062.
13. Holstein JH, Culemann U, Pohlemann T. What are predictors of mortality in patients with pelvic fractures? Clin Orthop Relat Res. 2012;470(8):2090–2097.
14. Patel NK, Sarraf KM, Joseph S, Lee C, Middleton FR. Implementing the National Hip Fracture Database: an audit of care. Injury. 2013;44(12):1934–1939.
15. Balogh ZJ, Reumann MK, Gruen RL, Mayer-Kuckuk P, Schuetz MA, Harris IA, et al. Advances and future directions for management of trauma patients with musculoskeletal injuries. Lancet. 2012;380(9847):1109–1119.