Hip Fragility Fractures: One Or Two Pathologies? A Systematic Review and Meta-Analysis of Demographic, Diagnostic and Therapeutic Aspects.

There is evidence that hip fragility fractures (HFF) are at least two different types of disease: intra- and extracapsular fractures (ICF and ECF). However, they are still mainly considered as one entity. Differentiating them may provide clues to improve their prevention, treatments and prognosis, and to reduce clinical, organisational and economic impacts. This work addressed published evidence about differences between ICF and ECF in older people, comparing demographic, etiologic, and therapeutic aspects, producing a summary of the state of the art, and determining which variables are associated with significant differences. A systematic review based on PRISMA methodology was conducted, searching in Google Scholar, Springer and Scopus from 01.01.1980 to 01.03.2024. Publications with p-values obtained from quantitative tests (p < 0.05 statistically significant) were included. For meta-analysis, Weighted Mean Method was used. 51 studies (19 countries, 5 continents, 129,075 subjects) were included. 78.4% of main objectives was searching for differences between both HFF. 60.8% provide evidence for demographic variables; 29.4% for diagnostic variables; 11,8% for therapeutic variables. ECF occurred at an older age (p < 0.05) in 43 studies (84.3%). There were no differences in sex (96.1%). 14 routine orthogeriatric blood parameters were studied. Haemoglobin, vitamin-B12, albumin and parathormone presented differences in >50% of the studies. Surgical management was significantly different in all studies. Significant demographic, diagnostic and therapeutic differences exist between ICF and ECF. There is a lack of studies combining variables, especially haematological exams.