Lavagnolo U, Maluta T, Marcucci L, De Marchi M, D’Agostino ES, Vecchini E, Magnan B, Samaila EM. Do non-simultaneous bilateral proximal femoral fractures in the elderly have a similar pattern? World J Orthop 2026; 17(7): 119838 [DOI: 10.5312/wjo.119838]
Corresponding Author of This Article
Umberto Lavagnolo, MD, Orthopedics and Traumatology Unit, Department of Surgery and Dentistry, Azienda Ospedaliera Universitaria Integrata, University Hospital of Verona, Piazzale Aristide Stefani 1, Verona 37126, Veneto, Italy. umberto.lavagnolo@univr.it
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Orthopedics
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Lavagnolo U, Maluta T, Marcucci L, De Marchi M, D’Agostino ES, Vecchini E, Magnan B, Samaila EM. Do non-simultaneous bilateral proximal femoral fractures in the elderly have a similar pattern? World J Orthop 2026; 17(7): 119838 [DOI: 10.5312/wjo.119838]
World J Orthop. Jul 18, 2026; 17(7): 119838 Published online Jul 18, 2026. doi: 10.5312/wjo.119838
Do non-simultaneous bilateral proximal femoral fractures in the elderly have a similar pattern?
Umberto Lavagnolo, Tommaso Maluta, Lorenzo Marcucci, Matteo De Marchi, Enrico Salvatore D’Agostino, Eugenio Vecchini, Bruno Magnan, Elena Manuela Samaila
Umberto Lavagnolo, Tommaso Maluta, Lorenzo Marcucci, Matteo De Marchi, Enrico Salvatore D’Agostino, Eugenio Vecchini, Bruno Magnan, Elena Manuela Samaila, Orthopedics and Traumatology Unit, Department of Surgery and Dentistry, Azienda Ospedaliera Universitaria Integrata, University Hospital of Verona, Verona 37126, Veneto, Italy
Author contributions: Lavagnolo U and Maluta T conceived and conducted the study and wrote the manuscript; De Marchi M and D’Agostino ES collected the data; Lavagnolo U processed the database and performed the statistical analyses; Vecchini E, Samaila EM, and Magnan B revised the work, contributing to conceiving, refining the study design and the writing of the manuscript.
Institutional review board statement: In consideration of the retrospective analysis, the Local Research Ethics Committee has confirmed that no ethical approval is required.
Informed consent statement: All patients signed informed consent to be enrolled in the study.
Conflict-of-interest statement: The authors declare no conflict of interest.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.
Data sharing statement: The data supporting the findings of this study are owned by the University of Verona and are available upon reasonable request.
Corresponding author: Umberto Lavagnolo, MD, Orthopedics and Traumatology Unit, Department of Surgery and Dentistry, Azienda Ospedaliera Universitaria Integrata, University Hospital of Verona, Piazzale Aristide Stefani 1, Verona 37126, Veneto, Italy. umberto.lavagnolo@univr.it
Received: February 7, 2026 Revised: March 8, 2026 Accepted: May 25, 2026 Published online: July 18, 2026 Processing time: 154 Days and 7.7 Hours
Abstract
BACKGROUND
Proximal femoral fractures (PFFs) in the elderly carry a substantial risk of a second contralateral fracture non-simultaneous bilateral (NSB) PFF.
AIM
To describe NSB-PFFs in terms of incidence, fracture pattern symmetry, timing between fractures, and associated risk factors.
METHODS
A single-center retrospective analysis was conducted on 1455 patients surgically treated for a PFF between June 2021 and June 2024. Among them, 136 patients with a documented non-simultaneous contralateral PFF were identified. Demographics, fracture type, treatment, and time interval between fractures were collected and analysed.
RESULTS
The incidence of NSB-PFF in the entire group was 10.5%. The cohort was predominantly female (79.4%), with a median age of 86.1 years. A strong correlation was found between the pattern of the first and second fracture (P < 0.0001). The median interval between fractures was 4.1 years, with most events occurring within 2-5 years. Multivariate analysis confirmed that the type of the first fracture was an independent predictor of the contralateral fracture pattern (odds ratio = 6.71; 95%CI: 3.11-14.48; P < 0.001), while age and sex were not significantly associated.
CONCLUSION
Patients sustaining a first PFF represent a high-risk group for a contralateral fracture, which often mirrors the initial fracture pattern and occurs within a vulnerability window.
Core Tip: This retrospective study shows that approximately one in ten elderly patients sustaining a proximal femoral fracture (PFF) will later experience a contralateral fracture. The second fracture frequently reproduces the same fracture pattern as the first, and multivariate analysis confirms that the initial fracture type is an independent predictor of the contralateral fracture pattern. Most second fractures occur within a 2-5 years interval after the first event. These findings suggest that patients with a first PFF represent a clearly identifiable high-risk population in whom targeted secondary prevention strategies should be prioritized.
