Small-vessel disease: The predominant cerebrovascular subtype in patients with traumatic neck of femur fracture

The association between stroke and hip fracture is well described with the underlying stroke subtype thought to be cortical stroke associated with hemiplegia. Small-vessel disease (SVD), a subtype of cerebrovascular disease, is characterised by white matter lesions on magnetic resonance imaging (MRI). White matter lesions (WMLs) are associated with an increased risk of gait impairment, falls and hip fracture. We hypothesised that WMLs are a risk factor for hip fracture, independent of the trauma of hip fracture and peri-operative risk factors, and that SVD is the predominant cerebrovascular disease subtype associated with hip fracture. We prospectively studied 26 consecutive patients presenting to a metropolitan teaching hospital with traumatic neck of femur (hip) fracture (THF) and compared them with 27 age-matched controls undergoing elective hip replacement (EHR), as well as 28 age-matched, community-dwelling volunteers (NC). A standardised medical history and MRI scan were performed on all participants. MRI scans were analysed by an experienced neuroradiologist blinded to the clinical diagnosis using a validated, semi-quantitative rating scale for the assessment of WMLs. WML score is significantly greater in both groups of patients compared with age-matched controls. Although those with THF were consistently greater than EHR, this difference failed to reach significance. Compared with age-matched controls, traumatic hip fracture appears to be associated with the extent rather than the topography of WMLs. In our study, SVD is the predominant cerebrovascular disease subtype associated with hip fracture.