Hip fractures are a major acute orthopedic condition among the elderly population. During Hajj (the Islamic pilgrimage to Makkah), hip fractures are a leading cause for admissions and prolonged hospital stay. Unfortunately, the data on injuries during Hajj are scarce or incomplete. The objective of this study is to identify the modifiable risk factors for hip fractures during the Hajj season.
Methodology
Between the sixth and 15th of Dhul Hijjah 1418 H (3-12 April, 1998), a team from the Field Epidemiology Training Program conducted a case-control study in 3 out of 4 major hospitals in Makkah. Cases of hip fractures were compared to other patients with fractures. An interviewer-administered questionnaire was used. In addition to demographic data, cause, site, and mechanism of injury, we also sought chronic diseases or impairment history. The exact type of fracture (surgeon's diagnosis) was noted as well. Odds ratio (OR, 95% CI) was used to compare factors under study among case patients and control patients. The difference between two means was tested using t-test. The level of significance was set at 0.5.
Results
Sixty-one case patients and 118 control-patients from 17 different nationalities were included. Fifty-five (90.2%) case patients were Hajjees (pilgrims) compared with 65 (55.1%) control patients (OR 7.5, 95% CI 2.8-21.1). The mean age in years (SD) of cases and controls was 65 (11) and 42 (22) respectively; the difference between the two means was significant The older the age the higher the risk for hip fracture. The male to female sex ratio was 2:1. Hip fractures were more likely to result from falls (OR 12.9, 95% CI 5.2-33.0), particularly in or around Haram (the Holy Mosque) (OR 10.5, 95% CI 4.3-25.9). Slipping (25, 47.2%) and falling on the escalators (9, 22.0%) were among the main mechanisms reported. Two hip fractures occurred in Zamzam (the well area) and three others in bathrooms annexed to Haram.
Conclusion
Falls, especially around Haram, were the main cause for hip fractures among Hajjees. The risk of falls was facilitated by the hard, smooth, slippery and occasionally wet, marbled surfaces of Haram, the surrounding courtyards, and stairways. Environmental alteration and educational messages could help. Moreover, a trauma surveillance system is recommended.