Highlights
- •Fracture displacement in intracapsular proximal femur fractures in elderly is not secondary to different pre-injury characteristics.
- •Both groups have statistically similar short and long-term mortality rates irrespective of the treatment modality used.
- •Long-term mortality (at 7-9 years) in geriatric proximal femur fracture cohort is significantly high at above 75%.
Abstract
Background
Proximal femur fractures in geriatric patients are associated with substantial mortality.
Management of intracapsular proximal femur fractures has been based on age, displacement,
cognition, and pre-injury mobility. However, over the last decade, there has been
a tendency to offer arthroplasty rather than internal fixation for these patients
irrespective of displacement, to allow early mobilisation and negate the higher rate
of reoperation due to failed internal fixation. There are no previous investigations
analysing whether the severity of fracture displacement is related to different patient
characteristics.
Aim
This study examines whether patients sustaining undisplaced or displaced intracapsular
proximal femur fractures represent different patient groups with different pre-injury
characteristics and post-operative mortality, irrespective of treatment modality.
Methods
A retrospective series of 329 consecutive patients over the age of 55 years who sustained
intracapsular proximal femur fractures, who underwent surgical management at a district
general hospital over a period of 2 years (2012-2013) were identified using the national
hip fracture database. Demographics, American Society of Anaesthesiologist (ASA) grade,
pre-injury outdoor mobility status, cognitive status, and admission serum investigations,
fracture displacement, type of surgery, and mortality rates at short term (2 years)
& long-term (7-9 years) were reviewed.
Results
There were 109 male and 220 female patients with a minimum follow-up of 7 years. The
mean age at surgery was 81.6 years (range 55-103 years). There were 63 (19.1%) undisplaced
fractures (Garden 1 &2) and, 265 (80.5%) displaced fractures (Garden 3 & 4).
The median survival in this cohort was 2.95 years (95% CI 2.3-3.6). Mortality rates
were 77.4% (n=257) at long-term (7-9 years) follow-up. Admission patient characteristics
showed no statistically significant difference between displaced and undisplaced fracture
groups. This included ASA, pre-operative cognition, and mobility status. Fracture
displacement was not an independent predictor of mortality at short or long term.
Conclusion
In patients sustaining intracapsular proximal femur fractures, the degree of displacement
is not a caveat for a different patient group. Fracture displacement is not predicted
by the pre-injury level of function and does not predict short or long-term mortality.
Keywords
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Article info
Publication history
Published online: January 08, 2022
Accepted:
January 4,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
