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Observational Study
. 2021 Feb;92(1):40-46.
doi: 10.1080/17453674.2020.1831236. Epub 2020 Oct 26.

How deadly is a fracture distal to the hip in the elderly? An observational cohort study of 11,799 femoral fractures in the Swedish Fracture Register

Olof Wolf  1 , Sebastian Mukka  2 , Jan Ekelund  3 , Michael Möller  4 , Nils P Hailer  1
Affiliations
Observational Study

How deadly is a fracture distal to the hip in the elderly? An observational cohort study of 11,799 femoral fractures in the Swedish Fracture Register

Olof Wolf et al. Acta Orthop. 2021 Feb.

Abstract

Background and purpose - Unlike hip fractures, diaphyseal and distal femoral fractures in elderly patients have not been widely studied. We investigated the demographics, comorbidities and mortality of patients with femoral fractures at any anatomical level with a focus on early mortality.Patients and methods - We analyzed 11,799 patients ≥ 65 years with a femoral fracture registered in the Swedish Fracture Register from 2011 to 2014. The cohort was matched with the National Patient Register to obtain data on comorbidities classified according to the Charlson Comorbidity Index (CCI). Generalized linear models were fitted to estimate the adjusted relative risk of mortality.Results - Mean age of the cohort was 83 years and 69% were women. Patients with distal femoral fractures had the lowest degree of comorbidity, with 9% having a CCI of ≥ 3 compared with 14% among those with proximal and 16% among those with diaphyseal fractures. Unadjusted 90-day mortalities were 13% (95% CI 9.4-16) after fractures in the distal, 13% (CI 10-16) in the diaphyseal, and 15% (CI 14-15) in the proximal segment. The adjusted relative risk for 90-day mortality was 1.1 (CI 0.86-1.4) for patients with distal and 0.97 (CI 0.76-1.2) for patients with diaphyseal femoral fractures when compared with patients with hip fractures.Interpretation - Elderly patients with femoral fractures distal to the hip may have similar adjusted early mortality risks to those with hip fractures. There is a need for larger, preferably prospective, studies investigating the effect of rapid pathways and geriatric co-management for patients with diaphyseal and distal femoral fractures.

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Figures

Figure 1.
Figure 1.
Flowchart of patients included in the study.
Figure 2.
Figure 2.
Unadjusted cumulative mortality up to 1 year after index fracture per femoral segment with 95% confidence intervals.
See this image and copyright information in PMC

References

    1. Adunsky A, Lerner-Geva L, Blumstein T, Boyko V, Mizrahi E, Arad M. Improved survival of hip fracture patients treated within a comprehensive geriatric hip fracture unit, compared with standard of care treatment. J Am Med Dir Assoc 2011; 12(6): 439–44. - PubMed
    1. Al-Ani A N, Samuelsson B, Tidermark J, Norling A, Ekstrom W, Cederholm T, Hedstrom M. Early operation on patients with a hip fracture improved the ability to return to independent living: a prospective study of 850 patients. J Bone Joint Surg Am 2008; 90(7): 1436–42. - PubMed
    1. Bartels S, Gjertsen J E, Frihagen F, Rogmark C, Utvag S E. High failure rate after internal fixation and beneficial outcome after arthroplasty in treatment of displaced femoral neck fractures in patients between 55 and 70 years. Acta Orthop 2018; 89(1): 53–8. - PMC - PubMed
    1. Beaupre L A, Khong H, Smith C, Kang S, Evens L, Jaiswal P K, Powell J N. The impact of time to surgery after hip fracture on mortality at 30- and 90-days: does a single benchmark apply to all? Injury 2019; 50(4): 950–5. - PubMed
    1. Delgado A, Cordero G G E, Marcos S, Cordero-Ampuero J. Influence of cognitive impairment on mortality, complications and functional outcome after hip fracture: dementia as a risk factor for sepsis and urinary infection. Injury 2020; 51Suppl1: S19–S24 - PubMed

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