Determining factors for the mortality following hip fractures

doi:10.1016/0020-1383(84)90209-2

Injury

Volume 15, Issue 6, May 1984, Pages 411-414

https://doi.org/10.1016/0020-1383(84)90209-2 Get rights and content

Abstract

In this study 518 patients with hip fractures were followed up prospectively for an average of 3 years (range 2.5–3.5 years).

On admission to hospital the patients were allocated to one of 4 social function groups according to their dependence on the social welfare system.

The life expectancy was analysed at follow-up and found to be determined primarily by the patient's social dependence prior to fracture, and secondarily by the age of the patient. Other generally accepted determining factors were not found to have any significant influence on the survival rates.

References (23)

R.K. Beals
Survival following hip fracture—long follow-up of 607 patients
J. Chron. Dis.
(1972)
J.H. Reno et al.
Fractures of the hip—mortality survey
Am. J. Surg.
(1958)
W.G. Schenk et al.
The fractured hip—a major surgical and sociologic problem
Am. J. Surg.
(1956)
P.A. Alffram
An epidemiologic study of cervical and trochanteric fractures of the femur in an urban population
Acta Orthop. Scand.
(1964)
L. Ceder et al.
Rehabilitation after hip fracture in the elderly
Acta Orthop. Scand.
(1979)
A.N.G. Clark et al.
Management of the fractured neck of femur in the elderly female
Geront. Clin. (Basel)
(1966)
D.S. Colbert et al.
Mortality after hip fracture and assessment of some contributory factors
Irish J. Med. Sci.
(1976)
E. Dahl
Mortality and life expectancy after hip fractures
Acta Orthop. Scand.
(1980)
B. Ebskov et al.
Incidence of reamputation and death after gangrene of the lower extremity
Prosth. Orth. Int.
(1980)
T.P. Eddy
Deaths from domestic falls and fractures
Br. J. Prev. Soc. Med.
(1972)

J.G. Evans et al.

A prospective study of fractured proximal femur: factors predisposing to survival

Age Ageing

(1979)

Cited by (74)

Clinical and radiological outcome of the Chimaera short nailing system in inter- and subtrochanteric fractures
2023, Injury
cephalomedullary devices are popular treatment for femoral intertrochanteric or subtrochanteric fractures. Various complications include post-surgical lateral thigh pain and cut-out. To prevent those complications, a new concept cephalomedullary device system was designed (Chimaera, Orthofix®). This study aimed to evaluate the clinical and radiological outcomes in patients with femoral intertrochanteric or subtrochanteric fractures treated with the proximal femoral cephalomedullary device system.
A prospective cohort study involved consecutive patients with Arbeitsgemeinschaft für Osteosynthesefragen/ Orthopaedic Trauma Association type 31-A1, 2, 3 fractures treated with the Chimaera short cephalomedullary device system from October 2016 to September 2017 at our level 1 trauma center. The Parker and Palmer mobility score and Jensen social function scores and post-surgical lateral thigh pain were assessed at 3 months post-operatively and compared to before surgery. Radiologic assessment consisted of controlling the position of the cephalic screw by using the tip-apex distance (TAD) and Cleveland zone as well as union and cut-out rates.
We included 99 patients (79 women; 100 hips; one bilateral fracture 3 months after a first trochanteric fracture) with a mean follow-up of 2 years. The Parker and Palmer mobility score decreased by 22% at 3 months post-operatively as compared with the pre-fracture score (42/99 patients showed a return to their pre-injury level). The Jensen social function score increased by 16.5% at 3 months post-operatively as compared with the pre-fracture score (68/99 patients showed a return to their pre-injury level). No major intra-operative complication was recorded. Nine TAD scores were > 25 mm. The mean TAD was 16.5 mm (range 5–36), and the lag screw position was well positioned in most (95%) hips according to Cleveland zones. Three patients required revision surgery (one for cut-out of the lag screw, one for hip osteoarthritis and one for gluteus medius insufficiency). All patients but the one with the cut-out showed fracture union.
The Chimaera short cephalomedullary device exhibited good mid-term functional and radiological outcomes.
Factors associated with one year mortality in ill patients with proximal femoral fractures treated non operatively
2021, Injury
Citation Excerpt :
The proportion of death in one year in female was 3 times higher than in men (75% vs 25%). This finding is opposed to the published results that men have two times more risk of death comparing to women [13,14]. A possible explanation is the average age of female patients that was statically higher than men (82.8 vs 71.1) which may reflect a more fragile patient.
Introduction: Non-operative treatment is an exceptional indication for the treatment of proximal femur fracture. The aim of the study was to analyze the mortality rate in one year and associated factors in severely ill patients submitted to non-operative treatment. Methods: It was included 28 patients treated from August 2014 to September 2019. Eighteen (64.3%) patients were female and 10 (35.7%) were male. The mean age was 78.7 ± 11.9 years old. The main outcome evaluated was the mortality rate in one year. It was also evaluated the correlation with gender, age, personal habits, number of comorbidities and Charlson Comorbidity Index (CCI). Results: The functional result was assessed with WOMAC score via telephone call. The mortality rate in one year was 42.8% without statistical positive correlation with any of the studied parameters. Patients with three or more comorbidities didn't have a higher mortality rate comparing to survived patients (83.3% vs 81.3%). The CCI also didn't show any correlation with high mortality (6.9 vs 7.1). The functional result of the survived patients was poor (78.2 points WOMAC). Conclusion: The conclusion is that the mortality rate in one year of ill patients with hip fractures treated non-operatively is 42.8% without correlation with age, gender of number of comorbidities, and the functional result of the survived patients is poor.
Walking ability before and after a hip fracture in elderly predict greater long-term survivorship
2016, Journal of Orthopaedic Science
Citation Excerpt :
This finding is present also in other studies with women to have significantly lower mortality after surgery, with a possible explanation that men have more comorbid diseases than women [11,22,6,23]. However, many studies fail to demonstrate gender as a risk factor of early mortality in patients who underwent surgery after a hip fracture [24,4,20,25,17]. A similar finding is present in the present study, as gender does not seem to have an impact in mortality in patients with a hip fracture.
The morbidity and mortality after a hip fracture in the elderly population are multifactorial. The aim of this study is to determine the long-term impact of specific factors to mortality rate and mobility after a hip fracture in the elderly.
Elderly suffering a hip fracture after a low-energy trauma was included in the study, whereas moribund patients with severe comorbid conditions and high-energy trauma were excluded. All the patients were treated operatively during 2003. Data for survivorship and mobilization was collected six months, one and ten years after the operation. Kaplan–Meier log rang test was used for the survival analysis and cox regression for multivariate analysis of prediction factors such as age, gender, time to surgery after trauma, type of fracture, ambulation status before injury and early walking ability after the surgery.
Two hundred and thirty three patients were finally included to the study. Gender (p = 0.64) and type of fracture (p = 0.92) seem to have no statistically significant impact on survivorship. Age (p < 0.001), time of surgery after the trauma (p = 0.001), ambulation status (p < 0.001) and early walking ability after the surgery (p < 0.001) seem to have statistically significant impact on mortality, as independent factors. The significance is present one year and ten years after the surgery. However, according to the multivariate analysis, time to surgery after trauma and age lose significance, while early walking ability remain significant one and ten years after surgery (p < 0.001). Ambulation status seem to lose significance early after surgery, but reach significance ten years postoperatively (p < 0.001).
In summary, it could be stated that early walking ability after an operation for a hip fracture in elderly is the most significant prediction factor of survivorship one and ten years postoperatively. Ambulation status before injury is a significant long-term predictor factor for survivorship.
Favorable radiographic outcomes using the expandable proximal femoral nail in the treatment of hip fractures - A randomized controlled trial
2014, Journal of Orthopaedics
Citation Excerpt :
Randomization was done by sealed envelopes that were prepared in advance using a computer-generated randomized list and concealment was strictly maintained. Each patient's background data were collected on admission, and included age, gender, laterality of the fracture, comorbidities (specifically, ischemic heart disease, congestive heart failure, hyperlipidemia, hypertension, diabetes mellitus, history of cerebrovascular accident, chronic renal failure, atrial fibrillation, Parkinson's disease and dementia), pharmacological treatment, smoking status, ASA score,17 residency (living in own home, nursing home or institution), social function and independence status [using Jensen's classification]18 and mobility [using Parker and Palmer's scoring system].19 Surgery was performed on the first available operative day following optimization of the patient's medical state.
To compare the functional and radiographic results of dynamic hip screw (DHS) and expandable proximal femoral nail (EPFN) in the treatment of extracapsular hip fractures.
A randomized controlled trial of sixty hip fracture patients. Outcomes included mortality, residency, independence, mobility, function and radiographic results at a minimum of 1 year.
Twenty-nine EPFN patients demonstrated fewer cases of shaft medialization or femoral offset shortening compared to the 31 DHS patients. Mortality, complications and functional outcomes were similar.
EPFN provides stable fixation of pertrochanteric hip fractures and prevents neck shortening that is commonly observed after DHS fixation.
Does the use of a "track and trigger" warning system reduce mortality in trauma patients?
2011, Injury
Citation Excerpt :
This study has not formally assessed pre-operative co-morbidities. Studies which do account for co-morbidities have shown no increase in mortality in male patients with hip fractures as compared with females.17–19 Men in the Scottish hip fracture audit had higher ASA scores and pre-operative morbidity compared to females.
Despite the lack of robust evidence, numerous different “track and trigger” warning systems have been implemented. These have only been validated in an emergency medical admissions setting. The Modified Early Warning Score (MEWS) is the chosen track and trigger system used in the University Hospitals of Leicester trauma unit, but has not been validated in trauma patients. A considerable proportion of all trauma admissions are elderly patients with proximal femoral fractures and significant co-morbidities. Early recognition of physiological deterioration and prompt action could therefore be lifesaving in this patient group.
To identify whether the implementation of the MEWS system coupled with a critical care outreach service resulted in a reduction in mortality in a busy trauma unit.
A retrospective study. The MEWS system was implemented in all trauma and orthopaedic wards at the Leicester Royal Infirmary in the summer of 2005. The numbers of emergency trauma inpatient admissions and deaths from January 2002 to December 2009 were obtained. The diagnosis, primary procedures and cause of death, if known, were noted. Comparisons were made pre- and post-MEWS. Student's t-test was used for statistical analysis.
32,149 patients were admitted (55% male; 45% female). Overall there were 889 deaths (77% female; 33% male, P < 0.0001). The in-hospital mortality rate for orthopaedic trauma patients was 2.8% throughout the 7-year study period. 61% of those who died were admitted with proximal femoral fractures. The modal age group with the highest mortality was 81–90 years. Overall, females had a considerably greater mortality rate than males. The mortality rate was lower post-MEWS in males (1.82–1.418%; P = 0.214), females (4.871–3.364%; P = 0.108) and all patients (3.215–2.294%; P = 0.092), but this was not statistically significant.
The use of a track and trigger warning system has not led to a statistically significant reduction in mortality in trauma patients. In view of the apparent lack of clinical effectiveness of the MEWS/outreach partnership, the cost effectiveness of this initiative needs to be questioned. Possible reasons for these findings include: failure of the MEWS to be correctly applied, inadequate action once the threshold is triggered, or unsuitability of this tool for this patient population. A better system for identifying and treating elderly, medically unwell trauma patients with co-morbidities needs to be developed.
The effect of clopidogrel and aspirin on blood loss in hip fracture surgery
2011, Injury
Anti-platelet drugs are commonly used for primary and secondary prevention of thrombo-embolic events and following invasive coronary interventions. Their effect on surgery-related blood loss and perioperative complications is unclear, and the management of trauma patients treated by anti-platelets is controversial. The anti-platelet effect is over in nearly 10 days. Notably, delay of surgical intervention for hip fracture repair for >48 h has been reported to increase perioperative complications and mortality.
Intra-operative and perioperative blood loss, the amount of transfused blood and surgery-related complications of 44 patients on uninterrupted clopidogrel treatment were compared with 44 matched controls not on clopidogrel (either on aspirin alone or not on any anti-platelets).
The mean perioperative blood loss was 899 ± 496 ml for patients not on clopidogrel, 1091 ± 654 ml for patients on clopidogrel (p = 0.005) and 1312 ± 686 ml for those on combined clopidogrel and aspirin (p = 0.0003 vs. all others). Increased blood loss was also associated with a shorter time to operation (p = 0.0012) and prolonged surgical time (p = 0.0002). There were no cases of mortality in the early postoperative period.
Patients receiving anti-platelet drugs can safely undergo hip fracture surgery without delay, regardless of greater perioperative blood loss and possible thrombo-embolic/postoperative bleeding events.

View all citing articles on Scopus

View full text

Determining factors for the mortality following hip fractures

Abstract

J. Chron. Dis.

Am. J. Surg.

Am. J. Surg.

An epidemiologic study of cervical and trochanteric fractures of the femur in an urban population

Acta Orthop. Scand.

Rehabilitation after hip fracture in the elderly

Acta Orthop. Scand.

Management of the fractured neck of femur in the elderly female

Geront. Clin. (Basel)

Mortality after hip fracture and assessment of some contributory factors

Irish J. Med. Sci.

Mortality and life expectancy after hip fractures

Acta Orthop. Scand.

Incidence of reamputation and death after gangrene of the lower extremity

Prosth. Orth. Int.

Deaths from domestic falls and fractures

Br. J. Prev. Soc. Med.

A prospective study of fractured proximal femur: factors predisposing to survival

Age Ageing