Patterns and complications of femur fractures below the hip in patients over 65 years of age.

This study is a retrospective review of 105 femur fractures below the hip in 99 patients over 65 years of age treated between 1970 and 1986. Problems in medical management and a high complication rate prompted this study, which focused on the fracture patterns and complications associated with these injuries. There were 25 subtrochanteric, 47 shaft, and 33 supracondylar fractures. These were isolated injuries in 89 of the patients. The overall complication rate was 45%; the orthopaedic complication rate was 15%. The mortality rate was 10% within 60 days of injury. Thirty-nine patients (39%) returned to their preinjury functional status or were able to walk with ambulatory assistive devices. Changes in mental status before fracture were associated with an increased rate of complications. Age, sex, preinjury functional status, number of preexisting medical problems, timing of surgery, type of anesthesia, and operative versus nonoperative treatment were not significantly different between survivor and nonsurvivor groups. The development of a new, postinjury medical problem in the acute treatment period was the most significant factor leading to a poor result and death. Successful management of this fracture requires aggressive medical management in the elderly.