Predictors of mortality in elderly patients with an intertrochanteric or a femoral neck fracture.

BACKGROUND: We retrospectively analyzed 112 intertrochanteric femur fracture patients and 136 femoral neck fracture patients to determine mortality rates and factors affecting mortality. Internal fixation is the standard treatment method for intertrochanteric femur fracture patients in our institute, and arthroplasty, as a treatment choice, shows an increase in mortality rates. We wanted to convey if there was any decrease in mortality rate of intertrochanteric femur fracture patients when compared with femoral neck fracture patients who were almost always treated with arthroplasty.
METHODS: Patients' age at admission, trauma date, delay until surgery, comorbidities, operation durations, anesthesia, and treatment types were evaluated by patients' folders. All preoperative and postoperative radiographs checked over for treatment type. Patients' recent health and activity status were determined by telephone interview.
RESULTS: There were no significant differences in mortality rates between patients of two fracture types. Treatment type, anesthesia type, and sex were significant predictors in univariate analyses. In multivariate analyses, only age and delay in surgery identified as predictors of mortality, age was the most significant. Although intertrochanteric femur fracture patients were significantly older than femoral neck fracture patients, the estimated mean survival time was higher for intertrochanteric femur fracture patients (57.9 months) than for femoral neck fracture patients (48.8 months).
CONCLUSION: We think that, in addition to the shorter delay in surgery, internal fixation choice led to decrease the mortality rate of intertrochanteric femur fracture patients. In conclusion, to decrease the mortality rate after hip fracture, since age and sex cannot be changed, needless delays in surgery should be avoided. Also, we recommend internal fixation and regional anesthesia to decrease the mortality rate.