Abstract
Background. Due to demographic change, more proximal femoral fractures can be expected in the future. However, accurate growth rates as well as follow-up research extending more than 1 year postsurgery are still lacking. Materials and methods. First, we defined inclusion and exclusion criteria for the retrospective cohort study. Based on these, we collected all surgical interventions conducted ...
Abstract
Background. Due to demographic change, more proximal femoral fractures can be expected in the future. However, accurate growth rates as well as follow-up research extending more than 1 year postsurgery are still lacking. Materials and methods. First, we defined inclusion and exclusion criteria for the retrospective cohort study. Based on these, we collected all surgical interventions conducted between 1 January 2006 and 31 December 2015. For a total of 2000 consecutive procedures, we retrieved and analysed a total of 12 variables influencing mortality. Data were retrieved from the prospectively established database; all patients still alive were contacted by phone, and missing data were collected. The endpoint of the study was consistently set for all patients at 2 years postsurgery. Results. The follow-up rate was 100%. Growth rate increased by 74.1% over a period of 10 years. Mean age of the total population was 79.4 years, and women were predominantly affected (71.7%). Surgical treatment was based on osteosynthesis procedures (57%) using DHS, PFN, or screws, as well as on arthroplasty (43%) performing total hip arthroplasty or implanting largehead prostheses. The revision rate was 14.5%, and mortality 2 years postsurgery was 32.4%. Through a multivariate analysis (Cox regression), the following seven influence factors showed statistically significant impact on mortality: age > 82 years, male gender, CRP > 10 mg/ dl, haemoglobin < 12 g/ dl, ASA 3 or 4, dementia, and postoperative infection-but not timing of surgery. Conclusion. The growth rate of proximal femoral fractures progressed more rapidly than expected. Through a multivariate analysis, a total of six intrinsic variables were verified, which influenced the mortality. The prevention of infection-as the only additional extrinsic factor in this study-represents a more important role than early surgical treatment.
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