Pertrochanteric Fractures in the Elderly: Is the Severity of Fracture Pattern associated with age and an increased rate of mortality?

Abstract

Purpose: This study was aimed at assessing whether there is a correlation between age and pertrochanteric femur fracture severity and if this may be tied to mortality at a 1-year interval. Background: Pertrochanteric hip fractures are a common low energy fractures and represent a major cause of morbidity and mortality in the elderly population. To date, association of a worse fracture pattern to loss of Bone Mineral Density has not been proven. We set out to assess whether fracture severity may be tied to age in this specific patient population. Methods: From May 2010 to January 2013, we retrospectively collected the data of all patients (>60 years old) sustaining a low energy pertrochanteric fracture which were admitted at the Kaplan Medical Center. The following parameters were collected and evaluated: (1) demographics, (2) fracture pattern, (3) time from admission to surgery, (4) time from surgery to mortality. Results: We included 578 fractures in the study. These were divided into 4 groups according to age. We analyzed the data using a Spearman's rho correlation and Pearson Chi-Square Test but found no significant difference in fracture stability with increase in age. For the 544 fractures that were operated on at Kaplan Medical Center we found that 1-year mortality was significantly higher with increasing age (p=0.000) and male sex (p=0.001). With every additional patient year, the mortality risk rose by 8.3%. Moreover, the relative mortality risk in the male patients of our cohort was 1.93 as compared to the female ones. Fracture severity and time from admission to surgery were not found to have a significant effect on mortality. Conclusions: Statistically the pertrocanteric fracture severity classified after the AO does not correlate with the age or one-year mortality of the patient. The one-year mortality rate was significant higher with increased age and male sex.