High-energy Femur Fractures Increase Morbidity but not Mortality in Elderly Patients

Abstract

Trauma centers are projected to have an increase in the number of elderly patients with high-energy femur fractures. Greater morbidity and mortality have been observed in these patients. Further clarification regarding the impact of high-energy femur fractures is necessary in this population. Our purpose was to assess the influence of high-energy femur fractures on mortality and morbidity in patients 60years and older. Specifically, we asked (1) if the presence of a high-energy femur fracture increases in-hospital, 6-month, and 1-year mortality in patients 60years and older, and (2) if there is a difference in morbidity (number of complications, intensive care unit [ICU] and total hospital length of stay, discharge disposition, accompanying fractures, and surgical intervention) between patients 60years and older with and without high-energy femur fractures. A retrospective review of 242 patients was performed. Patients with traumatic brain injury or spine injury with a neurologic deficit were excluded. A control group, including patients admitted secondary to high-energy trauma without femur fractures, was matched by gender and Injury Severity Score (ISS). In-hospital mortality, 6-month and 1-year mortality, complications, ICU and total hospital length of stay, discharge disposition, accompanying fractures, surgical intervention, and covariates were recorded. Statistical analyses using Fisher's exact test, ANOVA, Kaplan-Meier estimates, and Cox regression models were performed to show differences in mortality (in-hospital, 6-month, 1-year), complications, length of ICU and total hospital stay, discharge disposition, surgical intervention, and accompanying fractures between elderly patients with and without femur fractures. The average ages of the patients were 72.8years (±9years) in the femur fracture group and 71.8years (±9years) in the control group. Sex, age, ISS, and comorbidities were homogenous between groups. In-hospital (p=0.45), 6-month (p=0.79), and 1-year mortality (p=0.55) did not differ in patients with and without high-energy femur fractures. Elderly patients with high-energy femur fractures had an increased number of complications (p=0.029), longer total hospital length of stay (p=0.039), were discharged more commonly to rehabilitation centers (p<0.005), had more accompanying long bone fractures (p=0.002), and were more likely to have surgery (p<0.001). Average ICU length of stay was similar between the two groups (p=0.17). High-energy femur fractures increased morbidity in patients 60years and older; however, no increase in mortality was observed in our patients. Concomitant injuries may play a more critical role in this population. Additional studies are necessary to clarify the role of high-energy femur fracture mortality in this age group. Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.