Mortality in centenarians with hip fractures

The proximal femur is one of the primary areas of weakness in the skeleton due to osteoporosis. With more than 50,000 Americans aged at least 100 years, an increasing number of these extremely elderly patients will present with hip fractures. A paucity of literature exists on functional outcomes and mortality rates in the centenarian population who sustain hip fractures. This study evaluated the mortality rate in centenarians who sustained hip fractures to determine whether operative intervention is safe and appropriate.The authors retrospectively reviewed 23 patients (22 women and 1 man) aged at least 100 years with hip fractures treated at their institution between 2003 and 2010. Twenty-one patients were treated operatively and 2 were treated nonoperatively. Mean Charlson comorbidity index was 2 (range, 0 to 5). The patients' medical charts or the Social Security Death Index was used to determine their dates of death. Average patient age was 101.9 years at injury and 102.8 years at death. Cumulative in-hospital, 30- and 90-day, 6- and 12-month, and 2-, 3-, and 6-year mortality rates for operatively treated patients were 15%, 20%, 30%, 45%, 60%, 70%, 90%, and 95%, respectively. Both patients treated nonoperatively died within 90 days. One patient is still alive 6 years postoperatively. Postoperative complications occurred in 9 (43%) patients.Although this patient population is a relatively small subset of the elderly population, the number of these patients is rapidly increasing. Operating on patients older than 100 years carries an acceptable mortality rate. Age alone should not preclude centenarians from undergoing operative treatment for hip fractures.