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Imaging of the Microstructural Failure Mechanism in the Human Hip
Published on: September 29, 2023
Undisplaced intracapsular hip fractures in the elderly: predicting fixation failure and mortality. A prospective
N D Clement1, K Green, N Murray
1Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, UK. nickclement@doctors.org.uk
Insights
Elderly patients with undisplaced intracapsular hip fractures face high risks. American Society of Anesthesiologists (ASA) grade and femoral neck posterior tilt predict fixation failure, while ASA grade also predicts mortality.
Area of Science:
- Orthopedic Surgery
- Geriatric Medicine
- Biostatistics
Background:
- Undisplaced intracapsular hip fractures in the elderly have a significant revision rate (12-17%) and higher mortality.
- Predicting outcomes in this vulnerable population is crucial for effective patient management.
Purpose of the Study:
- To identify predictors of fixation failure and mortality in elderly patients with undisplaced intracapsular hip fractures.
- To evaluate the impact of socioeconomic status on fracture outcomes.
Main Methods:
- Prospective study of 162 elderly patients (≥65 years) with undisplaced (Garden I or II) intracapsular hip fractures.
- Data collected: demographics, American Society of Anesthesiologists (ASA) grade, femoral neck posterior tilt, and socioeconomic status.
- Follow-up for 1 year to assess fixation failure and mortality.
Main Results:
- American Society of Anesthesiologists (ASA) grade and posterior tilt were significant independent predictors of fixation failure.
- ASA grade was the sole significant independent predictor of 1-year mortality.
- Overall 1-year mortality was 19%; standardized mortality ratio was 2.3.
- Socioeconomic status did not impact outcomes, though deprived patients fractured younger.
Conclusions:
- American Society of Anesthesiologists (ASA) grade and femoral neck posterior tilt are key predictors for fixation failure in elderly hip fracture patients.
- ASA grade independently predicts mortality in this cohort, highlighting its importance in risk assessment.
Background:
Reported revision of internal fixation for undisplaced intracapsular hip fractures is between 12 and 17% at 1 year. This risk is greater for elderly patients, for whom mortality after such a fracture is also higher. Our purpose was to identify predictors of fixation failure and mortality for elderly patients sustaining undisplaced intracapsular hip fractures, and to assess whether their socioeconomic status affected their outcome.
Methods:
During a 3-year period we prospectively compiled a consecutive series of 162 elderly (≥65 years old) patients who underwent internal fixation for an undisplaced (Garden stage I or II) intracapsular hip fracture. Patient demographics, American Society of Anesthesiologists (ASA) grade, and posterior tilt (measured on the lateral radiograph) were recorded pre-operatively. All patients were followed up for a minimum of 1 year. Each patient's socioeconomic status was assigned by use of the Scottish Index of Multiple Deprivation. Patient mortality was established by use of the General Register Office for Scotland.
Results:
There were 28 failures of fixation during the study period. In Cox regression analysis, ASA grade and the presence of posterior tilt (p < 0.0001) were significant independent predictors of fixation failure. Overall unadjusted mortality at 1 year was 19% (n = 30/162). Cox regression analysis also affirmed ASA grade to be the only significant independent predictor of 1-year mortality (p = 0.003). The standardised mortality rate for the cohort was 2.3 (p < 0.001), and was significantly greater for patients less than 80 years of age (p = 0.004). Socioeconomic status did not affect outcome, but the most deprived patients sustain their fracture at a significantly younger age (p = 0.001).
Conclusion:
We have demonstrated that ASA grade and posterior tilt of the femoral neck are independent predictors of fixation failure of undisplaced intracapsular hip fractures in elderly patients, and ASA grade was also an independent predictor of mortality.
