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Published on: August 17, 2017
All-cause mortality risk in aged femoral intertrochanteric fracture patients
Xin-Ping Li1, Ping Zhang1, Shi-Wen Zhu2
1Department of Geriatrics, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, 100035, China.
Insights
Elderly Chinese patients with femoral intertrochanteric fractures face higher mortality. Geriatric co-management improves outcomes, with age and comorbidities being key risk factors. Early osteoporosis treatment is recommended.
Area of Science:
- Geriatric Medicine
- Orthopedic Surgery
- Public Health
Background:
- Femoral intertrochanteric fractures have a higher mortality rate than femoral neck fractures.
- Co-management models integrating orthopedics and geriatrics have shown promise in reducing hip fracture mortality.
- Limited data exists on the mortality of Chinese femoral intertrochanteric fracture patients managed under this model.
Purpose of the Study:
- To investigate the risk factors for all-cause postoperative mortality in elderly Chinese patients with femoral intertrochanteric fractures.
- To evaluate the effectiveness of the orthopedic-geriatric co-management model in this specific patient population.
Main Methods:
- A single-center, prospective cohort study involving 363 patients aged 65 years and older with femoral intertrochanteric fractures.
- Follow-up duration of 2-3 years, analyzing factors such as age, comorbidities, Bone Mineral Density (BMD), and anti-osteoporosis treatment.
- Statistical analysis using Kaplan-Meier survival curves and multivariate Cox proportional hazards models.
Main Results:
- Deceased patients were significantly older (mean age 83.4 years) and had more comorbidities, often without anti-osteoporosis medication.
- No significant differences were observed in gender, pre-fracture history, BMI, hip BMD, hemoglobin, or 25(OH)D levels between surviving and deceased patients.
- Early treatment with Zoledronic Acid within 3 days post-operation benefited elderly patients with intertrochanteric fractures.
Conclusions:
- Age and the presence of chronic diseases are critical factors influencing mortality in Chinese femoral intertrochanteric fracture patients under geriatric co-management.
- Physicians should prioritize these factors and consider anti-osteoporosis treatment when appropriate.
- The study highlights the importance of tailored management strategies for this vulnerable population.
Introduction:
The 1-year mortality rate after femoral intertrochanteric fracture is higher than that of femoral neck fracture, which also belongs to hip fracture (Cui et al. in Arch Osteoporos 14(1):55, 2019). With the application of the concept of co-management model of orthopedics and geriatrics, the short-term and long-term mortality of all types of hip fractures has decreased (Van Heghe et al. in Calcif Tissue Int, 2021, https://doi.org/10.1007/s00223-021-00913-5 ). However, the mortality of Chinese femoral intertrochanteric fracture patients under this model has not been reported in the literatures.
Aim:
This paper aims to study the risk factors of postoperative all-cause mortality in aged patients with femoral intertrochanteric fracture under the co-management model of orthopedics and geriatrics.
Materials And Methods:
This is a single-center prospective cohort study based on the real world, under the co-management of orthopedics and geriatrics, 363 patients aged ≥ 65 years with femoral intertrochanteric fracture were enrolled and followed up for 2-3 years; 52 patients were lost to follow up. Age, gender, body mass index (BMI), history of comorbidities, hip Bone Mineral Density (BMD), fracture history, 25(OH)D level, hemoglobin level, anti-osteoporosis treatment were risk factors to be tested. Kaplan-Meier survival curves and multivariate Cox proportional hazards models were constructed to analyze the impact of factors on all-cause mortality.
Results:
(1) Most of the dead patients were older (the mean age was 83.4 years, compared with 79.8 years for surviving patients), with more complications and without anti-osteoporosis medication; gender, pre-fracture history, BMI, total hip BMD, hemoglobin, 25(OH)D had no difference between the dead and the living patients. (2) Elderly patients with Intertrochanteric fracture can benefit from the early treatment of Zoledronic Acid (within 3 days after the operation).
Conclusion:
Under the co-management of orthopedics and geriatrics, to Chinese patients with Femoral Intertrochanteric fracture, Doctors should pay more attention to their age and chronic disease, and give anti-osteoporosis treatment if allowed.
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