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Fractures: Bone Repair

Fractures: Bone Repair

Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the procedure...

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Updated: Jun 23, 2026

Method and Instrumented Fixture for Femoral Fracture Testing in a Sideways Fall-on-the-Hip Position

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Published on: August 17, 2017

Frailty is a Vital Tool for Predicting Outcomes Following Prophylactic Femur Fixation.

Omar Sbaih¹, Victor Koltenyuk, Nithin Gupta

¹From the Georgetown University School of Medicine (Sbaih), Washington, DC, REAM Orthopedics (Sbaih, Koltenyuk, Gupta, Dixon, Gill, Williamson), Columbus, OH, Bowers Neurosurgical Frailty and Outcomes Data Science Lab (Sbaih, Koltenyuk, Gupta, Gill), Flint, MI, New York Medical College (Koltenyuk), Valhalla, NY, Department of Orthopaedic Surgery (Gupta), Jefferson Health New Jersey, Cherry Hill, NJ, American University of the Caribbean School of Medicine (Dixon), Miramar, FL, Mayo Clinic Alix School of Medicine (Gill), Phoenix, AZ, and Department of Orthopaedic Surgery (Ogburn, Williamson, Alderete), University of Texas Health San Antonio, San Antonio, TX.

The Journal of the American Academy of Orthopaedic Surgeons

|June 22, 2026

Summary

The revised Risk Analysis Index (RAI-rev) better predicts mortality in patients undergoing prophylactic femur fixation than the modified Frailty Index (mFI-5). Higher frailty scores increase mortality risk, especially for pathologic fracture fixation.

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Frailty Assessment in an Aging Mouse Model

Frailty Assessment in an Aging Mouse Model

Published on: September 23, 2025

Area of Science:

Orthopedic Surgery
Geriatric Medicine
Surgical Outcomes Research

Background:

Frailty assessment is crucial for identifying high-risk surgical patients, particularly those undergoing prophylactic femur fixation (ProphFF) for metastatic disease.
These patients are inherently high-risk due to their underlying conditions.
Characterizing frailty's impact on ProphFF outcomes is essential for improving patient selection and care.

Purpose of the Study:

To evaluate the relationship between frailty and postoperative outcomes in patients undergoing ProphFF.
To compare the predictive performance of the revised Risk Analysis Index (RAI-rev) and the five-factor modified Frailty Index (mFI-5) for adverse outcomes.
To assess differences in outcomes between ProphFF and pathologic femur fixation (PathFF).

Main Methods:

Utilized data from the 2015-2020 American College of Surgeons National Surgical Quality Improvement Program database.
Included patients aged ≥18 years undergoing ProphFF or PathFF, measuring frailty with RAI-rev and mFI-5.
Employed propensity score matching and multivariable logistic regression, including ROC curve analysis, to compare outcomes and frailty measures.

Main Results:

Increasing frailty scores (RAI-rev and mFI-5) were independently associated with higher 30-day mortality risk.
RAI-rev demonstrated superior discrimination for mortality (C-statistic 0.73) compared to mFI-5 (C-statistic 0.57).
PathFF was associated with a higher likelihood of mortality compared to ProphFF.

Conclusions:

Preoperative frailty, especially as measured by RAI-rev, independently predicts mortality and morbidity in patients undergoing prophylactic femur fixation.
RAI-rev shows promise as a valuable tool for identifying high-risk patients before ProphFF.
Pathologic fracture fixation carries a higher risk of revision surgery and mortality than prophylactic fixation, underscoring the need for careful patient selection.