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Study determines risk factors for mortality in patients with femoral neck fractures

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COPENHAGEN — Age, gender, cognitive status and timing of surgery are all factors that influence the mortality of patients who undergo treatment for displaced femoral neck fractures, according to a presentation at the 12th EFORT Congress 2011 here.

Tarjei Vinje, MD, presented his team’s findings, which point toward there being little difference in short-term mortality and no significant difference in 1- or 3-year mortality between patients who underwent internal fixation using two screws and those who underwent bipolar hemiarthroplasty.

Vinje’s team used The Norwegian Hip Fracture Register to gather case reports from 3,436 patients aged 65 years or older who underwent internal fixation using two screws (patients) or 8,877 patients who had bipolar hemiarthroplasty for displaced femoral neck fractures.

The investigators assessed mortality through multiple analyses, including a power analysis that Vinje reported “showed the study sample to be sufficient to detect a difference in mortality of 3% at 1- and 3- years postoperatively.”

According to the study abstract, the findings indicate an overall 1-year mortality of 28% and 3-year mortality of 50%. Male gender, cognitive impairment, high age and a delay of surgery lasting longer than 48 hours after the initial injury were, Vinje reported, associated with an increased mortality risk.

Patients who received a biopolar hemiarthroplasty demonstrated a significant increase in risk of death at the 30-day, 120-day, and 240-day marks when compared with internal fixation using two screws. However, Vinje said no difference could be found in mortality risk when comparing the two operations at the 1-year and 3-year postoperative marks.

“Age, sex, cognitive status and preoperative delay determine mortality,” he said. “There was an increased risk of early death for patients receiving bipolar hemiarthroplasty, but it was not associated with too substantial a decrease in life expectancy.”

Reference:

• Vinje T, Gjertsen J, Lie S, et al. Mortality after operation for displaced femoral neck fracture: A study from the Norwegian Hip Fracture Register of 12,313 displaced femoral neck fractures treated with two screws or a bipolar hemiarthroplasty. Paper #2277. Presented at the 12th EFORT Congress 2011. June 1-4. Copenhagen.

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