Mortality and the factors affecting patients over 65 age with unstable intertrochanteric fractures treated with proximal femoral nail

Abstract

Objective: We aimed to investigate the factors affecting postoperative mortality associated with intertrochanteric femoral fractures in patients age 65 and older who were treated with osteosynthesis with a proximal femoral nail (PFN). Materials and Methods: Patients were categorized and examined according to age, gender, pre-operative American Society of Anesthesiologist (ASA) scores, time of surgery and type of anesthesia. Patients with more than two systemic additional diseases and an ASA of score 5 were not included in the study. Post-operative mortality results and the factors associated with mortality were investigated. Results: Thirty-one patients (36.1%) were male and 55 (63.9%) were female. The mean age was 78.31 years and forty-eight of the patients were under 80 years old (55.8%) and 38 were over 80 years old (44.2%). According to the Jensen fracture classification, 35 (40.6%) of the patients were evaluated as type 3, 15 (17.4%) patients were type 4 and 36 (42%) patients were type 5. The ASA score was used for preoperative risk assessment. Thirty (34.8%) patients had an ASA score of 1-2, while 56 (65.2%) had an ASA asore of 3-4. Patients were categorized as “3 days before” or “3 days after” according to the time of surgery, and the mean time to surgery was 3.7 days. The type of anesthesia was classified as general and regional with 65 patients (75.5%) operating under regional anesthesia and 21 patients (24.4%) under general anesthesia. After a mean follow-up of 18 months, the mortality rate was 20.9% (18/86). Mortality was significantly higher in patients over 80 years old (36.8% vs 8.3%, p=0.004). Conclusion: Patients 80 years and older are at serious risk for mortality when they have unstable trochanteric fractures treated with PFN. These patients are at especially high risk for mortality within the first year and should be monitored closely.