Time to surgery and pre-fracture mobility are key survival factors after neck of femur fractures

Proximal  femoral  fracture  is  the  most  common  cause  of  acute  orthopaedic  admission. Around one in ten patients die within 30 days of admission. A study from the UK presented at the EFORT Congress in Istanbul has identified new factors indicating which patients are most at risk, allowing for more targeted care before and after surgical intervention. The primary factor in reducing mortality is speed of surgical intervention.

Istanbul, 6 June 2013  – Time to surgery and pre-fracture mobility were identified as new factors to be significant pre-operative predictors of 30 day mortality after neck of femur fractures, according to new research from the UK, presented at the 14th Congress of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) in Istanbul. About 7,500 experts are discussing current developments in their field at this Congress.

70,000 hip fractures occur annually in the UK alone, with annual costs to health services of about £2 billion. A study by researchers from the UK and Sweden put the annual cost of hip fractures in six major European countries at over 15 billion euros. Around 10% of patients die within 30 days of admission. 30 day mortality is regarded as an important indicator of the quality of healthcare provided.

“Time to surgery and pre-fracture mobility were the new factors identified to be significant pre-operative  predictors  of  30  day  mortality,”  said  Mr.  Manjunath  Ramappa  (Northumbria NHS  Healthcare  Foundation  Trust  and  North  Shields,  UK),  one  of  the  authors  of  the  new study. These factors had been considered important previously. “However they were not significant predictors in previous scoring systems,” he said. “This could be due to changing population   characteristics.”   The   study   meanwhile   confirms   that   other   factors   used   in previous scoring systems, such as age or gender continue to be significant predictors.

The study included all 1,157 patients with a proximal femoral fracture admitted to the NHS Trust from the beginning of April 2010 until the end of 2011. Ramappa said the study’s conclusion  that  time  to  surgery  needs  to  be  upgraded  as  a  significant  predictor  confirms recent trends in treatment of proximal femoral fracture.

The 10% 30 day mortality statistic reflects standards of care but also characteristics of the general population. It may be changes in these characteristics that lie behind the second significant pre-operative predictor identified by the study: pre-fracture mobility. “Certain population characteristics have been constantly changing in the UK,” said Ramappa, “such as average BMI and average life expectancy which have been increasing. These factors have a tendency to decrease overall pre-fracture mobility. This could have led to pre-fracture mobility  now  becoming  a  significant  pre-operative  predictor  of  mortality.  We  think  these factors are applicable across Europe as well.”

Men  are  more  at risk

While  gender  has  been  recognised  in  the  past  as  a  factor  in  higher  rates  of  mortality  in cases of proximal femoral fracture, it is interesting to note that this remains the case. “Male patients tend to have more co-morbidities, especially pulmonary and cardiovascular co- morbidities, as compared to female patients,“ said Ramappa. “This could contribute to increased mortality rates in male fracture neck of femur patients.”

Identifying at-risk patients to optimise care

Time to surgery is the factor identified by the new study that health care systems can immediately  act  on,  where  necessary,  whereas  pre-fracture  mobility  cannot  be  modified. This   has   clear   implications.   “In   the   current   economic   climate,   resources   need   to   be efficiently  utilised,“  said  Ramappa.  “Resources  such  as  a  high  dependency  unit  can  be targeted to patients identified to have increased 30 day mortality, based on pre-operative predictors. Our pre-operative predictors are simple to use.”


The   European   Federation   of   National   Associations   of   Orthopaedics   and   Traumatology (EFORT) is the umbrella organisation linking Europe´s national orthopaedic societies. EFORT was founded in  1991 in  the Italian Marentino. Today it  has 42 national member societies from 43 member countries and six associate scientific members.

EFORT   is   a   non-profit   organisation.   The   participating   societies   aim   at   promoting   the exchange  of  scientific  knowledge  and  experience  in  the  prevention  and  treatment  of diseases and injuries of the musculoskeletal system. EFORT organises European congresses, seminars, courses, forums and conferences. It also initiates and supports basic and clinical research.

Source: EFORT Abstract 1283: Pre operative predictors of 30 day mortality following fracture neck of femur

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