How deadly is a fracture distal to the hip in the elderly? An observational cohort study of 11,799 femoral fractures in the Swedish Fracture Register

Abstract

Background and purpose — Unlike hip fractures, diaphyseal
and distal femoral fractures in elderly patients have
not been widely studied. We investigated the demographics,
comorbidities and mortality of patients with femoral fractures
at any anatomical level with a focus on early mortality.

Patients and methods — We analyzed 11,799 patients
≥ 65 years with a femoral fracture registered in the Swedish
Fracture Register from 2011 to 2014. The cohort was
matched with the National Patient Register to obtain data on
comorbidities classified according to the Charlson Comorbidity
Index (CCI). Generalized linear models were fitted to
estimate the adjusted relative risk of mortality.

Results — Mean age of the cohort was 83 years and 69%
were women. Patients with distal femoral fractures had the
lowest degree of comorbidity, with 9% having a CCI of ≥ 3
compared with 14% among those with proximal and 16%
among those with diaphyseal fractures. Unadjusted 90-day
mortalities were 13% (95% CI 9.4–16) after fractures in
the distal, 13% (CI 10–16) in the diaphyseal, and 15% (CI
14–15) in the proximal segment. The adjusted relative risk
for 90-day mortality was 1.1 (CI 0.86–1.4) for patients with
distal and 0.97 (CI 0.76–1.2) for patients with diaphyseal
femoral fractures when compared with patients with hip
fractures.

Interpretation — Elderly patients with femoral fractures
distal to the hip may have similar adjusted early mortality
risks to those with hip fractures. There is a need for larger,
preferably prospective, studies investigating the effect of
rapid pathways and geriatric co-management for patients
with diaphyseal and distal femoral fractures.