@article{Wolf_Mukka_Ekelund_Möller_Hailer_2020, title={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}, volume={92}, url={https://actaorthop.org/actao/article/view/374}, DOI={10.1080/17453674.2020.1831236}, abstractNote={<p><strong>Background and purpose</strong> — Unlike hip fractures, diaphyseal<br>and distal femoral fractures in elderly patients have<br>not been widely studied. We investigated the demographics,<br>comorbidities and mortality of patients with femoral fractures<br>at any anatomical level with a focus on early mortality.</p> <p><br><strong>Patients and methods —</strong> We analyzed 11,799 patients<br>≥ 65 years with a femoral fracture registered in the Swedish<br>Fracture Register from 2011 to 2014. The cohort was<br>matched with the National Patient Register to obtain data on<br>comorbidities classified according to the Charlson Comorbidity<br>Index (CCI). Generalized linear models were fitted to<br>estimate the adjusted relative risk of mortality.</p> <p><br><strong>Results —</strong> Mean age of the cohort was 83 years and 69%<br>were women. Patients with distal femoral fractures had the<br>lowest degree of comorbidity, with 9% having a CCI of ≥ 3<br>compared with 14% among those with proximal and 16%<br>among those with diaphyseal fractures. Unadjusted 90-day<br>mortalities were 13% (95% CI 9.4–16) after fractures in<br>the distal, 13% (CI 10–16) in the diaphyseal, and 15% (CI<br>14–15) in the proximal segment. The adjusted relative risk<br>for 90-day mortality was 1.1 (CI 0.86–1.4) for patients with<br>distal and 0.97 (CI 0.76–1.2) for patients with diaphyseal<br>femoral fractures when compared with patients with hip<br>fractures.</p> <p><strong>Interpretation —</strong> Elderly patients with femoral fractures<br>distal to the hip may have similar adjusted early mortality<br>risks to those with hip fractures. There is a need for larger,<br>preferably prospective, studies investigating the effect of<br>rapid pathways and geriatric co-management for patients<br>with diaphyseal and distal femoral fractures.</p>}, number={1}, journal={Acta Orthopaedica}, author={Wolf, Olof and Mukka, Sebastian and Ekelund, Jan and Möller, Michael and Hailer, Nils P}, year={2020}, month={Oct.}, pages={39–45} }