Troponin T as a predictive marker of morbidity in patients with fractured neck of femur.
BACKGROUND
This study aims prospectively to assess perioperative measurement of Troponin T, a marker of myocardial injury, as a predictor of morbidity and mortality in patients undergoing surgery for fractured neck of femur.


METHODS
All patients aged 65 years and over presenting with a fractured neck of femur over a 4-month period were initially included. Exclusion criteria were renal failure, polymyositis and conservative fracture management. Troponin T levels were measured on admission, day 1 and 2 post-surgery. According to local protocol, a level of >0.03 ng/mL was considered to be raised. Adverse outcome measures were cardiorespiratory events (myocardial infarction, congestive cardiac failure, unstable angina, major arrhythmias requiring treatment and pulmonary embolism), death and length of inpatient stay.


RESULTS
One hundred and twenty-nine patients presented with femoral neck fractures. 108 patients were included after application of the exclusion criteria. 42 (39%) showed a Troponin rise. Of these, 25 sustained one or more outcome complications versus seven with no rise (p<0.001). The mean hospital stay was 25.7 days for patients with elevated Troponin, 18.3 days in the normal group (p<0.012). There were nine deaths in the raised Troponin group, and five with no rise (p<0.05).


CONCLUSIONS
The principle causes of early death after hip fracture surgery are cardiac failure and myocardial infarction. Troponin T is a sensitive enzymatic marker of myocardial injury. The association between raised Troponin and hip fractures has not previously been made. In our series, 39% showed a perioperative Troponin rise. This was significantly associated with increased morbidity, mortality and longer hospitalisation. Many patients appear to be having silent events, causing significant morbidity. We recommend Troponin measurement in all patients to identify this risk and allow appropriate optimisation measures.
Dawson-Bowling
Sebastian
S
South East Thames Orthopaedic Rotation, United Kingdom. sebd_b@hotmail.com
Chettiar
Krissen
K
Cottam
Howard
H
Worth
Richard
R
Forder
Justin
J
Fitzgerald-O'Connor
Isobel
I
Walker
David
D
Apthorp
Hugh
H
D000368:Aged; D015415:Biomarkers / Q000097:blood; D004630:Emergencies; D004812:Epidemiologic Methods; D005265:Femoral Neck Fractures / Q000097:blood* / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology; D011183:Postoperative Complications / Q000097:blood*; D011379:Prognosis; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D020107:Troponin T