title: High-energy femur fractures increase morbidity but not mortality in elderly patients.
abstract: BACKGROUND
  Trauma centers are projected to have an increase in the number of elderly patients with high-energy femur fractures. Greater morbidity and mortality have been observed in these patients. Further clarification regarding the impact of high-energy femur fractures is necessary in this population.
  
  
  OBJECTIVE
  Our purpose was to assess the influence of high-energy femur fractures on mortality and morbidity in patients 60 years and older. Specifically, we asked (1) if the presence of a high-energy femur fracture increases in-hospital, 6-month, and 1-year mortality in patients 60 years and older, and (2) if there is a difference in morbidity (number of complications, intensive care unit [ICU] and total hospital length of stay, discharge disposition, accompanying fractures, and surgical intervention) between patients 60 years and older with and without high-energy femur fractures.
  
  
  METHODS
  A retrospective review of 242 patients was performed. Patients with traumatic brain injury or spine injury with a neurologic deficit were excluded. A control group, including patients admitted secondary to high-energy trauma without femur fractures, was matched by gender and Injury Severity Score (ISS). In-hospital mortality, 6-month and 1-year mortality, complications, ICU and total hospital length of stay, discharge disposition, accompanying fractures, surgical intervention, and covariates were recorded. Statistical analyses using Fisher's exact test, ANOVA, Kaplan-Meier estimates, and Cox regression models were performed to show differences in mortality (in-hospital, 6-month, 1-year), complications, length of ICU and total hospital stay, discharge disposition, surgical intervention, and accompanying fractures between elderly patients with and without femur fractures. The average ages of the patients were 72.8 years (± 9 years) in the femur fracture group and 71.8 years (± 9 years) in the control group. Sex, age, ISS, and comorbidities were homogenous between groups.
  
  
  RESULTS
  In-hospital (p = 0.45), 6-month (p = 0.79), and 1-year mortality (p = 0.55) did not differ in patients with and without high-energy femur fractures. Elderly patients with high-energy femur fractures had an increased number of complications (p = 0.029), longer total hospital length of stay (p = 0.039), were discharged more commonly to rehabilitation centers (p < 0.005), had more accompanying long bone fractures (p = 0.002), and were more likely to have surgery (p < 0.001). Average ICU length of stay was similar between the two groups (p = 0.17).
  
  
  CONCLUSIONS
  High-energy femur fractures increased morbidity in patients 60 years and older; however, no increase in mortality was observed in our patients. Concomitant injuries may play a more critical role in this population. Additional studies are necessary to clarify the role of high-energy femur fracture mortality in this age group.
  
  
  METHODS
  Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Scott and White Memorial Hospital, 2401 S 31st Street, Temple, TX, 76508, USA, kpatel@sw.org.
authors.forename: Kushal V
authors.initials: KV
authors.lastname: Patel
authors.forename: Kindyle L
authors.initials: KL
authors.lastname: Brennan
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Davis
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Jupiter
authors.forename: Michael L
authors.initials: ML
authors.lastname: Brennan
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003422:Critical Care; D005264:Femoral Fractures / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008875:Middle Aged; D010351:Patient Discharge; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D013997:Time Factors