title: When does hip fracture surgery fail?
abstract: BACKGROUND
  Hip fractures remain the most common orthopaedic injury requiring hospital admission. Failed surgery for any cause carries a higher morbidity, mortality, and healthcare-related cost. The aims of this study were to determine risk factors for surgical complications of hip fracture surgery, when they occurred and their effect on mortality.
  
  
  METHODS
  From a prospectively collected consecutive database of 795 hip fractures admitted between July 2007 and June 2008, all surgical and non-surgical complications were identified as well as re-operation for any cause and mortality in the 4 years since surgery.
  
  
  RESULTS
  Fifty-five (6.9%) patients were found to have developed a surgical complication requiring further intervention. Risk factors included younger age, smoking and cannulated screw fixation. Cannulated screw fixation was associated with a 30.9% rate of re-operation. Post-operative medical complication occurred in 21.8%. It was associated with a 78.5% mortality at 4 years with a median time to mortality of 58 days (95% CI 0-120 days).
  
  
  CONCLUSIONS
  Mechanical failure was the most common reason for cannulated screw re-operation. Hip hemiarthroplasty most commonly failed by infection. Inter-trochanteric and sub-trochanteric fracture fixation had very low failure rates. Post-operative medical complications, but not surgical complications, were associated with a higher mortality rate.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Royal Infirmary Edinburgh, UK. Electronic address: drjerrytsang@gmail.com.
authors.forename: S T J
authors.initials: ST
authors.lastname: Tsang
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Royal Infirmary Edinburgh, UK.
authors.forename: S A
authors.initials: SA
authors.lastname: Aitken
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Royal Infirmary Edinburgh, UK.
authors.forename: S K
authors.initials: SK
authors.lastname: Golay
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Royal Infirmary Edinburgh, UK.
authors.forename: R K
authors.initials: RK
authors.lastname: Silverwood
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Royal Infirmary Edinburgh, UK.
authors.forename: L C
authors.initials: LC
authors.lastname: Biant
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails / Q000009:adverse effects; D001863:Bone Screws / Q000009:adverse effects; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects*; D006620:Hip Fractures / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D012959:Socioeconomic Factors; D016019:Survival Analysis; D017211:Treatment Failure; D014946:Wound Infection / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*
keywords: Complications; Elderly; Hip fractures