title: The fate of proximal femoral fractures in the 10th decade of life: an analysis of 117 consecutive patients.
abstract: BACKGROUND
  To date, there is a lack of valid data with larger populations of patients in their 10th decade of life in the analyses of proximal femoral fractures.
  
  
  METHODS
  The inclusion criteria focused on all proximal femoral fractures in patients 90-99 years of age who underwent surgical treatment between 2009 and 2012. After a period of at least 2 years post-surgery, a retrospective collection of empiric data, including the survival time and surgical revision rate, was performed. Missing data were collected per telephone interview.
  
  
  RESULTS
  A total of 121 proximal femoral fractures in 117 patients in their 10th decade of life were treated. The mean age was 92.3 years. 61 fractures of the femoral neck received hemi- or total hip arthroplasty, while 60 pertrochanteric or subtrochanteric fractures were treated by osteosynthesis using proximal femoral nail (PFN) or dynamic hip screw (DHS). At the time of follow-up, 83/117 patients (71%) were already deceased. The mortality after 30 days, 6 months, 1 year and 2 years was 16%, 37%, and 43%, and 55%, respectively. A total of 22 surgical revisions (19%) were performed: 10 due to early infections, 8 due to haematomas, and 4 due to implant failures with a "cut out" of the femoral neck screw exclusively in DHS. The duration of surgery (with regard to surgical revision) and ASA classification (with regard to survival rate) were significant influence factors. Contralateral proximal femoral fractures were identified in 24/117 patients (20%), irrespective of study period.
  
  
  CONCLUSIONS
  The proximal femoral fractures in the 10th decade of life are associated with high postoperative mortality within the first 6 months. Surgical revision due to complications did not result in a statistically significant reduction of the survival time. From the osteosynthetic perspective, the DHS was associated with a significantly higher "cut-out" rate compared to PFN procedure. With regard to the alloarthoplasty, there were no significant differences observed between hemi- and total hip arthroplasty. A contralateral femoral fractures was observed in 20% of the total study population, but peri-implant or periprosthetic femoral fractures have not been observed in any of the cases thus far.
authors.affiliation: Clinic for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str. 86, 93049 Regensburg, Germany. Electronic address: franz.mueller@barmherzige-regensburg.de.
authors.forename: Franz
authors.initials: F
authors.lastname: Müller
authors.affiliation: Clinic for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str. 86, 93049 Regensburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Galler
authors.affiliation: Clinic for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str. 86, 93049 Regensburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Zellner
authors.affiliation: Clinic for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str. 86, 93049 Regensburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Bäuml
authors.affiliation: Clinic for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str. 86, 93049 Regensburg, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Füchtmeier
mesh_terms: D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000401:mortality; D005260:Female; D005264:Femoral Fractures / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000401:mortality; D016330:Frail Elderly; D006801:Humans; D008297:Male; D057068:Periprosthetic Fractures / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Complications; Geriatric patients; Outcome; Proximal femoral fractures