title: Delay to surgery does not affect survival following osteoporotic femoral fractures.
abstract: OBJECTIVE
  Fragility femoral fractures occur in a similar group of patients to hip fractures but they are not routinely managed along standardised guidelines. This study looked specifically at whether delay to surgery has an impact on mortality and morbidity.
  
  
  METHODS
  An international, multi-centre retrospective review was carried including all patients over 60 years with fragility femoral fractures, including most periprosthetic fractures, between December 2008-2014.
  
  
  RESULTS
  243 patients met the inclusion criteria with mean follow-up 25 months. 197 (81%) were female with mean age 81 years. Median time to surgery was 2 days; 39% were operated on <24h, 23% 24-48h, and 37% at >48h. 3- and 12-month mortality were 14% (95% CI: 9-18%) and 26% (20-31%) respectively. On Kaplan-Meier plotting, relationships were apparent between survival and sex, and ASA grade, but not delay to surgery or fracture type.
  
  
  CONCLUSIONS
  Fragility femoral fractures have equivalent mortality to hip fractures but we found no link between delay to surgery and mortality. We believe it is safe to delay surgery, within reason, whilst their acute and chronic medical problems are optimised. We believe this information will help develop guidelines similar to hip fracture pathways.
authors: Department of Orthopaedics, Royal Sussex County Hospital, Eastern Rd, Brighton BN2 5BE, UK. Electronic address: kit1kit1@icloud.com.
authors: Kit
authors: K
authors: Brogan
authors: Department of Orthopaedics, Worthing hospital, Lyndhurst Rd, Worthing BN11 2DH, UK.
authors: Harold
authors: H
authors: Akehurst
authors: Department of Orthopaedics, Waikato Hospital, Selwyn Street and Pembroke Street, Hamilton 3204, New Zealand.
authors: Elizabeth
authors: E
authors: Bond
authors: Department of Orthopaedics, Royal Sussex County Hospital, Eastern Rd, Brighton BN2 5BE, UK.
authors: Chris
authors: C
authors: Gee
authors: Department of Orthopaedics, Royal Sussex County Hospital, Eastern Rd, Brighton BN2 5BE, UK.
authors: William
authors: W
authors: Poole
authors: Department of Orthopaedics, Worthing hospital, Lyndhurst Rd, Worthing BN11 2DH, UK.
authors: Nirav N
authors: NN
authors: Shah
authors: Department of Orthopaedics, Waikato Hospital, Selwyn Street and Pembroke Street, Hamilton 3204, New Zealand.
authors: Steve
authors: S
authors: McChesney
authors: Department of Orthopaedics, Royal Sussex County Hospital, Eastern Rd, Brighton BN2 5BE, UK.
authors: Stephen
authors: S
authors: Nicol
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005264:Femoral Fractures / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery; D017102:Fracture Healing; D015577:Geriatric Assessment / Q000379:methods*; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery; D057068:Periprosthetic Fractures / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: Distal femoral; Femur; Fragility; Mortality; Non-NOF; Osteoporotic; Periprosthetic