Mortality and morbidity after hip fracturesBMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6924.343b (Published 29 January 1994) Cite this as: BMJ 1994;308:343
EDITOR, - Graham Keene and colleagues once again highlight the considerable morbidity and mortality attached to proximal femoral fracture, particularly in those patients with extracapsular fractures.1 The two year difference in mean age between patients with extracapsular fracture (80 years) and intracapsular fracture (78 years) is clinically important and presumably statistically significant, although this is not reported. A significant four year difference in the age of elderly women (aged 65 and over) with extracapsular or intracapsular fractures in Belfast has been reported, but there were no significant differences in mortality between cervical and trochanteric fractures within age groups.2 In Newcastle, when age was taken into account there was no difference in the fatality of trochanteric and cervical fractures.3
The high mortality of hip fracture is starkly highlighted by rates of 28% at six months and 33% at one year. Similarly high values have been reported in elderly women in Belfast (mean age 81 years) who had a six month mortality of 29% and a one year mortality of 35%.4
It is important that the influence of age, sex, and domicile, in addition to other variables, is considered before comparisons between mortality and morbidity figures are made. A report from Belfast of a six month mortality of 15% suggests that not all elderly subjects with fractures were enrolled.5 Similarly low mortality may occur if studies include only elderly people residing in the community at the time of fracture, excluding the frail elderly in institutional, residential, and nursing home care. It is clear that if a purchasing authority seeks to compare measures of outcome and length of stay, or if comparitive audit is undertaken, the nature of the population and its selection must be clearly identified.
The continuing increase in the elderly proportion of the population will result in increasing numbers of hip fractures and attendant higher age related mortality and morbidity. Hospital care, outcome, and preventive measures need to be addressed from both a humanitarian and a financial perspective.