Evaluation of Variables Influencing Mortality in Periprosthetic Femur Fractures: Do Fracture Type and Surgical Method Affect Mortality?

Abstract

Introduction: We investigated the factors influencing mortality in patients with periprosthetic femur fractures (PFF). Our aim was to assess the effects of fracture types and treatment methods on mortality. Methods: We identified 52 patients who met the inclusion criteria and underwent surgery for PFF between January 1996 and December 2020. Patient records were analyzed retrospectively to collect reports on patient demographics, hospitalization, and surgical details. The following parameters were assessed: age, sex, side, time to PFF, surgical procedure, fracture pattern, and American Society of Anesthesiologists Classification. The Vancouver classification was used to identify fracture patterns. Results: The mean age was 73.6±13.5 years. Average of 5 years elapsed until PFF (range, one month to twenty years). Open reduction and internal fixation were performed in 61.5% of the patients, and revision arthroplasty was performed in 38.5%. Significant differences were found between patients’ ages (p=0.033) and fracture types (p<0.001). The overall 30-day and 12-month mortality rates were 19.2%, and the 12-month mortality was 36.5%. The survival time of those who underwent surgical osteosynthesis was significantly longer than that of those who underwent revision arthroplasty (p=0.048). The risk of mortality for fracture classification B1 was higher than that for type A [odds ratio (OR): 6.93; confidence interval (CI): 95% (1.16-41.09) p=0.033], and the risk of mortality for fracture type B3 was higher than that for type A [OR: 16.75; CI: 95% (1.12-248.45) p=0.041]. Conclusion: The surgical method and type of fracture affected mortality. Mortality was higher among patients who underwent revision arthroplasty and had Vancouver type B3 fractures.

Keywords

• periprosthetic femur fractures
• mortality
• vancouver classification
• osteosynthesis
• arthroplasty