Aims: To compare the 30-day and 12-month mortality rates following 5 acute fracture locations: hip, acetabular, pubic rami, distal femur and combined tibia/ankle/complex foot fractures. To compare the subsequent rates of inpatient complications and hospital re-admissions in the 12 months post-fracture.
Methods: This retrospective cohort study identified 3668 patients aged 65 or older who presented with an acute fracture of their lower limb and divided them into the five fracture subgroups for analysis. Data collected included age, gender, length of stay, baseline comorbidities, inpatient complications, readmission rates and date of death.
Results: At 12-months post-fracture, the hip fracture cohort had the highest mortality rate at 26.0%, followed by pubic rami (20.7%), distal femur (20.3%), acetabular (18.8%) and tibia/ankle/foot (5.3%). The tibia/ankle/foot cohort were a younger population with fewer baseline comorbidities and inpatient complications. Amongst the remaining four cohorts, baseline patient characteristics and inpatient complications were similar, with few statistically significant differences identified between the groups. Irrespective of the location of the lower limb fracture, high rates of hospital re-admission were observed by 12 months (46.7-62.5%) and 5.5-10.7% were re-admitted for a second lower limb fracture by 12 months.
Conclusions: Older patients who sustain hip fractures have the highest 12-month mortality rate compared to other lower limb fractures; however sustaining a fracture of the acetabulum, distal femur or pubic rami are also associated with substantial morbidity and mortality. Irrespective of the location of the lower limb fracture, all are associated with subsequent hospital presentations and lower limb fractures within 12 months.