Prognostic factors affecting survival of patients with intertrochanteric femoral fractures over 90 years treated with proximal femoral nailing.

Objective: This study aimed to analyze the prognostic factors affecting the survival of patients over 90 years with intertrochanteric fractures treated with proximal femoral nailing.

Materials: Records of 53 patients over 90 years old treated in our clinic between 2009 and 2018 for intertrochanteric fractures with proximal femoral nailing were retrospectively reviewed. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) were analyzed for validity as prognostic factors. Kaplan-Meier test was used to estimate overall survival. A multivariate Cox algorithm was used to determine independent factors associated with survival. The minimum follow-up duration was one year.

Results: The average age at the time of surgery was 92.8 years. There were 39 women and 14 men. The right femur was involved in 29 (54.7%) patients and the left in 24 (45.3%) patients. At the time of this study, 32 (60.3%) patients were deceased. There were 21 (39.7%) surviving patients with a mean survival of 41.2 months (range 12-113). Survival rates at first month, 6 months and 1 year after surgery were 90.6%, 88.6% and 86.7%, respectively. The mean survival after surgery was 29.6 (2 days-95 months) months for deceased patients. Among all the parameters, ASA score and delay to surgery were independently associated with worse overall survival.

Conclusion: An ASA score of 4 increased mortality by a factor of 26 and delay to surgery increased mortality by a factor of 1.3. Both were prognostic factors influencing overall survival.