Traumatic Femur Fracture Five Year Survival Analysis: A Retrospective Cohort Study in a Local General Orthopaedic Centre

Introduction: 
Traumatic femoral fractures are principally Orthopaedic emergencies requiring surgical management. Yet, some patients opt for a non-invasive alternative. This study aims to analyze the five-year survival and predictors for survival between operatively and non-operatively treated femoral fractures in a local general Orthopaedic Centre. 

Methodology: 
This cross-sectional study involves retrospective review of 142 medical records of inpatients treated by Orthopaedic Department, Hospital Tuanku Fauziah, Perlis between 1st January 2013 and 31st December 2013. Patient's five-year survival status was obtained from the national registry.  

Results: 
Patients were generally Malay (n=123,86.0%), men (n=86,60.6%), aged 44.6 (±25.9) years old, with proximal femur fractures (n=60,42.3%) and managed operatively (n=124,87.3%) using intramedullary devices (n=45,31.7%). Kaplan-Meier survival analysis utilizing Log-Rank test revealed an overall femoral fracture five-year survival of 77.5% and significant difference in survival experience between operatively treated (80.6%) and non-operatively treated (55.6%) patients, p=0.001. Proximal femur fracture patients had lower five-year survival (53.3%) compared to non-proximal femur fractures (p<0.001). Age (AdjHR=1.05,95% CI:1.03-1.06,p<0.001) and type of management (non-operatively treated AdjHR=2.31,95% CI:1.10-4.85,p=0.028) were significant prognostic factors for mortality following femur fracture. Sub-analysis revealed patients with proximal femur fractures were mostly female (n=37,61.7%), Malays (n=46,76.7%) with median (IQR) age of 73.5 (18.0) years old, managed operatively (n=45,81.7%) via screw fixation (n=19,31.7%) and if operatively treated, had significantly higher five-year survival (57.1%) compared to those not operatively treated (36.4%), p=0.050. Identifiable factor for mortality post proximal femoral fracture was age (HR=1.03,95% CI:1.00-1.06,p=0.044). 

Discussion/Conclusion: 
Age and type of management had significant impact on survival of patients post femoral fracture. Small sample size of proximal femur fractures impeded further sub-analysis.

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