How deadly is a fracture distal to the hip in the elderly? An observational cohort study of 11,799 femoral fractures in the Swedish Fracture Register

Figures & data

Figure 1. Flowchart of patients included in the study.

Table 1. Baseline demographic characteristics of the study population of 11,799 patients with femoral fractures. Values are distribution of the Charlson Comorbidity Index category and subcategories (%) depending on fracture segment

Description	Proximal	Diaphyseal	Distal
Distribution, n (%)	10,964 (93)	469 (4)	366 (3)
Mean age (SD)	83 (8)	82 (9)	82 (9)
Sex, n (%)
Male	3,441 (31)	141 (30)	68 (19)
Female	7,523 (69)	328 (70)	298 (81)
CCI ^a
0	54	54	63
1–2	33	29	28
3 or more	14	16	9
Charlson subcategories ^a
Myocardial infarction	9.4	8.3	6.6
Congestive heart failure	13	11	13
Peripheral vascular disease	3.3	1.5	1.9
Cerebrovascular disease	11	8.7	9.8
Dementia	17	11	7.4
Chronic pulmonary disease	10	11	6.6
Rheumatic disease	3.8	6.4	5.7
Peptic ulcer disease	1.0	0.6	0.5
Mild liver disease	0.7	0.0	1.4
Diabetes without chronic
complications	13	10	9.3
Hemiplegia or paraplegia	1.6	1.3	1.6
Renal disease	4.6	3.4	5.7
Diabetes with chronic
complications	2.3	2.3	3.0
Malignancy	8.9	12	4.6
Moderate or severe liver
disease	0.2	0.2	0.3
Metastatic solid tumor	2.3	7.5	1.1
Aids/HIV	0	0	0

^a Proportion (%) within segment

Figure 2. Unadjusted cumulative mortality up to 1 year after index fracture per femoral segment with 95% confidence intervals.

Table 2. Unadjusted 90-day mortality dependent on fracture location and adjusted for age, sex, and the Charlson Comorbidity Index (CCI), including stratified analyses for sex and CCI groups. Values are percentage and relative risks (RR) with 95% confidence intervals (CI)

Fracture location	Mortality (%)	RR (CI)
Unadjusted 90-day mortality
Proximal	15 (CI 14–15)
Diaphyseal	13 (CI 10–16)
Distal	13 (CI 9.4–16)
Proximal		1 ref
Diaphyseal		1.0 (0.8–1.2)
Distal		1.1 (0.9–1.4)
90-day mortality when stratified by sex
Men
Proximal		1 ref
Diaphyseal		1.2 (0.8–1.6)
Distal		1.1 (0.6–1.7)
Women
Proximal		1 ref
Diaphyseal		0.8 (0.6–1.1)
Distal		1.2 (0.9–1.5)
90-day mortality when stratified by CCI
No (CCI = 0)
Proximal		1 ref
Diaphyseal		0.8 (0.5–1.2)
Distal		0.9 (0.5–1.3)
Moderate (CCI = 1–2)
Proximal		1 ref
Diaphyseal		0.8 (0.5–1.2)
Distal		1.4 (1.0–2.0)
High (CCI = 3 or more)
Proximal		1 ref
Diaphyseal		1.2 (0.8–1.6)
Distal		1.1 (0.6–1.7)

Table 3. Unadjusted 30- and 365-day mortality dependent on fracture location. Values are mean percentage (95% CI)

Fracture location	30-day	365-day
Proximal	7.5 (7.0–8.0)	26 (25–27)
Diaphyseal	8.3 (5.8–11)	21 (18–25)
Distal	6.3 (3.8–8.8)	21 (17–25)