Radiological parameter associated with the survival of old patients with hip fracture

• Published in: Injury 2021-11, Vol.52 (11), p.3388-3396
• Main Authors: Bayram, Serkan, Yıldırım, Ahmet Müçteba, Birişik, Fevzi, Salduz, Ahmet
• Format: Article
• Language: English
• Subjects: bone quality; elderly patients; Hip fracture; lower extremity arterial calcification; mortality; sarcopenia
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2021.07.027

•Sarcopaenia was significantly higher in the deceased group.•Femoral arterial calcification was significantly higher in the deceased group.•Femoral calcification was the only independent radiological parameter of survival.•Rate of femoral calcification was significantly higher in intertrochanteric group. We aimed to investigate the relationship between radiological parameters and survival of patients with hip fracture aged >65 years. We performed a retrospective cohort study with reviewed recorded data of patients who were treated for hip fracture. Radiological parameters were included the psoas:lumbar vertebral index (PLVI) by evaluating computed tomography (to assess sarcopenia), the cortical thickness index (CTI), Dorr morphology, canal-to-calcar ratio (CCR) and presence of iliac and femoral arterial calcification on both lower extremities by evaluating hip and pelvis radiographs. A multivariate Cox algorithm was applied to recognize these radiological factors independently associated with survival. A total of 304 patients [200 (65.8%) female and 104 (34.2%) male] were included, and the average age was 79.3 ± 8.3 years. During the study period, 154 (50.6%) patients died, whereas 150 (50.4%) were alive with a mean survival of 35.7 months. The survival rates at 1 month, 6 months and 1 year after surgery were 92.8%, 79.7% and 73.4%, respectively. A total of 120 patients were diagnosed with femoral neck fracture, at a mean age of 75.1 years, and 204 patients were diagnosed with intertrochanteric fracture, at a mean age of 82.2 years. The multivariate analysis demonstrated that presence of femoral calcification on the fracture side were independently associated with a poor overall survival. Although sarcopaenia was significantly higher in the deceased group, sarcopaenia was not significantly correlated with survival. However, the presence of femoral calcification on the fracture side was the only independent radiological parameter associated with poor overall survival, as patients had 1.4 times higher mortality rate. We did not find a significant difference between the intertrochanteric and femoral neck fracture groups with regard to CCR, CTI and Dorr type. However, the rate of femoral calcification in both the fracture and unaffected sides was significantly higher in the intertrochanteric group. Level III prognostic study.