[Survival of proximal femoral fractures vs. mean life expectancy of the general population : Retrospective analysis of 1000 geriatric patients minimum 10 years after operation]

BACKGROUND

Surgery for geriatric proximal femoral fractures (PF) is associated with high mortality rates within the first year. Studies with follow-up of at least 10 years after surgery are lacking.

MATERIAL AND METHODS

Based on our database, we reviewed patients with PF who underwent surgery and were followed for a minimum of 10 years. Only patients aged 65-99 years were included. The primary endpoint was survival compared to the mean life expectancy of the general population evaluated by the German Federal Statistical Office. The secondary endpoint was any revision later than 1 year after surgery. After a minimum of 10 years telephone calls were conducted with living patients or their relatives.

RESULTS

From a total of 1203 consecutive patients 1000 patients with 1000 PF were evaluated after a mean of 12.2 years (range 10.0-14.0 years). The mean survival was 4.5 ± 1.6 years, and the 10-year survival rate was 13.1%. A total of 7 periods with a range of 5 years were analyzed, starting from 65-69 years up to 95-99 years. Compared to the mean life expectancy of the general population, the survival rate of the sample was significantly shorter up to 9 years. Both genders were equally affected. With increasing age, this gap declined based on shorter life expectancy. A subgroup analysis revealed that patients with survival > 1 year did not demonstrate significantly better results. Revisions later than 1 year after the index surgery were infrequent, and only 27 (2.7%) were recorded.

CONCLUSION

Geriatric patients with PF have significantly shorter life expectancy than the general population evaluated by the German Federal Statistical Office. This reflects fragility and morbidity of patients with PF.

Mortality and complications after treatment of acute diabetic Charcot foot

AIMS

Charcot foot is a rare but disabling complication to diabetic neuropathy, and can cause permanent, limb-threatening deformities. The aim of this study was to investigate a population of patients a Charcot foot on a case-by-case basis, in order to assess the consequences of an acute Charcot foot and its complications.

METHODS

The study was conducted a retrospective study of patients admitted to the Copenhagen Wound Healing Center between 1996 and 2015 with the diagnosis of Charcot foot (DM14.6) and diabetes mellitus type 1 or 2 (DE10.X and DE11.X). Physical and electronic records were used, and compared to data from the Danish Diabetes Registry.

RESULTS

In total 392 patients were identified of which 173 were included. There were 26% with type 1 diabetes (initial HbA1c 81.7 ± 21.4 mmol/mol) and 74% with type 2 diabetes (initial HbA1c 66.5 ± 20.3 mmol/mol). Primary off-loading was with a removable walker in 95% of the cases (average off-loading time 8.3 months). The 5-year mortality was 14% with a mean survival time of 12.7 years. There was an association between lack of compliance and occurrence of foot complications, as well as between having a Charcot foot and leaving the workforce.

CONCLUSION

More patients had type 1 diabetes compared to the background population, and they had a higher HbA1c than the general population of diabetes patients. A total of 67% developed complications such as ulcers, while patients non-compliant to treatment did significantly worse than those being compliant. The 5-year mortality was low, 14%, and comparable to diabetes patients without Charcot foot.