Association between fracture location and one-year mortality in patients aged 65 years and older after lower extremity trauma: a retrospective cohort study

Fractures in older patients are associated with increased mortality. Our study evaluated 30-day and one-year mortality among older patients based on fracture location. A descriptive retrospective cohort analysis was conducted including all patients aged 65 years or older hospitalized at a level I trauma center with a pelvic or lower extremity fracture between January 1, 2016 and December 31, 2019. Mortality rates were compared with age- and gender-matched data from the Swiss general population. In addition, an exploratory multivariable logistic regression analysis was performed to assess the association between fracture location and one-year mortality, adjusting for age and sex. A total of 1,739 patients were included. The overall 30-day mortality rate was 12%, and the one-year mortality rate was 34%. In comparison, the age- and gender-matched one-year mortality rate of the general Swiss population was 8% (p < 0.001). Unadjusted one-year mortality was highest after femur fractures (41%), followed by pelvic fractures (33%) and lower leg or foot fractures (11%). Among specific fracture types, pertrochanteric femur fractures showed the highest one-year mortality (47%), followed by Tile type C pelvic fractures (43%), distal femur fractures (40%), and femoral neck fractures (39%). In contrast, patients with fractures of the lower leg or foot had a one-year mortality rate of 12% or less, with the exception of tibial shaft fractures (26%). In the multivariable analysis adjusting for age and sex, pelvic fractures, femur fractures, and multiple fracture locations were associated with higher odds of one-year mortality compared with lower leg or foot fractures. One-year mortality in geriatric patients differed substantially by fracture location. After adjustment for age and sex, fracture location remained associated with one-year mortality, with the highest mortality observed after femur and pelvic fractures. These findings suggest that fracture location represents a clinically relevant marker associated with mortality risk in older patients after lower extremity trauma.