• Franz Müller, Michael Galler, Tanja Kottmann, Michael Zellner, Christian Bäuml, and Bernd Füchtmeier.
• Klinik für Unfallchirurgie, Orthopädie und Sportmedizin, Krankenhaus Barmherzige Brüder, Prüfeninger Str. 86, 93049, Regensburg, Deutschland. dr.med.franz.mueller@gmail.com.
• Unfallchirurg. 2018 Jul 1; 121 (7): 550-559.

BackgroundDue to demographic change, more proximal femoral fractures can be expected in the future. However, accurate growth rates as well as follow-up research extending more than 1 year postsurgery are still lacking.Materials And MethodsFirst, we defined inclusion and exclusion criteria for the retrospective cohort study. Based on these, we collected all surgical interventions conducted between 1 January 2006 and 31 December 2015. For a total of 2000 consecutive procedures, we retrieved and analysed a total of 12 variables influencing mortality. Data were retrieved from the prospectively established database; all patients still alive were contacted by phone, and missing data were collected. The endpoint of the study was consistently set for all patients at 2 years postsurgery.ResultsThe follow-up rate was 100%. Growth rate increased by 74.1% over a period of 10 years. Mean age of the total population was 79.4 years, and women were predominantly affected (71.7%). Surgical treatment was based on osteosynthesis procedures (57%) using DHS, PFN, or screws, as well as on arthroplasty (43%) performing total hip arthroplasty or implanting large-head prostheses. The revision rate was 14.5%, and mortality 2 years postsurgery was 32.4%. Through a multivariate analysis (Cox regression), the following seven influence factors showed statistically significant impact on mortality: age >82 years, male gender, CRP >10 mg/dl, haemoglobin <12 g/dl, ASA 3 or 4, dementia, and postoperative infection-but not timing of surgery.ConclusionThe growth rate of proximal femoral fractures progressed more rapidly than expected. Through a multivariate analysis, a total of six intrinsic variables were verified, which influenced the mortality. The prevention of infection-as the only additional extrinsic factor in this study-represents a more important role than early surgical treatment.

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