• Mellick J Chehade, Tania Carbone, Danny Awwad, Anita Taylor, Corinna Wildenauer, Boopalan Ramasamy, and Margaret McGee.
• *Faculty of Health Sciences, Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, Australia; and †Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia.
• J Orthop Trauma. 2015 Dec 1; 29 (12): 538-43.

ObjectivesTo determine the influence of fracture stability on early patient mortality and complications requiring reoperation after trochanteric hip fracture.DesignProspective consecutive cohort study.SettingThe orthopaedic unit of a public teaching hospital.ParticipantsSeven hundred twenty-eight patients with 743 consecutive stable (n = 446) pertrochanteric and unstable (n = 297) pertrochanteric or intertrochanteric fractures (median age: 84 years, 71% females) resulting from a low-impact injury and surgically managed. Mean follow-up of surviving patients was 4 years (range: 2-6 years).InterventionFracture fixation by dynamic hip screw extramedullary device or intramedullary nail (Austofix or Gamma3) based on surgeon preference.Main Outcome MeasuresMortality within 6 and 12 months and surgical complications requiring device reoperation within 12 months of surgery (multivariate logistic regression and Kaplan-Meier survival analyses).ResultsPatients with unstable fractures were at 1.61 times (95% confidence interval: 1.18-2.21, P = 0.003) and 1.37 times (95% confidence interval: 1.02-1.83, P = 0.037) greater odds of dying within 6 and 12 months, respectively, than those with stable fractures. Older age, male gender, higher American Society of Anesthesiologists classification, in residential care, and inpatient-reported medical complications were also independent risk factors for early mortality. Increasing fracture instability and fixation using the Austofix nail were associated with early device reoperation. Comparable results were reported for the dynamic hip screw and Gamma3 nail, although the Gamma3 nail may offer advantages for more complex unstable fractures.ConclusionsFracture instability influences early mortality after surgical fixation of trochanteric hip fracture. The Austofix double lag screw device had suboptimal results.Level Of EvidencePrognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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