High Charlson Comorbidity Index Score is associated with early fracture-related complication for internal fixation of neck of femur fractures

The incidence of geriatric hip fractures continues to rise in our aging population and has become a major public health concern globally. The primary outcome of this study was to determine whether Age-adjusted Charlson Comorbidity Index (ACCI) is associated with increased fracture-related complications in neck of femur fractures treated by internal fixation. This was a cohort study between January 2014 to June 2018. All patients >= 50 years old with an acute neck of femur fracture after low-energy trauma fixed with cannulated hip screws were included and followed-up for 1 year at a tertiary centre. Primary outcome was to determine whether ACCI was associated with increased fracture-related complications. Secondary outcomes were revision rate, mortality, and function after surgery. Further analysis were performed within a younger group (age 50-65) and elder group (age > 65), as displaced fractures (Garden Type III/IV) were in younger group. 233 hip fractures (68 males; 165 females) with a mean age of 73.04 +/- 12.89 were included in the study. Surgical outcomes showed that the complication rate of hip screw fixation for all patients was 21.5% (50 patients) at 1 year. ACCI was significantly higher in all patients with complications (p = 0.000). Analysis within younger (p = 0.000) and elder groups (p = 0.006) both showed significance. Stepwise logistic regression modelling showed ACCI had positive correlation with complications with ACCI = 6 (OR 4.27, p = 0.02). R-2 values were comparatively better after controlled by Garden Type III/IV at ACCI = 4 (OR 6.42 (1.70, 24.25), p = 0.01). The authors recommend that for patients with a Garden Type I/II and ACCI >= 6 or a Garden Type III/IV and ACCI >= 4, a direct arthroplasty surgery should be considered.

Automated summary

The incidence of geriatric hip fractures is a major public health concern globally. This study found that the Age-adjusted Charlson Comorbidity Index (ACCI) is associated with increased fracture-related complications in neck of femur fractures. The authors recommend considering direct arthroplasty surgery for certain patient groups based on the ACCI score.