eur res j

The European Research Journal

2149-3189

Prusa Medical Publishing

10.18621/eurj.1828923

Orthopaedics

Ortopedi

Analysis of Early Reoperation and Mortality Following Intertrochanteric Fracture Fixation in Elderly Patients: A Focus on Frailty, Bone Quality, and Technical Factors

https://orcid.org/0000-0002-0628-5794

Karasu

Recep

Department of Orthopedics and Traumatology, Bursa City Hospital, Bursa, Türkiye

https://orcid.org/0000-0002-3643-931X

Şahin

Namık

Department of Orthopedics and Traumatology, Acıbadem Bursa Hospital, Bursa, Türkiye

https://orcid.org/0000-0002-3002-5028

Dinç

Mustafa

Department of Orthopedics and Traumatology, Bursa City Hospital, Bursa, Türkiye

https://orcid.org/0009-0003-4963-9980

Bayrak

Hünkar Çağdaş

Department of Orthopedics and Traumatology, Çekirge State Hospital, Bursa, Türkiye

02 01 2026

12 2 272 279 11 23 2025 12 25 2025

2015

The European Research Journal

Objectives: Intertrochanteric femur fractures in older adults carry high risks of early complications and mortality. This study aimed to identify independent predictors of early fixation failure and postoperative mortality by integrating patient-, fracture-, and technique-related factors.Methods: This single-center retrospective cohort included 150 patients aged ≥65 years who underwent surgical fixation with a Dynamic Hip Screw (DHS) or Proximal Femoral Nail Antirotation (PFN-A) for the AO Foundation/Orthopaedic Trauma Association (AO/OTA) 31-A intertrochanteric fractures. Evaluated variables included comorbidity burden assessed using the Charlson Comorbidity Index, bone quality assessed using the Singh Index, pre-fracture mobility assessed using the Functional Ambulation Scale, fracture pattern, and reduction–fixation quality. Results: Early reoperation occurred in 12.6% of patients, and 6-month mortality was 24%. Independent predictors of early reoperation included fracture instability (AO/OTA 31-A3; adjusted odds ratio [aOR]=1.41) and higher Charlson Comorbidity Index score (aOR=2.47). In contrast, better bone quality (higher Singh Index; aOR=0.16), superior reduction–fixation quality (aOR=0.12), and higher pre-fracture mobility (aOR=0.75) were protective against reoperation. Early mortality was independently associated with a higher Charlson Comorbidity Index score (aOR=1.74), poorer bone quality (aOR=0.42), and lower pre-fracture mobility (aOR=0.24). Implant type did not significantly influence either outcome.Conclusions: Early fixation failure is primarily influenced by fracture instability, osteoporosis severity, and fixation quality, whereas early mortality reflects comorbidity burden and frailty. Incorporating comorbidity burden, bone quality, and pre-fracture mobility into preoperative assessment may improve risk stratification and guide personalized perioperative management in elderly patients with intertrochanteric femur fractures.

Intertrochanteric Femur Fracture Early Reoperation Mortality Predictors Geriatric Trauma Fixation Stability

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