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

Recep Karasu; Namık Şahin; Mustafa Dinç; Hünkar Çağdaş Bayrak

doi:10.18621/eurj.1828923

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

Abstract

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.

Keywords

Ethical Statement

This study was approved by the Şevket Yılmaz Training and Research Hospital Clinical Research Ethics Committee (Decision No: 2011-KAEK-25 2015/11-08; date: 06.03.2015). All procedures were conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. Because the study was retrospective and no additional intervention was performed on the participants, the informed consent form was waived.

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Details

Primary Language

English

Subjects

Orthopaedics

Journal Section

Research Article

Authors

Recep Karasu ^*
0000-0002-0628-5794
Türkiye

Namık Şahin
0000-0002-3643-931X
Türkiye

Mustafa Dinç
0000-0002-3002-5028
Türkiye

Hünkar Çağdaş Bayrak
0009-0003-4963-9980
Türkiye

Early Pub Date

January 2, 2026

Publication Date

February 1, 2026

Submission Date

November 23, 2025

Acceptance Date

December 25, 2025

Published in Issue

Year 2026 Volume: 12 Number: 2

DOI

https://doi.org/10.18621/eurj.1828923

IZ

https://izlik.org/JA78GW27AT

Cite

RIS / Bibtex

APA

Karasu, R., Şahin, N., Dinç, M., & Bayrak, H. Ç. (2026). Analysis of Early Reoperation and Mortality Following Intertrochanteric Fracture Fixation in Elderly Patients: A Focus on Frailty, Bone Quality, and Technical Factors. The European Research Journal, 12(2), 272-279. https://doi.org/10.18621/eurj.1828923

AMA

1.Karasu R, Şahin N, Dinç M, Bayrak HÇ. Analysis of Early Reoperation and Mortality Following Intertrochanteric Fracture Fixation in Elderly Patients: A Focus on Frailty, Bone Quality, and Technical Factors. Eur Res J. 2026;12(2):272-279. doi:10.18621/eurj.1828923

Chicago

Karasu, Recep, Namık Şahin, Mustafa Dinç, and Hünkar Çağdaş Bayrak. 2026. “Analysis of Early Reoperation and Mortality Following Intertrochanteric Fracture Fixation in Elderly Patients: A Focus on Frailty, Bone Quality, and Technical Factors”. The European Research Journal 12 (2): 272-79. https://doi.org/10.18621/eurj.1828923.

EndNote

Karasu R, Şahin N, Dinç M, Bayrak HÇ (February 1, 2026) Analysis of Early Reoperation and Mortality Following Intertrochanteric Fracture Fixation in Elderly Patients: A Focus on Frailty, Bone Quality, and Technical Factors. The European Research Journal 12 2 272–279.

IEEE

[1]R. Karasu, N. Şahin, M. Dinç, and H. Ç. Bayrak, “Analysis of Early Reoperation and Mortality Following Intertrochanteric Fracture Fixation in Elderly Patients: A Focus on Frailty, Bone Quality, and Technical Factors”, Eur Res J, vol. 12, no. 2, pp. 272–279, Feb. 2026, doi: 10.18621/eurj.1828923.

ISNAD

Karasu, Recep - Şahin, Namık - Dinç, Mustafa - Bayrak, Hünkar Çağdaş. “Analysis of Early Reoperation and Mortality Following Intertrochanteric Fracture Fixation in Elderly Patients: A Focus on Frailty, Bone Quality, and Technical Factors”. The European Research Journal 12/2 (February 1, 2026): 272-279. https://doi.org/10.18621/eurj.1828923.

JAMA

1.Karasu R, Şahin N, Dinç M, Bayrak HÇ. Analysis of Early Reoperation and Mortality Following Intertrochanteric Fracture Fixation in Elderly Patients: A Focus on Frailty, Bone Quality, and Technical Factors. Eur Res J. 2026;12:272–279.

MLA

Karasu, Recep, et al. “Analysis of Early Reoperation and Mortality Following Intertrochanteric Fracture Fixation in Elderly Patients: A Focus on Frailty, Bone Quality, and Technical Factors”. The European Research Journal, vol. 12, no. 2, Feb. 2026, pp. 272-9, doi:10.18621/eurj.1828923.

Vancouver

1.Recep Karasu, Namık Şahin, Mustafa Dinç, Hünkar Çağdaş Bayrak. Analysis of Early Reoperation and Mortality Following Intertrochanteric Fracture Fixation in Elderly Patients: A Focus on Frailty, Bone Quality, and Technical Factors. Eur Res J. 2026 Feb. 1;12(2):272-9. doi:10.18621/eurj.1828923