Factors influencing the primary mortality of patients with fractures of the neck of the femur have been reviewed by studying 470 cases treated at the Surgical Department of Koskela Hospital, Helsinki. Of these patients, 49 were male and 421 female. The average age of the patients was 77.4 years. One hundred and twelve patients were treated conservatively with traction and bed-rest and 358 were treated by operation. The surgery consisted of reduction and internal fixation in 236 cases, and replacement of the head with a prosthesis in 122 cases.
At the time of injury, 50 per cent of the patients were suffering from arteriosclerosis, 22.7 per cent from mental disorders, 201 had heart disease requiring digitalization, 43 cases had disturbances in their blood-pressure, 31 had a history of previous cerebrovascular accidents, 56 were suffering from diabetes mellitus and 49 from chronic renal disease, 43 had malignant disease, and 17 were suffering from chronic rheumatoid arthritis.
The primary mortality was defined as death occurring within 1 month of the injury or operation. The total primary mortality amounted to 87 patients, which was 18.5 per cent of the series. All but 5 patients who died were examined at post-mortem. In 25 per cent the cause of death was bronchopneumonia or hypostatic pneumonia, in 19.5 per cent it was due to pulmonary embolism, in 12.6 per cent to a cerebrovascular accident, and in 9.2 per cent to coronary thrombosis. Six patients died of malignant tumours and a further 6 of uncompensated cardiac disease.
The primary mortality was greater among those treated conservatively. This might be taken as evidence in favour of surgery, but the average age of the patients treated conservatively was 3 years higher and their poor general condition was the main reason why surgery was not undertaken. Among the patients treated surgically, mortality increased with age though it remained significantly lower than in the corresponding age-groups which were treated conservatively. In the groups over 85 years, however, the difference was no longer significant. The primary mortality was not related to the type of fracture nor to the method of surgical treatment.
