Determinants of mortality following intertrochanteric fractures, comorbidities versus reduction quality: retrospective cohort study

Abstract Background Intertrochanteric femoral fractures are common in the elderly population and are associated with substantial mortality. While fracture reduction quality is known to influence mechanical outcomes, its relative impact on mortality compared with patient-related comorbidities remains unclear. The objective of this study was to evaluate the impact of fracture reduction quality on survival in patients with intertrochanteric hip fractures, relative to the effect of comorbid diseases. Methods This retrospective cohort study included 297 elderly patients who underwent surgical treatment with a cephalomedullary nail for intertrochanteric femoral fractures at a tertiary care center between 2011 and 2022. Fractures were classified according to the AO/OTA system. Reduction quality was assessed using tip–apex distance, modified Baumgaertner criteria, Cleveland–Bosworth quadrant position, and neck–shaft angle. Mortality at 6, 12, and 24 months was recorded using data obtained from the national death notification system. The associations between mortality, reduction parameters, comorbid conditions, and ASA score were analyzed. Results Heart failure and dementia were identified as independent predictors of 6-month mortality. Heart failure remained significantly associated with 12- and 24-month mortality, while male sex was additionally associated with increased mortality at 24 months. Higher ASA scores (3–4) were consistently associated with increased mortality at all follow-up intervals. In contrast, AO/OTA fracture type and fracture reduction parameters were not significantly associated with mortality. Conclusion Mortality following intertrochanteric femoral fractures is largely determined by patient-related systemic factors, particularly heart failure and dementia, rather than fracture type or reduction quality. While optimal reduction remains essential for mechanical stability, improving survival outcomes in this patient population requires a focus on perioperative medical optimization and comprehensive management of comorbidities.