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Published in: European Journal of Trauma and Emergency Surgery 3/2013

01-06-2013 | Original Article

Mortality and quality of life after proximal femur fracture—effect of time until surgery and reasons for delay

Authors: M. Muhm, G. Arend, T. Ruffing, H. Winkler

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2013

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Abstract

Introduction

Studies yield conflicting results from the effect of early surgery on mortality. Some observed a positive, others a negative and some did not find any effect of early operation. In this study, mortality and quality of life in relation to time until surgery as well as reasons for delay were observed prospectively.

Material and methods

Data of 138 patients (>65 years) with proximal femoral fractures and consecutive surgery were observed. Demographic data as well as mortality rate, survival time and Barthel Index up to 1 year in relation to different time frames were observed. Reasons for operative delay were divided into being administrative or patient-related.

Results

Three-month mortality was 10.1% and 1-years was 23.9%. Neither time from injury until hospital admission nor from injury until surgery or from hospital admission until surgery up to 48 hours had any effect on mortality and survival time. The age of patients dying in the follow-up period was significantly higher than the age of patients surviving (86.8 vs. 84.4 years). No influence of any delay in time until surgery on the Barthel Index was observed.

Conclusion

In proximal femoral fractures, a delay of surgery up to 48 hours did not influence mortality and Barthel Index negatively, nor did other associating factors. Only the patients age at the time of injury influences mortality rate, survival time, and Barthel Index significantly. The older the patient at the time of injury; the higher the mortality rate, the shorter the survival time and the lower the Barthel Index.
Literature
1.
go back to reference Hoenig H, Rubenstein LV, Sloane R, Horner R, Kahn K. What is the role of timing in the surgical and rehabilitative care of community-dwelling older persons with acute hip fracture? Arch Intern Med. 1997;157:513–20.PubMedCrossRef Hoenig H, Rubenstein LV, Sloane R, Horner R, Kahn K. What is the role of timing in the surgical and rehabilitative care of community-dwelling older persons with acute hip fracture? Arch Intern Med. 1997;157:513–20.PubMedCrossRef
2.
go back to reference Osterkamp R. Bevölkerungsentwicklung in Deutschland bis 2050. Demografische und ökonomische Konsequenzen für die Alterschirurgie. Chirurg. 2005;76:10–8.PubMedCrossRef Osterkamp R. Bevölkerungsentwicklung in Deutschland bis 2050. Demografische und ökonomische Konsequenzen für die Alterschirurgie. Chirurg. 2005;76:10–8.PubMedCrossRef
3.
go back to reference Davis FM, Woolner DF, Frampton C, Wilkinson A, Grant A, Harrison RT, Roberts MTS, Thadaka R. Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly. Br J Anaesth. 1987;59:1080–8.PubMedCrossRef Davis FM, Woolner DF, Frampton C, Wilkinson A, Grant A, Harrison RT, Roberts MTS, Thadaka R. Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly. Br J Anaesth. 1987;59:1080–8.PubMedCrossRef
4.
go back to reference Sikorski JM, Senior J. The domiciliary rehabilitation and support program. Rationale, organisation and outcome. Med J Aust. 1993;159:23–5.PubMed Sikorski JM, Senior J. The domiciliary rehabilitation and support program. Rationale, organisation and outcome. Med J Aust. 1993;159:23–5.PubMed
5.
go back to reference Davis TRC, Sher JL, Porter BB, Checketts RG. The timing of surgery for intertrochanteric femoral fractures. Injury. 1988;19:244–6.PubMedCrossRef Davis TRC, Sher JL, Porter BB, Checketts RG. The timing of surgery for intertrochanteric femoral fractures. Injury. 1988;19:244–6.PubMedCrossRef
6.
go back to reference Lucke C, Phillip J, Krause D. Surgical results of pertrochanteric fractures. A 15-year study. Unfallchirurg. 1995;98:272–7.PubMed Lucke C, Phillip J, Krause D. Surgical results of pertrochanteric fractures. A 15-year study. Unfallchirurg. 1995;98:272–7.PubMed
7.
8.
go back to reference Holmberg S, Conradi P, Kalén R, Thorngren KG. Mortality after cervical hip fracture. 3002 patients followed for 6 years. Acta Orthop Scand. 1986;57:8–11.PubMed Holmberg S, Conradi P, Kalén R, Thorngren KG. Mortality after cervical hip fracture. 3002 patients followed for 6 years. Acta Orthop Scand. 1986;57:8–11.PubMed
9.
go back to reference Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE. Survival experience of aged hip fracture patients. Am J Public Health. 1989;79:274–8.PubMedCrossRef Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE. Survival experience of aged hip fracture patients. Am J Public Health. 1989;79:274–8.PubMedCrossRef
10.
go back to reference Miller CW. Survival and ambulation following hip fracture. J Bone Joint Surg Am. 1978;60:930–4.PubMed Miller CW. Survival and ambulation following hip fracture. J Bone Joint Surg Am. 1978;60:930–4.PubMed
11.
go back to reference Böhnel P, Villiger KJ. Treatment and late results in para-articular femoral fractures. Unfallchirurg. 1987;90:292–7.PubMed Böhnel P, Villiger KJ. Treatment and late results in para-articular femoral fractures. Unfallchirurg. 1987;90:292–7.PubMed
12.
go back to reference Hunter GA. A comparison of the use of internal fixation and prosthetic replacement for fresh fractures of the neck of the femur. Br J Surg. 1969;56:229–32.PubMedCrossRef Hunter GA. A comparison of the use of internal fixation and prosthetic replacement for fresh fractures of the neck of the femur. Br J Surg. 1969;56:229–32.PubMedCrossRef
13.
go back to reference Perez JV, Warwick DJ, Case CP, Bannister GC. Death after proximal femoral fracture—an autopsy study. Injury. 1995;26:237–40.PubMedCrossRef Perez JV, Warwick DJ, Case CP, Bannister GC. Death after proximal femoral fracture—an autopsy study. Injury. 1995;26:237–40.PubMedCrossRef
14.
15.
go back to reference Jensen JS, Bagger J. Long-term social prognosis after hip fractures. Acta Orthop Scand. 1982;53:97–101.PubMedCrossRef Jensen JS, Bagger J. Long-term social prognosis after hip fractures. Acta Orthop Scand. 1982;53:97–101.PubMedCrossRef
16.
go back to reference Jette AM, Harris BA, Cleary PD, Campion EW. Functional recovery after hip fracture. Arch Phys Med Rehabil. 1987;68:735–40.PubMed Jette AM, Harris BA, Cleary PD, Campion EW. Functional recovery after hip fracture. Arch Phys Med Rehabil. 1987;68:735–40.PubMed
17.
go back to reference Kenzora JE, McCarthy RE, Lowell JD, Sledge CB. Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res. 1984;186:45–56.PubMed Kenzora JE, McCarthy RE, Lowell JD, Sledge CB. Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res. 1984;186:45–56.PubMed
18.
go back to reference Koval KJ, Zuckerman JD. Functional recovery after fracture of the hip. J Bone Joint Surg Am. 1994;76:751–8.PubMed Koval KJ, Zuckerman JD. Functional recovery after fracture of the hip. J Bone Joint Surg Am. 1994;76:751–8.PubMed
19.
20.
go back to reference White BL, Fisher WD, Laurin CA. Rate of mortality for elderly patients after fracture of the hip in the 1980’s. J Bone Joint Surg Am. 1987;69:1335–40.PubMed White BL, Fisher WD, Laurin CA. Rate of mortality for elderly patients after fracture of the hip in the 1980’s. J Bone Joint Surg Am. 1987;69:1335–40.PubMed
22.
go back to reference Beringer TR, Crawford VL, Brown JG. Audit of surgical delay in relationship to outcome after proximal femoral fracture. Ulster Med J. 1996;65:32–8.PubMed Beringer TR, Crawford VL, Brown JG. Audit of surgical delay in relationship to outcome after proximal femoral fracture. Ulster Med J. 1996;65:32–8.PubMed
23.
go back to reference Bonnaire F, Kuner EH, Lorz W. Femoral neck fractures in adults: joint sparing operations. II. The significance of surgical timing and implant for development of aseptic femur head necrosis. Unfallchirurg. 1995;98:259–64.PubMed Bonnaire F, Kuner EH, Lorz W. Femoral neck fractures in adults: joint sparing operations. II. The significance of surgical timing and implant for development of aseptic femur head necrosis. Unfallchirurg. 1995;98:259–64.PubMed
24.
go back to reference Jain R, Koo M, Kreder HJ, Schemitsch EH, Davey JR, Mahomed NN. Comparison of early and delayed fixation of subcapital hip fractures in patients sixty years of age or less. J Bone Joint Surg Am. 2002;84-A:1605–12.PubMed Jain R, Koo M, Kreder HJ, Schemitsch EH, Davey JR, Mahomed NN. Comparison of early and delayed fixation of subcapital hip fractures in patients sixty years of age or less. J Bone Joint Surg Am. 2002;84-A:1605–12.PubMed
25.
26.
go back to reference Parker MJ, Pryor GA. The timing of surgery for proximal femoral fractures. J Bone Joint Surg Br. 1992;74:203–5.PubMed Parker MJ, Pryor GA. The timing of surgery for proximal femoral fractures. J Bone Joint Surg Br. 1992;74:203–5.PubMed
27.
go back to reference Plietker J, Höfer A, Kalisch R. Early management of a fracture of the coxal end of the femur in elderly patients. Aktuelle Traumatol. 1992;22:76–9.PubMed Plietker J, Höfer A, Kalisch R. Early management of a fracture of the coxal end of the femur in elderly patients. Aktuelle Traumatol. 1992;22:76–9.PubMed
28.
go back to reference Raunest J, Kaschner A, Derra E. Incidence of complications and early mortality in surgical management of coxal femoral fractures. Langenbecks Arch Chir. 1990;375:156–60.PubMedCrossRef Raunest J, Kaschner A, Derra E. Incidence of complications and early mortality in surgical management of coxal femoral fractures. Langenbecks Arch Chir. 1990;375:156–60.PubMedCrossRef
29.
go back to reference Rogers FB, Shackford SR, Keller MS. Early fixation reduces morbidity and mortality in elderly patients with hip fractures from low-impact falls. J Trauma. 1995;39:261–5.PubMedCrossRef Rogers FB, Shackford SR, Keller MS. Early fixation reduces morbidity and mortality in elderly patients with hip fractures from low-impact falls. J Trauma. 1995;39:261–5.PubMedCrossRef
30.
go back to reference Todd CJ, Freeman CJ, Camilleri-Ferrante C, Palmer CR, Hyder A, Laxton CE, Parker MJ, Payne BV, Rushton N. Differences in mortality after fracture of hip: the East Anglian audit. BMJ. 1995;310:904–8.PubMedCrossRef Todd CJ, Freeman CJ, Camilleri-Ferrante C, Palmer CR, Hyder A, Laxton CE, Parker MJ, Payne BV, Rushton N. Differences in mortality after fracture of hip: the East Anglian audit. BMJ. 1995;310:904–8.PubMedCrossRef
31.
go back to reference Dorotka R, Schoechtner H, Buchinger W. The influence of immediate surgical treatment of proximal femoral fractures on mortality and quality of life. Operation within six hours of the fracture versus later than six hours. J Bone Joint Surg Br. 2003;85:107–13.CrossRef Dorotka R, Schoechtner H, Buchinger W. The influence of immediate surgical treatment of proximal femoral fractures on mortality and quality of life. Operation within six hours of the fracture versus later than six hours. J Bone Joint Surg Br. 2003;85:107–13.CrossRef
32.
go back to reference Zuckerman JD, Skovron ML, Koval KJ, Aharonoff G, Frankel VH. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg Am. 1995;77:1551–6.PubMed Zuckerman JD, Skovron ML, Koval KJ, Aharonoff G, Frankel VH. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg Am. 1995;77:1551–6.PubMed
33.
go back to reference Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anesth. 2008;55:146–54.PubMedCrossRef Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anesth. 2008;55:146–54.PubMedCrossRef
34.
go back to reference Weller I, Wai EK, Jaglal S, Kreder HJ. The effect of hospital type and surgical delay on mortality after surgery for hip fracture. J Bone Joint Surg Br. 2005;87:361–6.PubMedCrossRef Weller I, Wai EK, Jaglal S, Kreder HJ. The effect of hospital type and surgical delay on mortality after surgery for hip fracture. J Bone Joint Surg Br. 2005;87:361–6.PubMedCrossRef
35.
go back to reference Verbeek DO, Ponsen KJ, Goslings JC, Heetveld MJ. Effect of surgical delay on outcome in hip fracture patients: a retrospective multivariate analysis of 192 patients. Int Orthop. 2008;32:13–8.PubMedCrossRef Verbeek DO, Ponsen KJ, Goslings JC, Heetveld MJ. Effect of surgical delay on outcome in hip fracture patients: a retrospective multivariate analysis of 192 patients. Int Orthop. 2008;32:13–8.PubMedCrossRef
36.
go back to reference Lorhan PH, Shelby EA. Factors influencing mortality in hip fractures. Anesth Analg. 1964;43:539–43.PubMed Lorhan PH, Shelby EA. Factors influencing mortality in hip fractures. Anesth Analg. 1964;43:539–43.PubMed
37.
go back to reference Mullen JO, Mullen NL. Hip fracture mortality. A prospective, multifactorial study to predict and minimize death risk. Clin Orthop Relat Res. 1992;280:214–22.PubMed Mullen JO, Mullen NL. Hip fracture mortality. A prospective, multifactorial study to predict and minimize death risk. Clin Orthop Relat Res. 1992;280:214–22.PubMed
38.
go back to reference De Palma L, Rizzi L, Lorini G, Greco F. Survival after trochanteric fracture. Biological factors analyzed in 270 patients. Acta Orthop Scand. 1992;63:645–7.PubMed De Palma L, Rizzi L, Lorini G, Greco F. Survival after trochanteric fracture. Biological factors analyzed in 270 patients. Acta Orthop Scand. 1992;63:645–7.PubMed
39.
go back to reference Tornetta P 3rd, Mostafavi H, Riina J, Turen C, Reimer B, Levine R, Behrens F, Geller J, Ritter C, Homel P. Morbidity and mortality in elderly trauma patients. J Trauma. 1999;46:702–6.PubMedCrossRef Tornetta P 3rd, Mostafavi H, Riina J, Turen C, Reimer B, Levine R, Behrens F, Geller J, Ritter C, Homel P. Morbidity and mortality in elderly trauma patients. J Trauma. 1999;46:702–6.PubMedCrossRef
40.
go back to reference Orosz GM, Magaziner J, Hannan EL, Morrison RS, Koval K, Gilbert M, McLaughlin M, Halm EA, Wang JJ, Litke A, Silberzweig SB, Siu AL. Association of timing of surgery for hip fracture and patient outcomes. JAMA. 2004;291:1738–43.PubMedCrossRef Orosz GM, Magaziner J, Hannan EL, Morrison RS, Koval K, Gilbert M, McLaughlin M, Halm EA, Wang JJ, Litke A, Silberzweig SB, Siu AL. Association of timing of surgery for hip fracture and patient outcomes. JAMA. 2004;291:1738–43.PubMedCrossRef
41.
go back to reference Chilov MN, Cameron ID, March LM; Australian National Health and Medical Research Council. Evidence-based guidelines for fixing broken hips: an update. Med J Aust. 2003;179:489–93.PubMed Chilov MN, Cameron ID, March LM; Australian National Health and Medical Research Council. Evidence-based guidelines for fixing broken hips: an update. Med J Aust. 2003;179:489–93.PubMed
42.
go back to reference Grimes JP, Gregory PM, Noveck H, Butler MS, Carson JL. The effects of time-to-surgery on mortality and morbidity in patients following hip fracture. Am J Med. 2002;112:702–9.PubMedCrossRef Grimes JP, Gregory PM, Noveck H, Butler MS, Carson JL. The effects of time-to-surgery on mortality and morbidity in patients following hip fracture. Am J Med. 2002;112:702–9.PubMedCrossRef
43.
go back to reference Smektala R, Endres HG, Dasch B, Maier C, Trampisch HJ, Bonnaire F, Pientka L. The effect of time-to-surgery on outcome in elderly patients with proximal femoral fractures. BMC Musculoskelet Disord. 2008;9:171.PubMedCrossRef Smektala R, Endres HG, Dasch B, Maier C, Trampisch HJ, Bonnaire F, Pientka L. The effect of time-to-surgery on outcome in elderly patients with proximal femoral fractures. BMC Musculoskelet Disord. 2008;9:171.PubMedCrossRef
44.
go back to reference Moran CG, Wenn RT, Sikand M, Taylor AM. Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am. 2005;87:483–9.PubMedCrossRef Moran CG, Wenn RT, Sikand M, Taylor AM. Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am. 2005;87:483–9.PubMedCrossRef
45.
go back to reference Majumdar SR, Beaupre LA, Johnston DW, Dick DA, Cinats JG, Jiang HX. Lack of association between mortality and timing of surgical fixation in elderly patients with hip fracture: results of a retrospective population-based cohort study. Med Care. 2006;44:552–9.PubMedCrossRef Majumdar SR, Beaupre LA, Johnston DW, Dick DA, Cinats JG, Jiang HX. Lack of association between mortality and timing of surgical fixation in elderly patients with hip fracture: results of a retrospective population-based cohort study. Med Care. 2006;44:552–9.PubMedCrossRef
46.
go back to reference Rogers FB, Shackford SR, Vane DW, Kaups KL, Harris F. Prompt fixation of isolated femur fractures in a rural trauma center: a study examining the timing of fixation and resource allocation. J Trauma. 1994;36:774–7.PubMedCrossRef Rogers FB, Shackford SR, Vane DW, Kaups KL, Harris F. Prompt fixation of isolated femur fractures in a rural trauma center: a study examining the timing of fixation and resource allocation. J Trauma. 1994;36:774–7.PubMedCrossRef
47.
go back to reference Kitamura S, Hasegawa Y, Suzuki S, Sasaki R, Iwata H, Wingstrand H, Thorngren KG. Functional outcome after hip fracture in Japan. Clin Orthop Relat Res. 1998;348:29–36.PubMedCrossRef Kitamura S, Hasegawa Y, Suzuki S, Sasaki R, Iwata H, Wingstrand H, Thorngren KG. Functional outcome after hip fracture in Japan. Clin Orthop Relat Res. 1998;348:29–36.PubMedCrossRef
48.
go back to reference Hefley FG Jr, Nelson CL, Puskarich-May CL. Effect of delayed admission to the hospital on the preoperative prevalence of deep-vein thrombosis associated with fractures about the hip. J Bone Joint Surg Am. 1996;78:581–3.PubMed Hefley FG Jr, Nelson CL, Puskarich-May CL. Effect of delayed admission to the hospital on the preoperative prevalence of deep-vein thrombosis associated with fractures about the hip. J Bone Joint Surg Am. 1996;78:581–3.PubMed
49.
go back to reference Hedström M, Gröndal L, Ahl T. Urinary tract infection in patients with hip fractures. Injury. 1999;30:341–3.PubMedCrossRef Hedström M, Gröndal L, Ahl T. Urinary tract infection in patients with hip fractures. Injury. 1999;30:341–3.PubMedCrossRef
50.
go back to reference Versluysen M. How elderly patients with femoral fracture develop pressure sores in hospital. Br Med J (Clin Res Ed). 1986;292:1311–3.CrossRef Versluysen M. How elderly patients with femoral fracture develop pressure sores in hospital. Br Med J (Clin Res Ed). 1986;292:1311–3.CrossRef
51.
go back to reference Schliemann B, Seybold D, Gessmann J, Fehmer T, Schildhauer TA, Muhr G. Bipolar hemiarthroplasty in femoral neck fractures—impact of duration of surgery, time of day and the surgeon’s experience on the complication rate. Z Orthop Unfall. 2009;147:689–93.PubMedCrossRef Schliemann B, Seybold D, Gessmann J, Fehmer T, Schildhauer TA, Muhr G. Bipolar hemiarthroplasty in femoral neck fractures—impact of duration of surgery, time of day and the surgeon’s experience on the complication rate. Z Orthop Unfall. 2009;147:689–93.PubMedCrossRef
52.
go back to reference Sebestyén A, Boncz I, Sándor J, Nyárády J. Effect of surgical delay on early mortality in patients with femoral neck fracture. Int Orthop. 2008;32:375–9.PubMedCrossRef Sebestyén A, Boncz I, Sándor J, Nyárády J. Effect of surgical delay on early mortality in patients with femoral neck fracture. Int Orthop. 2008;32:375–9.PubMedCrossRef
53.
go back to reference Gdalevich M, Cohen D, Yosef D, Tauber C. Morbidity and mortality after hip fracture: the impact of operative delay. Arch Orthop Trauma Surg. 2004;124:334–40.PubMedCrossRef Gdalevich M, Cohen D, Yosef D, Tauber C. Morbidity and mortality after hip fracture: the impact of operative delay. Arch Orthop Trauma Surg. 2004;124:334–40.PubMedCrossRef
59.
go back to reference American Society of Anesthesiologists. New classification of physical status. Anesthesiology. 1963;24:111. American Society of Anesthesiologists. New classification of physical status. Anesthesiology. 1963;24:111.
60.
go back to reference Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Md State Med J. 1965;14:61–5.PubMed Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Md State Med J. 1965;14:61–5.PubMed
61.
go back to reference van der Putten JJ, Hobart JC, Freeman JA, Thompson AJ. Measuring change in disability after inpatient rehabilitation: comparison of the responsiveness of the Barthel index and the Functional Independence Measure. J Neurol Neurosurg Psychiatry. 1999;66:480–4.PubMedCrossRef van der Putten JJ, Hobart JC, Freeman JA, Thompson AJ. Measuring change in disability after inpatient rehabilitation: comparison of the responsiveness of the Barthel index and the Functional Independence Measure. J Neurol Neurosurg Psychiatry. 1999;66:480–4.PubMedCrossRef
62.
go back to reference Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of internal fixation: techniques recommended by the AO-ASIF group. 3rd ed. Berlin: Springer; 1991.CrossRef Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of internal fixation: techniques recommended by the AO-ASIF group. 3rd ed. Berlin: Springer; 1991.CrossRef
63.
go back to reference Orosz GM, Hannan EL, Magaziner J, Koval K, Gilbert M, Aufses A, Straus E, Vespe E, Siu AL. Hip fracture in the older patient: reasons for delay in hospitalization and timing of surgical repair. J Am Geriatr Soc. 2002;50:1336–40.PubMedCrossRef Orosz GM, Hannan EL, Magaziner J, Koval K, Gilbert M, Aufses A, Straus E, Vespe E, Siu AL. Hip fracture in the older patient: reasons for delay in hospitalization and timing of surgical repair. J Am Geriatr Soc. 2002;50:1336–40.PubMedCrossRef
64.
go back to reference Kostuj T, Smektala R, Schulze-Raestrup U, Müller-Mai C. Pertrochanteric fractures. What impact do surgical timing and implant choice have on the outcome? Unfallchirurg. 2011;116:53–60. doi:10.1007/s00113-011-2092-9.CrossRef Kostuj T, Smektala R, Schulze-Raestrup U, Müller-Mai C. Pertrochanteric fractures. What impact do surgical timing and implant choice have on the outcome? Unfallchirurg. 2011;116:53–60. doi:10.​1007/​s00113-011-2092-9.CrossRef
Metadata
Title
Mortality and quality of life after proximal femur fracture—effect of time until surgery and reasons for delay
Authors
M. Muhm
G. Arend
T. Ruffing
H. Winkler
Publication date
01-06-2013
Publisher
Springer-Verlag
Published in
European Journal of Trauma and Emergency Surgery / Issue 3/2013
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-013-0267-5

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