Proximal femur fractures in elderly patients: gender-related differences in survival and functional outcomes

Proximal femur fractures (PFFs) represent approximately 20% of all fragility fractures, consistently affecting mortality and morbidity of aging patients with osteoporosis. This study aims to investigate gender-related differences in survival and functional outcome after PFFs in elderly patients, analyzing possible gender-specific prognostic factors. Methods. It is a retrospective analysis of elderly patients with PFF who were surgically treated in a traumatology referral center in 2020. Demographic data, pre-injury ability to walk and use of aids, American Society of Anesthesiologists (ASA) score, medications, age-adjusted Charlson comorbidity index (ACCI) score, types of surgery performed, postoperative complications, type of discharge, functional outcomes, and mortality were recorded and analyzed to understand if there were gender-specific differences. Results. This series included 362 patients: 111 males (31%) and 251 (69%) females, with a mean age of 84 years at surgery. The two groups had the same baseline characteristics; however, males were more frail patients than females since the higher rate of anticoagulation, higher ASA and ACCI scores. Walking ability recovery occurred in 70% of males and 80% of females, without statistically significant differences (p = 0.1727), with an increase in the use of aids in 30% of males and 38% of females (p = 0.4366). Besides, 31% of males and 18% of females died within 1 year after surgery. In the general population, mortality was statistically significantly higher in males, older than 85 years, treated more than 48 hours after trauma and anticoagulated. Multivariate analysis showed only gender (p = 0.0289) and age (p <0.0001) as independent prognostic factors. Discussion. PFFs are more frequent in females; however, the multiple comorbidities that affected males when involved in PFFs lead to problematic functional recovery and higher mortality. Therefore, understanding and knowing these gender differences is fundamental to communicate adequately with patients and relatives. Moreover, these gender differences should be strongly considered to optimize treatments and rehabilitation protocols during hospitalization.