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.

We compared the mortality and outcome of 182 patients with proximal fractures of the femur after immediate and delayed surgical treatment. Seventy-nine patients were operated upon within six hours of the fracture (group 1) and 103 patients were operated upon after this period of time (group 2). At six months follow-up, group 1 had a significantly lower mortality rate. There was a good outcome in both groups with no differences in the outcome. Neither surgical nor anaesthetic factors appeared to have influenced mortality. The subdivision of groups revealed that patients operated on within 24 hours had a better outcome than those whose surgery was delayed. Although there may have been a bias, as patients were not randomly assigned to immediate or delayed surgical treatment, the data suggest that early stabilisation may be associated with a lower mortality rate. Even with pre-clinical delays of more than six hours early treatment should still be attempted, as better results seem to be achieved after 24 hours compared to a later time in our patients.