Fatal Trajectories: Identifying Key Predictors of Mortality After Femoral Fracture

Abstract

Femur fractures contribute substantially to morbidity and mortality in both the young and elderly populations. The prevalence varies among studies, with the highest prevalence observed in the East Asian region. In order to focus on the prevention of femur fractures, a thorough understanding of the existing evidence is imperative. This scoping review seeks to identify and map the predictors of mortality associated with femur fractures. Our objective is to highlight existing knowledge gaps, support interdisciplinary collaboration, and inform the development of policies aimed at reducing mortality related to these injuries.Original observational studies published in English between January 1983 and April 22, 2025, were included. A comprehensive literature search was conducted using the keywords "Mortality", "Femoral Fractures", and "Prognosis". Search was limited to the PubMed (MEDLINE) database. Identified records were exported and screened independently by two reviewers—the initial screening of titles and abstracts for relevance, followed by full-text review of potentially eligible studies. Any discrepancies in study selection were resolved through discussion or, when necessary, consultation with a third reviewer.Fifty-four (54) eligible studies were included in the final scoping review. The fracture site described mostly was the hip in 23 (42.6%) of articles, followed by the neck of femur (NOF) in 16 (29.6%), and the proximal femur in 13 (24.1%). Shaft and distal femur fractures in only one article (1.9%). Most studies reported mortality outcomes at one year (32 studies; 59.3%). Demographic and patient-related factors, pre- and post-operative management-related factors were presented in the articles and summarised. While we have identified the scope of the factors that would predict the mortality following femur fractures, this scoping review did not include a formal critical appraisal of the included studies to assess the quality or risk of bias in individual studies. We recommend a comprehensive review with a meta-analysis.