Comorbidities and Short-Term Outcomes After Proximal Femoral Fracture

Background: Proximal femoral (hip) fractures are a major global health issue, primarily affecting older adults after low-energy falls in osteoporotic bone. Incidence is increased, with high morbidity, mortality, and healthcare costs. Fractures are classified as intracapsular or extracapsular, with biomechanical differences guiding treatment. Objectives: This study primarily aimed to assess the association between the Age-Adjusted Charlson Comorbidity Index (ACCI) and fracture-related complications, with secondary objectives evaluating mortality, and postoperative short functional outcomes in proximal femur fractures. Methods: This prospective longitudinal study conducted at Basrah Teaching Hospital for the duration from 1st of July 2024 till 1st of July 2025, included 104 surgically managed adults with proximal femoral fractures. Data collection involved sociodemographic, fracture type, comorbidity assessment Charlson Comorbidity Index (CCI) and Age-Adjusted Charlson Comorbidity Index (ACCI), clinical and radiological evaluation, and surgical intervention. Postoperative outcomes were assessed at 2 weeks and 3 months, including complications and functional recovery using the Oxford Hip Score. Results: The study included 104 patients (mean age 65.3 ± 8.5 years, 57 (54.8% female). Most were non-employed 81 (77.9%) and urban residents 64 (61.5%). Over half 59 (56.7%) had severe comorbidities (CCI Grade 3), and 79 (76%) were high-risk by ACCI. Extracapsular fractures 59 (56.7%) were more common, with ORIF performed in 58 (55.8%). Functional recovery improved significantly (OHS: 18.7 at 2 weeks → 31.2 at 3 months). Higher CCI and ACCI scores were significantly associated with poorer OHS at 2 weeks (p=0.004, p=0.003) and 3 months (p=0.002, p=0.001), lower improvement, and higher mortality (up to 8.5%), particularly in Grade 3/high-risk groups. Conclusions: Proximal femoral fractures mainly affect older adults with high comorbidity burden. Surgery improves function, but higher CCI/ACCI scores predict poorer recovery, higher mortality, and complications. ACCI showed superior prognostic value, underscoring the importance of comorbidity assessment for outcome prediction and risk stratification.