All-cause mortality following internal fixation for isolated fractures in non-polytrauma admissions: A comprehensive 10-year nationwide linked-data retrospective cohort study.
File(s)
Accepted version
Supporting information
Author(s)
Muruet-Gutierrez, Walter
Hing, Caroline B
Aylin, Paul
Bottle, Alex
Musbahi, Omar
Type
Journal Article
Abstract
Introduction: Skeletal fractures are a leading cause of death and disability and a growing global public health concern. Internal fixation is a common surgical treatment indicated for several fractures, yet there are few comprehensive epidemiological studies describing mortality following the procedure.
Methods: Data were extracted from an England-wide administrative database (Hospital Episode Statistics, HES) and linked to mortality records from the Office for National Statistics (ONS). All records from patients aged 18 years or older who were admitted due to a non-polytrauma single fracture and who underwent internal fixation between 2013 and 2023 were included. Crude and adjusted mortality rates were calculated, as well as the restricted mean time lost (RMTL).
Results: A total of 630,758 admissions were included in the primary analysis. Of these, 55% were female, and the mean ± SD age was 59 ± 23 years. Primary open reduction internal fixation was the most common procedure (54% of cases), followed by closed reduction internal fixation (35%). Overall, mortality rates following internal fixation were 2% within 30 days, 5% within 90 days, and 10% within 365 days. Mortality rates were described by fracture region and reduction procedure. Variation in mortality rates across fracture regions and procedures was attenuated in the case-mix-adjusted estimates.
Conclusions: This study described national crude and adjusted mortality rates following internal fixation for the treatment of skeletal fractures. These findings provide population-level descriptive benchmarks for clinical and epidemiological interpretation and may inform decision-making by clinicians and patients, as well as the design of randomised controlled trials and other research studies.
Methods: Data were extracted from an England-wide administrative database (Hospital Episode Statistics, HES) and linked to mortality records from the Office for National Statistics (ONS). All records from patients aged 18 years or older who were admitted due to a non-polytrauma single fracture and who underwent internal fixation between 2013 and 2023 were included. Crude and adjusted mortality rates were calculated, as well as the restricted mean time lost (RMTL).
Results: A total of 630,758 admissions were included in the primary analysis. Of these, 55% were female, and the mean ± SD age was 59 ± 23 years. Primary open reduction internal fixation was the most common procedure (54% of cases), followed by closed reduction internal fixation (35%). Overall, mortality rates following internal fixation were 2% within 30 days, 5% within 90 days, and 10% within 365 days. Mortality rates were described by fracture region and reduction procedure. Variation in mortality rates across fracture regions and procedures was attenuated in the case-mix-adjusted estimates.
Conclusions: This study described national crude and adjusted mortality rates following internal fixation for the treatment of skeletal fractures. These findings provide population-level descriptive benchmarks for clinical and epidemiological interpretation and may inform decision-making by clinicians and patients, as well as the design of randomised controlled trials and other research studies.
Date Acceptance
2026-08-17
Citation
BMJ Open
ISSN
2044-6055
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Open
Copyright Statement
Copyright © 2026 Copyright Owner. This is the author’s accepted manuscript made available under a CC-BY licence in accordance with Imperial’s Research Publications Open Access policy (www.imperial.ac.uk/oa-policy)
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Publication Status
Accepted