All-cause mortality following internal fixation for isolated fractures in non-polytrauma admissions: a comprehensive 10-year nationwide linked data retrospective cohort study
In brief
Ten percent of patients die within a year after internal fixation
In a nationwide English cohort of 630,758 adults treated for a single fracture, overall mortality was 2% at 30 days, 5% at 90 days and 10% at one year after internal fixation. The rates varied by fracture site and surgical technique but remained similar after adjusting for patient case mix, offering benchmarks for clinicians and researchers.
- Journal
- BMJ open (Q1)
- Published
- 8 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Walter Muruet, Caroline Hing, Paul Aylin, Alex Bottle, Omar Musbahi
- PMID
- 42711087
- DOI
- 10.1136/bmjopen-2026-122170
Why clinicians should know about it
- Picked for Orthopedics and Sports Medicine (top studies of the week, 13 September 2026): Nationwide internal fixation mortality rates, clinical benchmark
- Picked for Emergency Medicine (top studies of the week, 13 September 2026): Mortality after internal fixation, unrelated to emergency care
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 underwent internal fixation between 2013 and 2023 were included. Crude and adjusted mortality rates were calculated as well as the restricted mean time lost. 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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.