Within the range of syndesmotic malreductions studied, the quality of syndesmotic reduction did not significantly influence clinical outcomes. These results challenge previous definitions of syndesmotic malreduction and the clinical importance of minor syndesmotic changes. It remains unclear, however, whether greater magnitudes of syndesmotic malreduction than those seen in this cohort would lead to inferior patient-reported outcomes.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Level III clinical outcome comparison.

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Objective: To report the mortality data and life expectancy of geriatric hip fracture patients who underwent nonoperative management and compare that with a matched operative cohort. Design: Retrospective cohort study. Setting: Level 1 trauma center. Patients: Geriatric (65 years of age and older) femoral neck or intertrochanteric fracture (OTA/AO 31A and 31B) patients. Intervention: Operative treatment with either arthroplasty, cannulated screws, sliding hip screw device, or cephalomedullary nail compared with nonoperative cohort. Main Outcome Measurements: In-hospital, 30-day, and 1-year mortality. Results: Two hundred thirty-one patients, comprising 154 operative and 77 nonoperative patients, were compared. There were no significant differences among age, sex, fracture location, Charlson Comorbidity Index, preinjury living location, dementia, and history of cardiac arrhythmia between the 2 cohorts. Nonoperatively managed patients were found to have a significantly higher percent in-hospital (28.6 vs. 3.9; P < 0.0001), 30-day (63.6 vs. 11.0; <0.0001), and 1-year (84.4 vs. 36.4; P < 0.0001) mortality. The mean life expectancy after a hip fracture for the nonoperative cohort was significantly shorter than the operative group (221 vs. 1024 days; P < 0.0001). Conclusions: Nonoperatively treated hip fracture patients had an 84.4% 1-year mortality that was significantly higher than a matched operative cohort. Our results demonstrate the bleak overall prognosis for nonoperatively treated geriatric hip fractures as well as the associated reduction in mortality with surgical treatment. Our findings offer helpful information by providing updated mortality data when discussing nonoperative hip fracture management with patients and their family. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.