Fracture laterality as an independent prognostic factor for clinical outcomes after hip fracture surgery
Bone & Joint Open · 13 Aug 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Fracture laterality is a free, already-recorded data point that could add modest prognostic information for discharge planning and rehabilitation intensity in frail hip fracture patients, if the association is confirmed prospectively.
The evidence
This Japanese administrative-database study followed 72,008 patients age 65+ who had surgery for hip fracture, asking whether the side of the fracture (left vs right) predicts outcomes. Overall in-hospital mortality did not differ significantly by side (adjusted OR 1.10, 95% CI 0.99-1.22, p=0.075), but right-sided fractures were associated with slightly worse independence at discharge (Barthel Index <60; adjusted OR 1.09, 95% CI 1.05-1.13, p<0.001), and among patients with high comorbidity burden (CCI \u2265 2), right-sided fracture carried a higher mortality risk (aOR 1.29, 95% CI 1.09-1.53).
in-hospital mortality: Odds ratio 1.0994 (95% CI 0.99035 to 1.2204; units not reported). Interpret in the study's stated comparison; this alone does not establish a treatment's causal effect.
Why this rigour score?
Registry cohort (adjusted)
Methods at a glance
Recorded assessment- Confounding adjustmentMultivariable regression
- Covariate balance confirmedNot applicable
- Outcome assessors blindedNot reported
- Comparable start of follow-upMet
- Adequate statistical powerNot applicable
- Prospective registrationNot met
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
How to read this assessment
The recorded methods are shown alongside the published score. A verified point-by-point calculation is not available for this version of the appraisal.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.If confirmed, should right-sided hip fracture prompt earlier or more intensive physical therapy referral at discharge planning?
2.In patients with high comorbidity burden and a right-sided hip fracture, should clinicians have a lower threshold for escalating perioperative monitoring given the observed mortality signal?
Original publication title
Fracture laterality as an independent prognostic factor for clinical outcomes after hip fracture surgery