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Introduction: Hip fractures in the elderly are a major cause of morbidity and mortality. Determining which patients will benefit from hip fracture surgery is crucial to reducing mortality and morbidity. Our objectives are: 1) to define the rate of index admission, 1-month and 1-year mortality in all hip fracture patients, and 2) to apply the Nottingham Hip Fracture Score (NHFS) to determine validity in an Asian population. Materials and Methods: This is a prospective cohort study of 212 patients with hip fractures above 60 years from September 2009 to April 2010 for 1-year. Sociodemographic, prefracture comorbidity and data on functional status was collected on admission, and at intervals after discharge. The main outcome measures were mortality on index admission, 1 month and 12 months after treatment. Results: In our study, the overall mortality at 1-month and 1-year after surgery was 7.3% and 14.6% respectively. Surgically treated hip fracture patients had lower odds ratio (OR) for mortality as compared to conservatively treated ones. The OR was 0.17 during index admission, 0.17 at 1-month, and 0.18 at 12-months after discharge. These were statistically significant. Adjustments for age, gender, and duration to surgery were taken into account. The NHFS was found to be a good predictor of 1-month mortality after surgery. Conclusion: Surgically treated hip fracture patients have a lower OR for mortality than conservatively managed ones even up to 1-year. The NHFS has shown to predict 1-month mortality accurately for surgically treated hip fracture patients, even for our Asian population. It can be used as a tool for clinicians at the individual patient level to communicate risk with patients and help plan care for fracture patients. Key words: Elderly, Femur neck, Geriatric, Intertrochanteric

Hip fractures are the leading fractures in the elderly and are associated with high morbidity and mortality. 1 They are a growing public health concern due to the functional and social repercussions in the elderly. According to the International Osteoporosis Foundation, the incidence of hip fractures in Singapore in the years 2007 to 2009 was 331 per 100,000. With improving healthcare and an ageing population, this figure is projected to rise exponentially. An increase in the incidence of first hip fractures would imply an expected increase in second hip fractures.Incidence rates of non-simultaneous bilateral fragility hip fractures in other countries range from 6% to 16%. 2-4 A first hip fracture is a major risk factor for sustaining a second one and the risk is highest during the initial year. 5 Other risk factors include age, osteoporosis, female, dementia, Parkinson's disease, etc. Moreover, second hip fractures are associated with a higher 1-year mortality rate of 31.6% compared to 27.3% after first fractures. 2 Detailed characteristics of non-simultaneous bilateral fragility hip fractures in the elderly Singaporean population are limited. This study aimed to describe the patient and treatment characteristics of non-simultaneous bilateral hip fractures in a tertiary orthogeriatric hip fracture centre. Materials and MethodsThis was a single-centre retrospective study of consecutive patients aged 60 and above who were admitted to a tertiary orthogeriatric hip fracture centre for fragility hip fractures over a 1-year period (October 2011 to September 2012). Patient and data records were accurate as of time of data collection in 2015. Fragility hip fractures include intertrochanteric (IT) fracture and neck of femur (NOF) fracture.Patients were identified from a hip fracture registry database that consisted of consecutive patients admitted to our institution. Presence of a previous contralateral hip fracture was confirmed with data in the patient files and assessment of radiographs. An example is seen in Figure 1. Pathological fractures other than osteoporotic were excluded. A flowchart of the selection process can be seen in Figure 2.Demographic data and fracture characteristics were collected. Age-adjusted Charlson comorbidity index (AACI)