1Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA J. Bernstein, University of Pennsylvania, 424 Stemmler Hall, Philadelphia, PA 19104, USA, Email: [email protected] A note from the Editor-in-Chief: We are pleased to present to readers of Clinical Orthopaedics and Related Research® the next "Not the Last Word." The goal of this section is to explore timely and controversial issues that affect how orthopaedic surgery is taught, learned, and practiced. We welcome reader feedback on all of our columns and articles; please send your comments to [email protected]. The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

Background Geriatric hip fracture patients exhibit high mortality post-injury. It's unclear if and when mortality reverts to baseline. We therefore ask, When, if ever, does the mortality rate of geriatric hip fracture revert to the population-wide baseline rate? How does the mortality rate after geriatric hip fracture compare to the population norms? Understanding this timeline is crucial for assessing disease burden and guiding treatment plans.Methods A cohort of 17,868 male patients aged 65-89 years treated for hip fracture within the VA healthcare system was studied. Patients were grouped by age at the time of fracture, and age-specific fractional survival was assessed annually for 10 years. For a comparison control group, a virtual cohort of 17,868 individuals, mirroring the age distribution of the patient group, was created and reduced over 10 cycles according to Social Security Administration expected mortality statistics.Results The year-one mortality rate among fracture patients was 35.4%, compared to 6.3% in age-matched controls. By year ten, only 8.5% of the fracture patients remained alive, vs. 39.8% in the general population. The annual risk of dying for patients who survived past the first year was consistently in the range 19%-21% for all subsequent years.Conclusion Hip fracture patients who survive the initial injury are still subject to annual mortality risk of approximately 20%, an elevation above population norms persisting for at least a decade. The data underscores the severity of geriatric hip fractures, and suggest that focusing one- or two-year survival rates may not fully capture the severity of the injury.

1Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA J. Bernstein ✉, University of Pennsylvania, 424 Stemmler Hall, Philadelphia, PA 19104, USA, Email: [email protected] A note from the Editor-in-Chief: We are pleased to present to readers of Clinical Orthopaedics and Related Research® the next "Not the Last Word." The goal of this section is to explore timely and controversial issues that affect how orthopaedic surgery is taught, learned, and practiced. We welcome reader feedback on all of our columns and articles; please send your comments to[email protected]. The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

1Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA J. Bernstein ✉, University of Pennsylvania, 424 Stemmler Hall, Philadelphia, PA 19104, USA, Email: [email protected] A note from the Editor-in-Chief: We are pleased to present to readers of Clinical Orthopaedics and Related Research® the next "Not the Last Word." The goal of this section is to explore timely and controversial issues that affect how orthopaedic surgery is taught, learned, and practiced. We welcome reader feedback on all of our columns and articles; please send your comments to [email protected]. The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.