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Hip fractures are associated with high rates of adverse outcome but previous research has not lead to the identification of any subgroups for whom surgery could be contraindicated. The purpose of this study was to identify factors that could help in the decision making process. We identified 965 consecutive patients operated for an isolated hip fracture from 1 April 1996 to 31 March 2003 in a single large volume centre. We collected information on age, gender, comorbidities and place of injury (in-house, outdoors, nursing home). Outcome measures were mortality and orientation at discharge. Multiple logistic regression and recursive partitioning were used to identify factors associated with poor outcome. Median age was 81.4 with 121 patients aged 90 and over. Seventy-six percent were female. The fall occurred at home in 59%, outdoors in 19% and at a nursing home in 22%. Death was significantly associated with the number of comorbidities, age and place of injury. Dementia (23%) was the most significant predictor of orientation to a new nursing home. Among 121 nonagerians, 89 survived and 59 returned home. Among 53 nonagerians with two or more comorbidities, 34 survived and 20 returned home. Comorbidities, age and provenance of patients appear to be the most significant factors associated with adverse outcome. However, even among nonagerians with a heavy comorbidity burden, results do not contraindicate surgical intervention. [ABSTRACT FROM AUTHOR]