Multiple fractures carry high burden of morbidity, mortality
MedWire News: Elderly individuals who suffer multiple fractures face high morbidity and mortality, particularly if they fracture their pelvis, proximal humerus, or proximal femur, research shows.
The results indicate that a multiple fracture after low-energy trauma "is a marker of mortality," say Nick Clement (Royal Infirmary of Edinburgh, UK) and co-authors writing in the Journal of Bone and Joint Surgery.
Clement's team prospectively studied all patients aged 65 years and over who presented to a hospital with a fracture between July 2007 and June 2008.
A total of 2335 such patients were seen; 23% were male and the mean age was 78 years.
In all, 119 (5.1%) patients had multiple fractures; 109 had two fractures, nine had three, and one patient had four fractures. Individuals with multiple fractures did not differ from those with single fractures with regard to gender or age.
Among patients with multiple fractures, the most frequent fracture sites were the distal radius (37.0%), proximal humerus (35.3%), and proximal femur (32.8%), followed by pelvis (12.6%), ankle (9.2%), and finger phalanx (7.6%).
Clement et al subdivided patients according to indicators of social deprivation. This showed that the incidence of fracture was highest among the least affluent individuals, who had around a 2.5-fold higher risk compared with the most affluent.
In terms of how the fracture occurred, road-traffic accidents and falls from a height were the major culprits, accounting for 36.4% and 27.3% of multiple fractures, respectively.
Less common causes included simple falls (4.5%), falling down stairs (12.5%), and direct blows/assault (4.4%).
More than 90% of patients with a multiple fracture were admitted to hospital, 80% underwent surgery, the mean length of hospital stay was 29.3 days, and less than half returned to their previous place of residence.
Finally, mortality at 1 year was significantly higher for patients with a multiple versus a single fracture, if the multiple fracture included a break of the pelvis, proximal humerus, or proximal femur. For instance, patients who fractured their proximal femur and proximal humerus were 1.8 times as likely to have died after 1 year as those who only fractured their proximal humerus.
The researchers conclude: "It seems likely that, with increasing longevity, multiple
fractures secondary to low-energy injuries will become more prevalent and form a greater proportion of the trauma workload in the future.
"These frail patients with an increased mortality risk may benefit from early identification and medical optimization, to facilitate rehabilitation and to provide for their potentially increased care needs, in an effort to improve their outcome and shorten their stay in hospital."
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By Joanna Lyford