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Bingol I, Kamaci S, Yilmaz ET, Oral M, Yasar NE, Dumlupinar E, Ata N, Ulgu MM, Birinci S, Bayram S, Tokgozoglu AM, Demirors H. The epidemiology of geriatric fractures: A nationwide analysis of 1 million fractures. Injury 2024; 55:111900. [PMID: 39332226 DOI: 10.1016/j.injury.2024.111900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 08/23/2024] [Accepted: 09/15/2024] [Indexed: 09/29/2024]
Abstract
OBJECTIVE Fractures among the geriatric population impose a substantial burden on healthcare systems. This study aims to investigate the incidence and distribution of fractures among geriatric individuals over seven years, analyzing changes by age and sex. The findings will inform national healthcare strategies for addressing the growing impact of geriatric fractures. MATERIALS AND METHODS Electronic health records from a nationwide personal health records system were analyzed, focusing on ICD-10 codes for fractures. Recurrent codes for the same patients within three months were excluded. Patients were categorized into three age groups (65-74, 75-84, and 85+ years), and fractures were grouped anatomically. Incidence rates for specific fracture locations were calculated based on the actual population at risk annually. Incidence rates were further stratified by sex and age groups using Turkey's age- and sex-specific populations. RESULTS A total of 1,004,663 geriatric fractures (66.9 % female, 33.1 % male) were identified over seven years. The overall fracture incidence among the geriatric population was 1.9 % (1910/100,000). Hip fractures were the most common (25.2 %), followed by wrist (15 %) and lumbar-pelvic fractures (11.9 %). Femur fractures were predominant in the 75-84 and 85+ age groups, while wrist fractures were more common in the 65-74 age group. Fracture incidences generally increased with age, except for ankle, foot, and toe fractures, which decreased with age for both sexes (p < 0.05). The male/female ratio was lowest for wrist, elbow, and humeral shaft fractures (1:3.2, 1:2.7, and 1:2.7, respectively). The lowest overall fracture incidence was observed in 2020 (1568/100,000), while the highest was in 2017 (2523/100,000). CONCLUSION With Turkey's aging population, the socioeconomic impact of geriatric fractures is anticipated to rise. Fracture patterns and incidence vary by age and sex among geriatric individuals. These findings provide valuable insights for healthcare planning and the development of community-based preventive measures tailored to specific fracture locations and demographics.
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Affiliation(s)
- Izzet Bingol
- Department of Orthopaedics and Traumatology, Ankara Yildirim Beyazit University, Ankara, Türkiye.
| | - Saygin Kamaci
- Department of Orthopaedics and Traumatology, Hacettepe University, Ankara, Türkiye
| | - Engin Turkay Yilmaz
- Department of Orthopaedics and Traumatology, Hacettepe University, Ankara, Türkiye
| | - Melih Oral
- Department of Orthopaedics and Traumatology, Hacettepe University, Ankara, Türkiye
| | - Niyazi Erdem Yasar
- Department of Orthopaedics and Traumatology, Health Sciences University, Ankara Bilkent City Hospital, Ankara, Türkiye
| | - Ebru Dumlupinar
- Faculty of Medicine, Department of Biostatistics, Ankara University, Ankara, Türkiye
| | - Naim Ata
- Ministry of Health, General Directorate of Health Information Systems, Ankara, Türkiye
| | - M Mahir Ulgu
- Ministry of Health, General Directorate of Health Information Systems, Ankara, Türkiye
| | | | - Sinem Bayram
- Ministry of Health, General Directorate of Health Information Systems, Ankara, Türkiye
| | | | - Huseyin Demirors
- Department of Orthopaedics and Traumatology, Bayındır Hospital, Ankara, Türkiye
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Walter N, Szymski D, Kurtz SM, Lowenberg DW, Alt V, Lau EC, Rupp M. Complications and associated risk factors after surgical management of proximal femoral fractures. Bone Jt Open 2023; 4:801-807. [PMID: 37866820 PMCID: PMC10590671 DOI: 10.1302/2633-1462.410.bjo-2023-0088.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
Aims This work aimed at answering the following research questions: 1) What is the rate of mechanical complications, nonunion and infection for head/neck femoral fractures, intertrochanteric fractures, and subtrochanteric fractures in the elderly USA population? and 2) Which factors influence adverse outcomes? Methods Proximal femoral fractures occurred between 1 January 2009 and 31 December 2019 were identified from the Medicare Physician Service Records Data Base. The Kaplan-Meier method with Fine and Gray sub-distribution adaptation was used to determine rates for nonunion, infection, and mechanical complications. Semiparametric Cox regression model was applied incorporating 23 measures as covariates to identify risk factors. Results Union failure occured in 0.89% (95% confidence interval (CI) 0.83 to 0.95) after head/neck fracturs, in 0.92% (95% CI 0.84 to 1.01) after intertrochanteric fracture and in 1.99% (95% CI 1.69 to 2.33) after subtrochanteric fractures within 24 months. A fracture-related infection was more likely to occur after subtrochanteric fractures than after head/neck fractures (1.64% vs 1.59%, hazard ratio (HR) 1.01 (95% CI 0.87 to 1.17); p < 0.001) as well as after intertrochanteric fractures (1.64% vs 1.13%, HR 1.31 (95% CI 1.12 to 1.52); p < 0.001). Anticoagulant use, cerebrovascular disease, a concomitant fracture, diabetes mellitus, hypertension, obesity, open fracture, and rheumatoid disease was identified as risk factors. Mechanical complications after 24 months were most common after head/neck fractures with 3.52% (95% CI 3.41 to 3.64; currently at risk: 48,282). Conclusion The determination of complication rates for each fracture type can be useful for informed patient-clinician communication. Risk factors for complications could be identified for distinct proximal femur fractures in elderly patients, which are accessible for therapeutical treatment in the management.
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Affiliation(s)
- Nike Walter
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
- Department of Psychosomatic Medicine, University Medical Center Regensburg, Regensburg, Germany
| | - Dominik Szymski
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Steven M. Kurtz
- Implant Research Center, Drexel University, Philadelphia, Pennsylvania, USA
| | - David W. Lowenberg
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Volker Alt
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | | | - Markus Rupp
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
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Schoeneberg C, Heuser L, Rascher K, Lendemans S, Knobe M, Eschbach D, Buecking B, Liener U, Neuerburg C, Pass B, Schmitz D. The Geriatrics at Risk Score (GeRi-Score) for mortality prediction in geriatric patients with proximal femur fracture - a development and validation study from the Registry for Geriatric Trauma (ATR-DGU). Osteoporos Int 2023; 34:879-890. [PMID: 36892634 DOI: 10.1007/s00198-023-06719-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/01/2023] [Indexed: 03/10/2023]
Abstract
UNLABELLED This study developed an easy-to-use mortality prediction tool, which showed an acceptable discrimination and no significant lack of fit. The GeRi-Score was able to predict mortality and could distinguish between mild, moderate and high risk groups. Therefore, the GeRi-Score might have the potential to distribute the intensity of medical care. PURPOSE Several mortality-predicting tools for hip fracture patients are available, but all consist of a high number of variables, require a time-consuming evaluation and/or are difficult to calculate. The aim of this study was to develop and validate an easy-to-use score, which depends mostly on routine data. METHODS Patients from the Registry for Geriatric Trauma were divided into a development and a validation group. Logistic regression models were used to build a model for in-house mortality and to obtain a score. Candidate models were compared using Akaike information criteria (AIC) and likelihood ratio tests. The quality of the model was tested using the area under the curve (AUC) and the Hosmer-Lemeshow test. RESULTS 38,570 patients were included, almost equal distributed to the development and to the validation dataset. The AUC was 0.727 (95% CI 0.711 - 0.742) for the final model, AIC resulted in a significant reduction in deviance compared to the basic model, and the Hosmer-Lemeshow test showed no significant lack of fit (p = 0.07). The GeRi-Score predicted an in-house mortality of 5.3% vs. 5.3% observed mortality in the development dataset and 5.4% vs. 5.7% in the validation dataset. The GeRi-Score was able to distinguish between mild, moderate and high risk groups. CONCLUSIONS The GeRi-Score is an easy-to-use mortality-predicting tool with an acceptable discrimination and no significant lack of fit. The GeRi-Score might have the potential to distribute the intensity of perioperative medical care in hip fracture surgery and can be used in quality management programs as benchmark tool.
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Affiliation(s)
- Carsten Schoeneberg
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Hellweg 100, 45276, Essen, Germany.
| | - Laura Heuser
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Hellweg 100, 45276, Essen, Germany
| | | | - Sven Lendemans
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Hellweg 100, 45276, Essen, Germany
| | - Matthias Knobe
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Medical Faculty, RWTH Aachen University Hospital, 52074, Aachen, Germany
| | - Daphne Eschbach
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Benjamin Buecking
- Department for Trauma Surgery, Klinikum Hochsauerland, Arnsberg, Germany
| | - Ulrich Liener
- Department of Orthopedics and Trauma Surgery, Marienhospital, Stuttgart, Germany
| | - Carl Neuerburg
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany
| | - Bastian Pass
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Hellweg 100, 45276, Essen, Germany
| | - Daniel Schmitz
- Department of Trauma, Orthopedic and Hand Surgery, Marienhospital Bottrop, Bottrop, Germany
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Kim HS, Lee JE, Choi RJ, Kim CH. Impact of concomitant upper-extremity injuries in patients with hip fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04608-w. [PMID: 36074171 DOI: 10.1007/s00402-022-04608-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/29/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Combined hip and upper-extremity fractures raise clinical concerns because upper-extremity fractures may hinder early mobilization, thereby affecting rehabilitation and mortality. This systematic review and meta-analysis aimed to evaluate the effects of combined upper-extremity and hip fractures on rehabilitation and mortality. MATERIALS AND METHODS We systematically searched MEDLINE, Embase, and the Cochrane Library for studies published before March 20, 2022, that evaluated the impact of concomitant upper-extremity injuries in geriatric patients with hip fractures. The pooled analysis identified differences in the (1) length of hospital stay, (2) discharge destination, and (3) mortality rates between the isolated and combined hip fracture groups. RESULTS A total of 217,233 patients with isolated hip fractures (n = 203,816) and combined hip and upper-extremity fractures (n = 13,417) from 12 studies were analyzed. The average length of hospital stay was significantly longer in the combined upper-extremity fracture group than in the isolated hip fracture group (mean difference = 1.67 days; 95% confidence interval [CI] 0.63-2.70; P = 0.002). Patients in the combined upper limb fracture group were less likely to be discharged directly home (odds ratio [OR] = 0.64; 95% CI 0.52-0.80; P < 0.001) and showed significantly higher 30-day mortality (OR = 1.44; 95% CI 1.32-1.58; P < 0.001). The mortality rate after 30 days was not significantly different between the two groups. CONCLUSIONS Concomitant upper-extremity fractures have debilitating effects on rehabilitation and early mortality in geriatric patients with hip fractures. Therefore, more focus should be placed on the early ambulation of patients with hip fractures and simultaneous upper limb fractures to promote rehabilitation and alleviate the public health burden. LEVEL OF EVIDENCE III meta-analysis.
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Affiliation(s)
- Han Soul Kim
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-gu, Incheon, Republic of Korea
| | - Jung Eun Lee
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-gu, Incheon, Republic of Korea
| | - Rak Jun Choi
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-gu, Incheon, Republic of Korea
| | - Chul-Ho Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-ku, Seoul, 06973, Republic of Korea.
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Haddad FS. Good quality research in many subspecialties. Bone Joint J 2022; 104-B:1009-1010. [PMID: 36047025 DOI: 10.1302/0301-620x.104b9.bjj-2022-0821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Fares S Haddad
- University College London Hospitals NHS Foundation Trust, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK.,The Bone & Joint Journal, London, UK
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Sharrock M, Hagan J, Lee J, Charalambous CP. Greater length of hospital stay for concurrent hip and upper limb fractures compared to isolated hip fractures: a systematic review of 13 studies including 210,289 patients and meta-analysis. Injury 2022; 53:2617-2624. [PMID: 35644643 DOI: 10.1016/j.injury.2022.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/22/2022] [Accepted: 05/22/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The impact of concurrent upper limb and fragility hip fractures has not been well defined. A greater understanding of this can guide decision making in the early peri-operative period and subsequent rehabilitation of such patients. AIMS To identify if patients with concurrent upper limb and fragility hip fractures have different outcomes and demographics than those with an isolated hip fracture. METHODS A search of MEDLINE and EMBASE was performed to identify cohort and case-control studies, comparing concurrent hip and upper limb fractures with isolated hip fractures. Meta-analysis was conducted using RevMan 5.4. Subgroup analyses were performed for concurrent distal radius and concurrent proximal humerus fractures. RESULTS 13 studies were included reporting on 196,916 patients with an isolated hip fracture and 13,373 with concurrent hip and upper limb fractures. Patients with concurrent upper limb fractures had a significantly longer length of hospital stay (mean difference: 3.97 days, 95% CI: 1.36, 6.57, P=0.003) as compared to those with isolated hip fractures. Patients with concurrent upper limb fractures were significantly more likely to be female (OR: 0.57, 95% CI: 0.46, 0.70, P<0.00001), reside at home pre-injury (OR: 0.6, 95% CI: 0.37, 0.96, P=0.03) and have no cognitive impairment (OR: 0.54, 95% CI: 0.35, 0.84, P=0.006). Patients with concurrent distal radius fractures had significantly lower 90-day mortality (OR: 0.70, 95% CI: 0.49, 0.99, P=0.04) and 1-year mortality (OR: 0.68, 95% CI: 0.51, 0.90, P=0.008). CONCLUSIONS Concurrent fragility hip and upper limb fractures are associated with increased length of hospital stay. We recommend early, aggressive, individualised rehabilitation to help improve outcomes and early hospital discharge in this highly vulnerable patient group.
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Affiliation(s)
- Martin Sharrock
- School of Surgery, North West Deanery, Manchester, UK; Queen Mary University of London, UK
| | - James Hagan
- The Mater Infirmorum Hospital, Belfast, Northern Ireland
| | - Joshua Lee
- Queen Mary University of London, UK; Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Charalambos P Charalambous
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK; School of Medicine, University of Central Lancashire, Preston, UK.
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