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Farid AR, Stearns SA, Atarere JO, Suneja N, Weaver MJ, Von Keudell AG. Trends in non-operative management of low-energy pelvic fracture: An analysis of the Nationwide Inpatient Sample. J Orthop 2023; 43:101-108. [PMID: 37564706 PMCID: PMC10410464 DOI: 10.1016/j.jor.2023.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 08/12/2023] Open
Abstract
Introduction Non-operative management is common for low-impact pelvic fractures. In this study, we characterize the epidemiology of those treated nonoperatively following low-energy pelvic fracture, while identifying recent management trends. Methodology Data from the Nationwide Inpatient Sample (NIS) database from 2011 to 2018 were analyzed. We identified adult patients diagnosed with pelvic fracture based on International Classification of Diseases (ICD) codes, excluding fractures of the acetabulum, femur, polytrauma, and open fractures to isolate cases caused by low-impact mechanisms. Codes indicating operative management were excluded. Demographic information and outcomes (length of stay, in-hospital mortality, hospital discharge status) were collected. Sub-analyses were performed to identify trends. Findings 123,936 eligible patients were identified. The average age was 68.7 years. 70% were female, showing a decline from 75% to 66% over the study period. Pubic bone involvement was observed in 59% of fractures. The mean Charlson Comorbidity Index (CCI) was 3.83, corresponding to a 10-year survival rate of 58.5%, which remained relatively stable throughout the study period. 62.4% of patients received treatment at urban teaching hospitals. Average length of hospital stay was 6.3 days. Discharge to a skilled nursing facility (SNF) was the most common outcome, ranging from 62.1% to 65.0% during the study period, while 20.0% of patients were discharged home (18.4%-21.1%). Mean in-hospital mortality was 3.28%, showing no significant change, with higher rates among male patients (5.1%) and patients of Asian descent (3.8%). Conclusion The majority of patients receiving nonoperative treatment for low-energy pelvic fractures were females in their mid-60s with moderate comorbidity. The study reveals a relatively high in-hospital mortality rate of 3.28%, particularly among male patients and those of Asian descent, indicating the need for increased surveillance for further injury in these groups. Most patients were discharged to a SNF, highlighting the necessity for extended rehabilitation in this population. This persistent trend is noteworthy considering the growing emphasis on the cost of inpatient admissions and advancements in outpatient management of orthopedic injuries.
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Affiliation(s)
- Alexander R. Farid
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephen A. Stearns
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph Okiemute Atarere
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nishant Suneja
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael J. Weaver
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Arvind Gabriel Von Keudell
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Trauma, Bispebjerg hospitalet, University of Copenhagen, 2400, Copenhagen, Denmark
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Steiger CN, Ceroni D. Mechanism and predisposing factors for proximal tibial epiphysiolysis in adolescents during sports activities. Int Orthop 2019; 43:1395-1403. [PMID: 30267244 DOI: 10.1007/s00264-018-4168-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 09/18/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Proximal tibial epiphysiolysis (PTE) can have debilitating consequences for young athletes. The mechanism and predisposing factors for this lesion have yet to be determined. To find a common denominator and a biomechanical explanation for PTE, we were using a retrospective analysis of 15 cases in combination with a systematic review of literature. METHODS A retrospective review of medical charts was performed to identify all PTE between 2003 and 2012. Records were screened for patient age and gender, sports activity, mechanism of injury, and treatment protocols. Additionally, a literature review (MEDLINE/PubMed database, the Cochrane Library, online search engines) was conducted. RESULTS Medical charts of 14 adolescents (15 Salter-Harris I and II fractures) were analyzed. The literature review revealed additional 75 fractures. The predominant mechanisms were landing from a jump, takeoff for a jump, stop and go movements, and eccentric muscle contraction with the knee in flexion. The main sports-activities implicated in these injuries were basketball. CONCLUSIONS Landing from a jump with a decreased knee and hip flexion movement increases tensile forces on the proximal tibia epiphysis. During physiological epiphysiodesis, the growth plate displays an increased vulnerability and such increased tensile forces can lead to a growth plate failure. Neuromuscular fatigue can alter coordination and proprioceptive accuracy during landing from a vertical jump and thus perturbs sagittal shock absorption. In our opinion, trainers should instruct young athletes in techniques that help avoiding uncontrolled high impact landings. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Christina N Steiger
- Département de l'enfant et de l'adolescent, Service d'orthopédie pédiatrique, Hôpitaux Universitaires de Genève, Rue Willy Donzé 6, 1205, Genève, Switzerland.
| | - Dimitri Ceroni
- Département de l'enfant et de l'adolescent, Service d'orthopédie pédiatrique, Hôpitaux Universitaires de Genève, Rue Willy Donzé 6, 1205, Genève, Switzerland
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Liu G, Li Y, Zhu Y, Chen W, Xing X, Shao J, Liu S, Lv H, Ji C, Zhang X, Zhang Y. Unhealthy lifestyles are associated with the increased risk of low-energy fracture in Chinese men ≥ 50 years, a population-based survey. Arch Osteoporos 2019; 14:57. [PMID: 31144116 DOI: 10.1007/s11657-019-0600-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 04/14/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aims to investigate the incidence of low-energy fractures in men aged 50 years and older in China and to explore associated risk factors. METHODS All the relevant data were available from the China National Fracture Survey (CNFS), which was a cross-sectional survey carried out in eight Chinese provinces (municipalities) between January and May 2015. RESULTS Through 2014, 76,687 men above 50 years participated in this study and 223 participants had low-energy fractures, indicating the incidence rate 290.8 (95%CI, 252.7-328.9)/100,000 men. Over 80% of the fractures occurred at home and on the common road. The fracture incidence rate presented a significant rising trend with advanced age (p = 0.039). Current smoking, alcohol overconsumption, insufficient sleep duration, and history of past fracture were identified as significant risk factors associated with low-energy fracture (p < 0.05). CONCLUSIONS These results will assist the decisions regarding allocation of healthcare provision to populations of greatest need and aid the design and implementation of strategies to reduce fracture incidence. Accordingly, individuals should be encouraged to reduce alcohol consumption, immediately quit smoking, and get sufficient sleep, especially in those with a history of past fracture. In addition, primary preventives especially home prevention should be emphasized.
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Zhang XJ, Zhu YB, Liu S, Chen W, Liu B, Zhang F, Lv HZ, Ji CN, Zhang XL, Zhang YZ. Incidence of Low-energy Upper Extremity Fractures and the Risk Factors in Chinese People 50 years or Older. Orthop Surg 2019; 11:304-310. [PMID: 30932355 PMCID: PMC6594479 DOI: 10.1111/os.12448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/02/2018] [Accepted: 06/05/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the incidence of low‐energy upper extremity fractures and identify the associated risk factors in Chinese people aged 50 years or older. Methods This study was a part of the Chinese National Fracture Survey, which was performed between January and May 2015 and aimed to investigate the epidemiology of traumatic fractures in China in 2014. The China National Fracture Study (CNFS) was registered with the Chinese Clinical Trial Registry (number ChiCTR‐EPR‐15005878). A stratified multistage cluster randomized sampling method was used to recruit subjects and the survey was conducted through a questionnaire. The relevant results have been published elsewhere. In the current study, 154 099 Chinese men and women aged 50 years or older were included for data collection and analysis. Low‐energy fractures were defined as fractures that were caused by simple falls from standing height. Individuals who had low‐energy upper extremity fractures were included in the case group and the remainder were included in the control group. Univariate and multivariate logistics regression analysis models were constructed to investigate the independent risk factors, after adjustment for confounding variables. Results In total, 184 patients sustained low‐energy upper extremity fractures in 2014, indicating that the overall incidence was 119.4/100 000 persons, with 57.4 and 180.9/100 000 person‐years in men and women. Approximately 80% of fractures occurred at home and on the common road (other than high way). In men, alcohol consumption (OR, 2.12; 95%CI, 1.11–4.06), residence at ≥2nd floor without an elevator (OR, 2.86; 95%CI, 1.16–7.06), sleep duration<7 h/day (OR, 2.77; 95%CI, 1.42–5.37), and history of past fractures (OR, 3.10; 95%CI, 1.21–7.93) were identified as significant risk factors. In women, obesity (BMI ≥ 28.0) (OR, 1.86; 95%CI, 1.31–2.66), living in the central region in China (OR, 1.53; 95%CI, 1.01–2.31), living at a higher latitude (40°–49.9°N) (OR, 1.79; 95%CI, 1.02–3.14), alcohol consumption (OR, 2.40; 95%CI, 1.58–3.63), more births (OR, 1.45; 95%CI, 1.15–1.83), sleep duration <7 h/day (OR, 2.21; 95%CI, 1.53–3.20), and history of past fracture (OR, 2.70; 95%CI, 1.52–4.80) were identified as significant risk factors. Conclusion Based on these results, health policies that focus on decreasing alcohol consumption and encouraging individuals to improve their quality and duration of sleep should be implemented in China. The significance of moving to a ground floor or to a building equipped with an elevator for men, and maintaining a healthy body weight for women should be emphasized to prevent upper extremity fractures.
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Affiliation(s)
- Xiao-Juan Zhang
- Department of Endocrinology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yan-Bin Zhu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Song Liu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Wei Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Bo Liu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Fei Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Hong-Zhi Lv
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Chen-Ni Ji
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Xiao-Lin Zhang
- Department of Statistics and Epidemiology, Hebei Medical University, Shijiazhuang, China
| | - Ying-Ze Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China.,Chinese Academy of Engineering, Beijing, China
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Furtado S, Rodrigues A, Dias S, Branco JC, Canhão H. Self-reported low-energy fractures and associated risk factors in people with diabetes: A national population-based study. Diabetes Res Clin Pract 2019; 147:93-101. [PMID: 30481576 DOI: 10.1016/j.diabres.2018.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/27/2018] [Accepted: 11/21/2018] [Indexed: 01/20/2023]
Abstract
AIMS Clinical risk factors and bone mineral densitometry underestimate low-energy fracture (LEF) risk in people with diabetes. We aim to estimate the prevalence of LEF in diabetics, compare with nondiabetics; and evaluate possible predictors of LEF in people with diabetes. METHODS Cross-sectional, population-based study in Portuguese subjects over 40 years-old. Estimates computed as weighted proportions/means, considering sample design. Multivariate logistic regression models to evaluate the association of diabetes and LEF; and predictors of LEF in diabetics. RESULTS 7675 subjects were analysed, of which 1173 reported diabetes. Diabetics were older (mean age 66.0 ± 11.49y), more frequently reported osteoporosis and falls in the previous 12 months (32.4% vs. 22.9%). Prevalence of self-reported LEF was 16.2% (95% CI:13.68-19.13) among diabetics (vs. 13.3%, 95% CI:12.14-14.57, in nondiabetics); OR for the association diabetes and LEF:1.26, 95% CI:1.01-1.58, p = 0.045 (in women, adjusted OR:1.41, 95% CI:1.05-1.89, p = 0.02). Thirty percent of diabetics reported at least one major LEF and 70% in other sites. In diabetics, LEF was independently associated with self-reported osteoporosis and falls in the previous 12 months. CONCLUSION People with diabetes reported more falls and had higher prevalence of self-reported LEF. Self-reported osteoporosis and falls were associated with LEF in diabetics. Our findings emphasize the need for fracture and falls preventive measures in diabetics.
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Affiliation(s)
- Sofia Furtado
- Department of Internal Medicine, Hospital São José, Centro Hospitalar Lisboa Central, Lisboa, Portugal.
| | - Ana Rodrigues
- EpiReumaPt Study Group-Sociedade Portuguesa de Reumatologia, Lisboa, Portugal; EpiDoc Unit-Unidade de Epidemiologia em Doenças Crónicas (CEDOC, NMS/UNL), Lisboa, Portugal
| | - Sara Dias
- EpiDoc Unit-Unidade de Epidemiologia em Doenças Crónicas (CEDOC, NMS/UNL), Lisboa, Portugal
| | - Jaime C Branco
- EpiReumaPt Study Group-Sociedade Portuguesa de Reumatologia, Lisboa, Portugal; EpiDoc Unit-Unidade de Epidemiologia em Doenças Crónicas (CEDOC, NMS/UNL), Lisboa, Portugal; NOVA University Lisbon: NOVA Medical School, National School of Public Health, Portugal; Department of Rheumatology, Serviço de Reumatologia, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Helena Canhão
- EpiReumaPt Study Group-Sociedade Portuguesa de Reumatologia, Lisboa, Portugal; EpiDoc Unit-Unidade de Epidemiologia em Doenças Crónicas (CEDOC, NMS/UNL), Lisboa, Portugal; NOVA University Lisbon: NOVA Medical School, National School of Public Health, Portugal
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Jia P, Bao L, Chen H, Yuan J, Liu W, Feng F, Li J, Tang H. Risk of low-energy fracture in type 2 diabetes patients: a meta-analysis of observational studies. Osteoporos Int 2017; 28:3113-3121. [PMID: 28795239 DOI: 10.1007/s00198-017-4183-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/30/2017] [Indexed: 12/13/2022]
Abstract
UNLABELLED In this meta-analysis, evidence of an association between type 2 diabetes mellitus (T2DM) and low-energy fractures has been evaluated including 12 observational studies. The results suggested that T2DM patients had an enhanced risk of low-energy fractures. INTRODUCTION Type 1 diabetes mellitus (T1DM) patients have been shown to be at enhanced risk of fracture injury, but less is known about low-energy fractures among patients with T2DM. METHODS We performed a meta-analysis of 12 observational studies identified in Medline and EMBASE that included 938,742 participants, including 30,827 low-energy fracture cases. The incidence rate ratios (IRRs) of low-energy fractures were determined using a random-effects model. RESULTS The IRRs of low-energy fracture for men and women were 1.37 (95% confidence interval [CI], 0.94-2.00; p = 0.096) and 1.22 (95% CI, 1.09-1.35; p = 0.000), respectively, and the overall IRR was 1.23 (95% CI, 1.12-1.35; p = 0.000). The IRRs for hip and vertebral fractures were 1.08 (95% CI, 1.02-1.15; p = 0.007) and 1.21 (95% CI, 0.98-1.48; p = 0.073), respectively. The IRRs of low-energy fracture in case-control, prospective, retrospective, and cross-sectional studies were 1.18 (95% CI, 0.81-1.72; p = 0.380), 1.17 (95% CI, 1.05-1.32, p = 0.006), 1.15 (95% CI, 1.02-1.29; p = 0.020), and 1.60 (95% CI, 1.21-2.12; p = 0.001), respectively. The IRRs of low-energy fracture for less than 5 years, 5 to 10 years, and more than 10 years were 1.30 (95%, CI 1.13-1.50; p = 0.000), 1.05 (95% CI, 1.03-1.08; p = 0.000), and 1.19 (95% CI, 1.00-1.41; p = 0.049), respectively. CONCLUSIONS Patients with T2DM had a greater risk of low-energy fracture especially of the hip, compared with that in non-diabetic subjects. However, since according to our funnel plot a publication bias may be present and due to study heterogeneity as well as the limited number of publications, the finding needs to be interpreted with caution.
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Affiliation(s)
- P Jia
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - L Bao
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - H Chen
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China.
| | - J Yuan
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
| | - W Liu
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
| | - F Feng
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - J Li
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - H Tang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China.
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