Multiple fractures in the elderly.
We present the prevalence of multiple fractures in the elderly in a single catchment population of 780,000 treated over a 12-month period and describe the mechanisms of injury, common patterns of occurrence, management, and the associated mortality rate. A total of 2335 patients, aged ≥ 65 years of age, were prospectively assessed and of these 119 patients (5.1%) presented with multiple fractures. Distal radial (odds ratio (OR) 5.1, p < 0.0001), proximal humeral (OR 2.2, p < 0.0001) and pelvic (OR 4.9, p < 0.0001) fractures were associated with an increased risk of sustaining associated fractures. Only 4.5% of patients sustained multiple fractures after a simple fall, but due to the frequency of falls in the elderly this mechanism resulted in 80.7% of all multiple fractures. Most patients required admission (> 80%), of whom 42% did not need an operation but more than half needed an increased level of care before discharge (54%). The standardised mortality rate at one year was significantly greater after sustaining multiple fractures that included fractures of the pelvis, proximal humerus or proximal femur (p < 0.001). This mortality risk increased further if patients were < 80 years of age, indicating that the existence of multiple fractures after low-energy trauma is a marker of mortality.
Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK. nickclement@doctors.org.uk
N D
ND
Clement
S
S
Aitken
A D
AD
Duckworth
M M
MM
McQueen
C M
CM
Court-Brown
D000058:Accidental Falls / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005264:Femoral Fractures / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006810:Humeral Fractures / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009104:Multiple Trauma / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D010384:Pelvic Bones / Q000293:injuries; D011379:Prognosis; D011446:Prospective Studies; D011885:Radius Fractures / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D012606:Scotland / Q000453:epidemiology