title: The outcome of tibial diaphyseal fractures in the elderly.
abstract: We describe the outcome of tibial diaphyseal fractures in the elderly (≥ 65 years of age). We prospectively followed 233 fractures in 225 elderly patients over a minimum ten-year period. Demographic and descriptive data were acquired from a prospective trauma database. Mortality status was obtained from the General Register Office database for Scotland. Diaphyseal fractures of the tibia in the elderly occurred predominantly in women (73%) and after a fall (61%). During the study period the incidence of these fractures decreased, nearly halving in number. The 120-day and one-year unadjusted mortality rates were 17% and 27%, respectively, and were significantly greater in patients with an open fracture (p < 0.001). The overall standardised mortality ratio (SMR) was significantly increased (SMR 4.4, p < 0.001) relative to the population at risk, and was greatest for elderly women (SMR 8.1, p < 0.001). These frailer patients had more severe injuries, with an increased rate of open fractures (30%), and suffered a greater rate of nonunion (10%). Tibial diaphyseal fractures in the elderly are most common in women after a fall, are more likely to be open than in the rest of the population, and are associated with a high incidence of nonunion and mortality.
authors.affiliation: Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, UK. nickclement@doctors.org.uk
authors.forename: N D
authors.initials: ND
authors.lastname: Clement
authors.forename: N J F
authors.initials: NJ
authors.lastname: Beauchamp
authors.forename: A D
authors.initials: AD
authors.lastname: Duckworth
authors.forename: M M
authors.initials: MM
authors.lastname: McQueen
authors.forename: C M
authors.initials: CM
authors.lastname: Court-Brown
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails / Q000706:statistics & numerical data; D002370:Casts, Surgical / Q000706:statistics & numerical data; D003161:Compartment Syndromes / Q000209:etiology / Q000401:mortality; D018483:Diaphyses / Q000293:injuries; D005260:Female; D005596:Fractures, Closed / Q000209:etiology / Q000401:mortality / Q000601:surgery; D005597:Fractures, Open / Q000209:etiology / Q000401:mortality / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012606:Scotland / Q000453:epidemiology; D013978:Tibial Fractures / Q000209:etiology / Q000401:mortality* / Q000601:surgery
keywords: Diaphysis; Elderly; Fracture; Mortality; Nonunion; Outcome; Tibia