title: In-Hospital Mortality Following Open and Closed Long Bone Fracture: A Comparative Study.
abstract: BACKGROUND
  Open fracture is a serious orthopaedic injury that can lead to significant patient morbidity and mortality. There is limited data on the mortality risk for open compared to closed long bone fracture.
  
  
  METHODS
  The Nationwide Inpatient Sample was used to identify all patients who were admitted with a long bone fracture in the United States between 1998 and 2010. Cox proportional hazards regression modeling was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) of mortality.
  
  
  RESULTS
  After adjusting for age, gender, race, insurance, and comorbidities, the HR of mortality was 2.89 (95% CI, 2.56-3.28; p<0.001) for open compared to closed fracture. Stratified by anatomical site, the HR of mortality for open compared to fracture was 3.43 for femur (95% CI, 2.78-4.23; p<0.001), 2.81 for tibia or fibula (95% CI, 2.17-3.64; p<0.001), 2.54 for humerus (95% CI, 1.81-3.56; p<0.001), and 1.56 for radius or ulna (95% CI, 1.10-2.23; p=0.014).
  
  
  CONCLUSIONS
  This data suggests that open fracture carries a worse prognosis compared to closed fracture at the same anatomical site.
authors.affiliation: Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: Adam
authors.initials: A
authors.lastname: Adler
authors.affiliation: Department of Orthopaedic Surgery and the Department of Epidemiology and Biostatistics, SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Boylan
authors.affiliation: Department of Epidemiology and Biostatistics, SUNY Downstate School of Public Health, Brooklyn, NY.
authors.forename: Carl
authors.initials: C
authors.lastname: Rosenberg
authors.affiliation: Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: Robert
authors.initials: R
authors.lastname: Pivec
authors.affiliation: Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: Bhaveen H
authors.initials: BH
authors.lastname: Kapadia
authors.affiliation: Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: Vidushan
authors.initials: V
authors.lastname: Nadarajah
authors.affiliation: Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: Qais
authors.initials: Q
authors.lastname: Naziri
authors.affiliation: Department of Orthopaedic Surgery, Beth Israel Medical Center, New York, NY.
authors.forename: Steven F
authors.initials: SF
authors.lastname: Harwin
authors.affiliation: Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: Carl B
authors.initials: CB
authors.lastname: Paulino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005596:Fractures, Closed / Q000453:epidemiology / Q000401:mortality*; D005597:Fractures, Open / Q000453:epidemiology / Q000401:mortality*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult