title: Geriatric High-Energy Polytrauma With Orthopedic Injuries: Clinical Predictors of Mortality.
abstract: BACKGROUND
  The impact of orthopedic injuries in the elderly patient with multi-trauma and the effect of operative fixation on these injuries have not been thoroughly evaluated.
  
  
  METHODS
  We reviewed geriatric patients (aged 65 and older) between 2004 and 2010 at a level 1 trauma center who sustained high-energy polytrauma (injury and severity score [ISS] ≥ 16) with associated orthopedic injuries. Patients were excluded if they had severe head and spine injuries, died on arrival, or had low-energy mechanisms of injury. Logistic regression was conducted to identify factors that predict mortality.
  
  
  RESULTS
  There were 154 patients who comprised our study group with an average age of 76 years and an ISS of 23. There were 96 males and 58 females. Overall, 52 patients died within 1 year of their admission: 21 patients during their initial hospital stay and 31 patients within 1 year following admission. In all, 64 (42%) patients underwent operative stabilization of their orthopedic injuries. Increased mortality was seen (P < .05) in female patients, those with lower admission Glasgow coma score, and those who underwent orthopedic surgery. Patients had worse outcomes if they sustained femur (P = .014), clavicle, or scapular fractures (P = .027). Other factures associated with higher mortality included pelvic/acetabular injury requiring surgery (P = .019) or spine fractures treated nonoperatively (P = .014).
  
  
  CONCLUSIONS
  The effect of orthopedic injuries on this geriatric polytrauma group contribute to worse outcomes when they included clavicle, scapula, and femur fractures. We also found that pelvic/acetabular fractures treated operatively and nonoperative spine fractures were associated with higher mortality rates. Risk/benefit consideration is suggested when contemplating operative intervention in these patients.
authors.affiliation: Department of Orthopaedic Surgery, St Louis University School of Medicine, St Louis, MO, USA.
authors.forename: Adham
authors.initials: A
authors.lastname: Abdelfattah
authors.affiliation: Department of Orthopaedic Surgery, St Louis University School of Medicine, St Louis, MO, USA.
authors.forename: Michael Del
authors.initials: MD
authors.lastname: Core
authors.affiliation: Department of Orthopaedic Surgery, St Louis University School of Medicine, St Louis, MO, USA.
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Cannada
authors.affiliation: Department of Orthopaedic Surgery, St Louis University School of Medicine, St Louis, MO, USA.
authors.forename: J Tracy
authors.initials: JT
authors.lastname: Watson
keywords: fixation; geriatric; orthopedic injuries; polytrauma