Abstract
BackgroundHip fractures are well researched in orthogeriatric literature. Equivalent investigations for fragility-associated periprosthetic and periosteosynthetic femoral, ankle joint, pelvic ring, and rib fractures are still rare.The purpose of this study was to evaluate mortality, functional outcome, and socioeconomic parameters associated to the upper-mentioned fragility fractures prospectively in a 2-year follow-up.MethodsOver the course of a year, all periprosthetic and periosteosynthetic femoral fractures (PPFF), ankle joint fractures (AJ), pelvic ring fractures (PR), and rib fractures (RF), that were treated on a co-managed orthogeriatric ward, were assessed. Parker Mobility Score (PMS), Barthel Index (BI), place of residence, and care level were recorded. After 2 years, patients and/or relatives were contacted by mailed questionnaires or phone calls in order to calculate mortality and reevaluate the mentioned parameters.ResultsFollow-up rate was 77.7%, assessing 87 patients overall. The relative mortality risk was significantly increased for PR (2.9 (95% CI: 1.5–5.4)) and PPFF (3.5 (95% CI: 1.2–5.8)) but not for RF (1.5 (95% CI: 0.4–2.6)) and AJ (2.0 (95% CI: 0.0–4.0)). Every fracture group except AJ showed significantly higher BI on average at follow-up. PMS was, respectively, reduced on average for PR and RF insignificantly, but significantly for PPFF and AJ in comparison to pre-hospital values. 10.0–27.3% (each group) of patients had to leave their homes permanently; care levels were raised in 30.0–61.5% of cases.DiscussionThis investigation provides a perspective for further larger examinations. PR and PPFF correlate with significant increased mortality risk. Patients suffering from PPFF, PR, and RF were able to significantly recover in their activities of daily living. AJ and PPFF conclude in significant reduction of PMS after 2 years.ConclusionAny fragility fracture has its impact on mortality, function, and socioeconomic aspects and shall not be underestimated. Despite some fractures not being the most common, they are still present in daily practice.
Highlights
Hip fractures as the most typical fragility fractures are a common object of investigation in literature
Compared to the age-adjusted population, after 2 years, a significant increase of the relative death risk could be detected after periprosthetic/periosteosynthetic femoral fractures (SMR 3.5 95% CI: 1.2–5.8) and after pelvic ring fractures (SMR 2.9 95% CI: 1.5–5.4)
The standardized mortality ratio was not significant for ankle joint fractures (SMR 2.0 95% CI: 0.0–4.0) and rib fractures (SMR 1.5 95% CI: 0.4–2.6), the latter being associated to the lowest relative death risk (Table 3 and Figure 1)
Summary
Hip fractures as the most typical fragility fractures are a common object of investigation in literature. The according examinations confirmed improved outcome in terms of survival and functionality in relation to orthogeriatric co-management.[1,2,3] Further relevant fragility fractures like periprosthetic and periosteosynthetic femoral, pelvic ring, ankle joint, and rib fractures are not yet well investigated in this context. The aim of the actual investigation was to examine death rates, mobility, activities of daily living, place of residence, and need for care after inward orthogeriatric treatment of these fragility fractures prospectively in a 2-year follow-up. Methods: Over the course of a year, all periprosthetic and periosteosynthetic femoral fractures (PPFF), ankle joint fractures (AJ), pelvic ring fractures (PR), and rib fractures (RF), that were treated on a co-managed orthogeriatric ward, were assessed. Despite some fractures not being the most common, they are still present in daily practice
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