Lower Limb Fractures Research Articles

Immunohistochemical evaluation of tissues following bone implant extraction from upper and lower limb.

Fractured bones can regenerate and restore their biological and mechanical properties to the state prior to the damage. In some cases, however, the treatment of fractures requires the use of supportive implants. For bone healing, three processes are essential: the inflammatory phase, the repair phase and the remodelling phase. A proper course of the first - inflammatory - stage is important to ensure a successful fracture healing process. In our study, we evaluated tissue samples immunohistochemically from the area surrounding the fractures of upper and lower limbs (bone tissue, soft tissue, and the implant-adhering tissue) for markers: CD11b, CD15, CD34, CD44, CD68, Cathepsin K, and TRAcP that are linked to the aforementioned phases. In soft tissue, higher expressions of CD68, CD34, CD15 and CD11b markers were observed than in other locations. TRAcP and Cathepsin K markers were more expressed in the bone tissue, while pigmentation, necrosis and calcification were more observed in the implant-adhering tissue. Since even the implant materials commonly perceived as inert elicit the observed inflammatory responses, new surface treatments and materials need to be developed.

Charcot arthropathy and acro-osteolysis in a 5-year-old girl with hereditary sensory and autonomic neuropathy type II: A case report

Charcot neuropathic arthropathy is a destructive process that can occur in patients with neuropathy associated with medical diseases such as diabetes. A rare cause of neuropathic arthropathy is congenital insensitivity to pain (CIP) which includes varying degrees of sensory loss and lack of pain perception contributing to absent withdrawal responses. The clinical manifestations of CIP include delayed diagnosis of fractures, joint dislocations, acro-osteolysis, avascular necrosis, osteomyelitis, heterotopic ossification, and Charcot arthropathy. We herein report a case of Charcot arthropathy of ankle joints in a 5-year-old girl with CIP due to underlying hereditary sensory and autonomic neuropathy who had recurrent upper and lower limb fractures with acro-osteolysis. She had an inability to perceive pain from the first year of her life. She also had mild developmental delay. Family history was unremarkable. Blood count, liver and thyroid function tests, erythrocyte sedimentation rate, C-reactive protein, blood electrolytes, blood sugar and other laboratory tests were normal. Charcot neuropathic arthropathy in children is rare and can be a part of congenital diseases like CIP. A high degree of suspicion may lead to early detection and can prevent joint and bone destruction and deformities.

Application of PVC pipes as an adjustable bilateral traction device in lower limb fractures

ObjectiveTo introduce a new type of simple adjustable bilateral bidirectional polyvinyl chloride (PVC) tube traction device and discuss the value of using this device before surgery in patients with lower limb fractures.MethodsTo introduce the manufacturing process of an adjustable bilateral traction device made of PVC pipes. From August 2018 to November 2019, the data of 36 patients with lower limb fractures who were treated with this traction device were retrospectively analysed. The treatment outcomes were analysed, including length of both lower limbs, fracture reduction, lower limb mobility, visual analogue scale (VAS) score, incidence of complications, and patient satisfaction.ResultsAll patients were able to move the affected limb immediately after using the device. The patient's pain was significantly reduced, they were able to turn over freely during bed rest, and the length of the affected limb was restored to that of the healthy limb. Thirty-four (94.5%) patients were satisfied with the reduction of the fracture end, 2 (5.5%) patients with tibiofibular fractures showed angular displacement of the fractured end and satisfactory reduction after the position of the bone traction needle was adjusted; 7 (19.5%) patients developed deep vein thrombosis of the affected lower limb during traction; there was no decubitus or vascular nerve injury, and the overall complication rate was 25% (9/36). All the patients and their families were satisfied with the results of this treatment.ConclusionThe aim of this study is to introduce a new type of traction device. It is advantageous in that it is light weight, low cost, easy to assemble, promotes immediate movement of the affected limb after assembly, improves patient comfort and can be used with a titanium steel needle for MRI examination under traction. In the clinical setting, it has been shown to be suitable for the temporary treatment of patients with lower leg fractures prior to surgery, particularly patients who, for various reasons, require nonsurgical treatment in the short term.

Surgical Treatment of an Unusual Ski Injury: Combined Tibial Fracture With Anterior Cruciate Ligament Avulsion and Segond Lesion

Background: Alpine skiing is considered to be a high-risk sport due to frequent knee injuries and lower limb fractures. The most common lower limb fracture is tibial shaft fracture, while the most common ligament injuries include anterior cruciate ligament (ACL) or medial collateral ligament tears. An injury rarely described in the literature is the association of a bony leg fracture with an ACL injury and Segond fracture. Indications: While the tibial fracture can be managed with intermedullary nailing and proximal ACL tears can be managed with primary repair, the combination of treatments including fixation of the Segond fracture is uncommon. Technique Description: We report combination treatment with nailing for the tibial fracture, primary repair for the ACL avulsion, and primary fixation of Segond fracture. Results: Simultaneous reduction and fixation of the fracture and stabilization of the knee with ACL and anterolateral ligament repair in a single stage resulted in an excellent outcome with complete healing of tibial fracture, ACL repair, and Segond fixation at final follow-up. Discussion/Conclusion: Even if combined leg fracture associated with ipsilateral ACL tear and Segond fracture is a very rare injury, the described technique based on 1-stage fixation of the 3 injuries is a viable option. This surgical technique can be considered a reparative treatment, with the goal of preserving the joint. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Epidemiology and 12-Month Outcomes of Patients Managed in a Thoracolumbosacral Orthosis After Trauma

Abstract Introduction Traumatic fractures of the thoracolumbar junction (T10–L3) are the most common fractures of the spinal column. The management of these injuries can be operative or nonoperative, and braces are often used, including the Boston Overlap Brace (BOB), a type of thoracolumbosacral orthosis (TSLO). Methods All patients admitted to the Alfred Hospital in 2015 and managed in a BOB for 2- or 3-column thoracolumbar burst fractures (without neurology) were included in the study. In-hospital and 6- and 12-month patient-reported outcome measures were collected. A random-effects regression model analysis for each outcome (self-reported) pain and functional outcome measures by the Glasgow Outcomes Scale–Extended (GOS-E) was undertaken. Results A total of 115 patients (62 male) were included with a median age of 53 years. Using a random-effects model, having a lower-limb fracture or a regional kyphosis angle >8° was associated with not having a good recovery after taking into account all other factors with a univariate relationship with this outcome. In terms of the outcome of self-reported pain, only female sex was associated with reporting pain. Conclusions This study included a large cohort of patients with management of a traumatic fracture with a BOB-type TLSO and provided information that should guide a larger study to review whether the factors associated with poorer outcome, including female sex and local kyphotic angle, need to be considered before deciding on the management of these fractures. Clinical Relevance The association between degree of deformity of fracture (>8°) and associated lower-limb injury with poorer patient outcomes may need to be taken into account before deciding to manage thoracolumbar fractures with a BOB-type TLSO although further longitudinal studies are required.

Bone Transport through Induced Membrane versus Conventional Bone Transport in Management of Infected long bone defects of Lower Limbs: a randomized controlled trial.

To compare bone transport through induced membrane (BTM) and conventional bone transport (BT) regarding docking site union and infection recurrence in management of infected long bone defects. prospective randomized controlled study. tertiary level center. 30 patients with infected non-united long bone fractures of lower limbs. 15 patients treated by BTM in group (A) and 15 patients treated by BT in group (B). External fixation time (EFT), External fixation index (EFI), Docking time (DT). Bone and functional outcomes evaluated by the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system. Postoperative complications evaluated according to Paley's classification. The mean docking time (DT) was significantly lower in BTM group in comparison to BT group (3.6 ± 0.82 months vs 4.8 ± 0.86 months respectively; P value 0.001). Docking site non-union and infection recurrence were significantly lower in BTM group in comparison to BT group (0% vs 40%; P value 0.02 and 0% vs 33.3%; P value 0.04 respectively) with no significant difference in EFI (P value 0.08). This is the first prospective randomized controlled study comparing BTM and BT techniques showing that BTM had significantly faster docking site union, lower incidence of postoperative complications including docking site non-union and infection recurrence rates and lower number of additional procedures needed at the expense of two staged operation in comparison to BT.

Clinical outcomes of non-COVID-19 orthopaedic patients admitted during the COVID-19 pandemic: a multi-centre interrupted time series analysis across hospitals in six different countries

ObjectivesTo assess across seven hospitals from six different countries the extent to which the COVID-19 pandemic affected the volumes of orthopaedic hospital admissions and patient outcomes for non-COVID-19 patients admitted...

752 How Do We Manage Open Fractures in Emergency Department? – a Closed Loop Audit

Abstract Aim Patient with an open fracture is resuscitated mainly by the emergency physician prior to being referred to the relevant surgical specialties. Yet, there is lack of uniform guidance in managing open fractures. This audit aimed to evaluate the existing guidelines at the emergency department. Method A retrospective search was performed at the Tertiary trauma center. Four main parameters were evaluated 1.) the photo documentation. 2.) Antibiotic administration rate 3.) Tetanus prophylaxis utilisation. 4.) Systematic evaluation of neurovascular status pre and post splint. Results 41 patients (M: F, 63%:37%) were analysed. The most common open-fracture were lower-limb long bone (39%) and phalanx (39%) , followed by upper-limb long bone fracture (9.8%), head (7.3%), facial (2.4%) and pelvis (2.4%). Multiple fractures were seen in 20.9%. Multiple open fractures were only seen in 1 case. The average transfer time by ambulance to the hospital was 116 mins. 97.5% of open fractures received antibiotics: 13.3%, 60%, and 100% of patients received antibiotics respectively within 1hr, 3hr, and 6hr from the time of injury. 48.8% received tetanus prophylaxis, and only 4.87% have documented tetanus assessment. 100% has a neurovascular examination. 72% of open fractures required surgical intervention. The average time to the theatre was 16.7 hours. Conclusions Antibiotic administration within the first hour from the timing of the injury is not practical in real-life situations. Future work should focus on creating a universe open fracture grading system, beyond lower-limb fracture, to better inform clinicians of the prognosis of open fracture and help with risk stratification.

Posterolateral Plate vs. Lateral Plate in Fixation of Weber B Ankle Fractures. A Systematic Review/Meta-Analysis

Introduction Ankle fractures represent 10% of all fractures making it the second most common lower limb fractures after hip fractures. Danis-Weber classification describes the injury based on the location of the lateral malleolar fracture as type A, B and C. Management of type B ankle fracture is often surgical through open reduction and internal fixation by plate and screws. The plate can be positioned laterally or postero-laterally. Aim of work To compare between posterolateral plate versus lateral plate in management of DanisWeber type B fibular fracture. Materials and methods A systematic review and meta-analysis in which search strategy done from 2000 to 2020. This study is done on 4 articles with total number of participants 333. The outcomes of interest are operative outcome, functional outcome measured by AOFAS and Olerud and Molander scoring system, complication rates outcome. Results Posteo-lateral plate is superior in less hardware irritation. Regarding operative timing, wound infection, screw loosening and functional outcomes both techniques are comparable with no statistically significant difference. Conclusion Both techniques are comparable with no stasticially difference regarding operative time, wound infection, screw lossening and functional outcomes. However, fixation of lateral malleolar fracture by posteo-lateral plate is superior in less hardware irritation.

Lower Limb Fractures in the Elderly: Challenges and Perspectives for Optimal Care

This article provides an in-depth examination of complex lower limb fractures in orthopedic and traumatology surgery among the elderly population. It highlights the rising incidence of these fractures, particularly in the elderly, emphasizing the importance of associatedrisk factors. The article explores current surgical approaches for fixation and rehabilitation of these fractures, while presenting emerging techniques under development, such as robot-assisted surgery and customized implants. The significance of a multidisciplinary approach in care, involving geriatricians, physiotherapists, and nurses, is emphasized to enhance outcomes and reduce postoperative complications. Lastly, the article underscores the importance of awareness and prevention, highlighting initiatives to reduce falls among the elderly andimprove bone health.

Survival analysis in nonagenarian patients with non-hip lower limb fractures.

The United Kingdom has an aging population with nearly 1 in 5 being over the age of 65, and over 0.5 million over the age of 90. The treatment of acute fractures of the lower limb in the nonagenarian cohort of patients poses a technical challenge to orthopaedic surgeons. To report the fracture incidence, survival outcomes of treating acute non-hip lower limb fractures in nonagenarians in Major Trauma Centre. Thirty Lower limb long bone fractures in patients of age from 90 to 99 years were identified during 12-mo at a Level 1 trauma centre from a computerized database. A retrospective evaluation performed for fracture incidence, treatment, length of hospital duration and mortality at 30-d, 1-year and 2-year. Thirty fractures (28 patients) were identified, twenty-four fractures were treated with surgery (mean age 93 years SD ± 2.59) and 6 managed conservatively (mean age 94 years SD ± 2.07). The mean length of the hospital stay was 18.2 d for both groups. The 30-d, 1-year and 2-year mortality risks were 1/23, 6/23 and 9/23 (4%, 26% and 39%) in the surgery group and 0/5, 1/5 and 2/5 (0%, 20% and 40%) in the conservative group, with no evidence for a difference between the two groups at any time point. Nonagenarians in the surgical group had similar length of hospital stay and mortality risks as those treated conservatively. Patients with fewer comorbidities and admitted from their own home were offered surgery.

Comparison of Nalbuphine Versus Clonidine as an Adjuvant to Intrathecal Hyperbaric Bupivacaine in Orthopedic Lower Limb Surgeries: A Randomized Controlled Double-Blind Study.

Nalbuphine and clonidine are used as adjuvants to intrathecal local anesthetics, but studies on their comparative efficacy have shown inconsistent results. This study aimed to compare nalbuphine, clonidine, or normal saline as adjuvants to intrathecal hyperbaric bupivacaine in orthopedic lower limb surgeries. Method: Sixty-threeAmerican Society of Anesthesiologists (ASA) I/II patients between 18 and 60 years old with lower limb fractures were randomized into three groups (n=21 each). Patients with contraindications to spinal block, bilateral lower limb fractures, or long-term opioid therapy were excluded. The subarachnoid block was given in L3-L4 interspace. Group N received 1 mg of nalbuphine, group Cl received 30 mcg of clonidine, and group C received 0.5 ml of normal saline with 15 mg (0.5%) of hyperbaric bupivacaine. Sensory and motor block characteristics, hemodynamic variables and side effects were noted, and the data were analyzed using Student's t-test, Mann-Whitney test, Chi-square test, and ANOVA followed by Tukey's test. Patients receiving intrathecal nalbuphine (group N) and clonidine (group Cl) had a faster onset of the sensory and motor block than controls (group C) (p=0.000). The time to two-segment regression was more prolonged in group Cl when compared to group N (p=0.000). Duration of spinal analgesia was 216.75 ± 25.96 minutes, 292.86 ± 24.92 minutes, and 178.50 ± 16.06 minutes in groups N, Cl, and C, respectively (p=0.000). The 24-hour rescue analgesic requirement was maximum in group C and least in group Cl (p=0.000). The three groups were comparable to each other in terms of side effects. Clonidine was found to be superior to nalbuphine as an intrathecal adjuvant with no significant side effects.

Retracted: Posterior Lumbar Plexus Block Anesthesia for Elderly Patients with Lower Limb Fracture.

[This retracts the article DOI: 10.1155/2022/8494796.].

Epidemiology of traumatic spinal fractures in patients aged 50 years or less at a center in Saudi Arabia from 2005 to 2016

Background: We retrospectively reviewed traumatic spinal fractures (TSFs), including their mechanisms of injury and associated injuries in patients aged ≤50 years admitted to our center over a period of 11 years. Our secondary objective was to investigate whether spine injuries have decreased since the introduction of new transportation-related legislation applications. Methods: Between 2005 and 2016, all patients admitted to the hospital due to TSFs, including cervical, thoracic, and lumbar spinal fractures, who were aged ≤50 years were included in this study. Patient demographics, mechanism of injury, associated injuries, hospital stay duration, treatment, complications, and mortalities were reviewed and analyzed. Results: Altogether, 373 patients (81% male; 19% female; median age, 28 years) were included in the study, and 579 spinal fractures were identified. The lumbar spine was the most affected part. The most common injury mechanism was motor vehicle accidents (MVA) (69.7%), followed by falls (26.8%). Neurological injuries were detected in 9.4% of patients. Associated injuries were observed in 45.3% of patients, and 33.6% of patients were surgically treated. Thoracic injuries and lower limb fractures were the most common injuries, and the postoperative complication rate was 3.9%. Conclusions: Although there was a significant decrease in TSFs after the speed control legislation over the study period, MVA and falls remained the most common causes of spinal injuries. Associated injuries, operated patients, and female sex were all associated with a prolonged hospital stay.

PREVAILING TRENDS OF MORPHOLOGICAL INJURIES IN DRIVERS AND PASSENGERS OF JEEPS AND SUVS IN FATAL ACCIDENTS

Forensic medical examination of corpses in traffic accidents is an important area of research in the field of road safety. Vehicle collisions often lead to tragic consequences, and are a significant part of the causes of violent deaths in the interior of cars. Despite constant changes in the design features of modern cars aimed at improving safety, mortality remains significant.
 The study is aimed at studying the injuries of the driver and passenger in the cabin of jeeps and SUVs in a head-on collision, taking into account the features of the car design and the mechanisms of force transmission to the body of the passengers.
 Aim of the work. Study, analysis and systematization of injuries typical for drivers and passengers in the interior of jeeps and SUVs in frontal collisions with partial overlap.
 Materials and methods. 168 acts of traffic accidents with a fatal outcome were analyzed, from which the injuries of the driver and passenger during a frontal collision in the cabin of jeeps and SUVs were considered.
 During the research, the following methods were used: system-structural analysis, observation, comparison and description. Also, a forensic examination of injuries was carried out for each case. Statistical analysis included the use of descriptive statistics and multivariate analysis to test the null hypothesis.
 Results. The analysis of injuries to the driver and passenger in the cabin of a modern J-class car showed that in cases of fatal auto trauma, the following injuries occurred, which were more typical for passengers compared to drivers: front and rear torso injuries, soft tissues of the right leg, bone fractures lower limbs on the right and left, pelvic fractures on the right and left, kidney damage, ruptures of the spleen and lungs.
 Conclusions. In cases of fatal traffic accidents in frontal collisions in the interior of jeeps and SUVs, the following injuries occurred, which were more typical for passengers compared to drivers: front and rear torso injuries, soft tissues of the right leg, bone fractures of both lower limbs, right and left pelvic fractures, kidney damage, ruptures of the spleen and lungs.

Added value of waist circumference to body mass index for predicting fracture risk in obesity: a prospective study from the CARTaGENE cohort.

Waist circumference (WC) is a stronger risk factor of metabolic disorders than body mass index (BMI), but whether it holds true for fracture risk prediction remains unclear. We aimed to evaluate relationships between WC and fracture incidence within BMI categories and evaluate whether BMI modifies these relationships. Men and women aged 40-70years from the CARTaGENE cohort were divided by BMI category at baseline: normal weight, overweight, and obesity. Incident fractures were identified over 7years via linkage with healthcare administrative databases. Cox proportional hazard models estimated the relationships between WC and incident fractures at any site and by skeletal site within each BMI category. Results are reported as adjusted hazard ratios (95% confidence intervals) per 10cm increase in WC. Effect modification was evaluated qualitatively by comparing relationships between BMI categories. Of the 18 236 individuals included, 754 sustained a fracture. Significant relationships were found between WC and distal lower limb fractures in the normal (1.25 [1.08, 1.45]) and overweight (1.28 [1.07, 1.52]) BMI categories, but not in the obesity category. In the overweight category, we found an increased risk of distal upper limb fractures with increasing WC (1.49 [1.04, 2.15]). No significant relationship was observed regarding WC and fracture risk at any site or major osteoporotic fractures. An effect modification of BMI on the relationships between WC and distal lower limb fractures was observed. WC provides both independent and additive information to BMI for the identification of individuals at risk of obesity-related fractures.

Prevalence of Psychiatric Morbidity and Stress Burden among Patients with Limb Fracture.

To assess the prevalence of psychiatric morbidity and stress burden among the patients with limb fractures and compare them with age and gender matched control group. The cross-sectional study was conducted on 25 patients each of lower and upper limb fractures, presenting 2 weeks or more after the fracture to orthopedics OPD of Dayanand Medical College and Hospital. Psychiatric manifestations and stress burden were assessed using Mini International Neuropsychiatric Interview (M.I.N.I.), perceived stress scale (PSS), and impact of event scale-revised (IES-R) on the patients. It was compared to an equal number of age and gender matched normal control group. Majority of the patients with limb fractures were male (70%). The upper limb fracture was in age group of 18-30 years (52%), and those with lower limb fracture were >50 years of age (48%). Most common psychiatric morbidity seen in patients was major depressive disorder (52%) which was statistically significant in comparison with control group. The impact of trauma on patients resulted in avoidance and hyperarousal symptoms significantly in lower limb fracture patients than upper limb ones (P < 0.05). The long bone injuries in patient cause significant psychiatric morbidity which increases the stress burden in such patients due to immobility and pain.

Trends of patients undergoing physiotherapy at tertiary care hospital – A Retrospective study

BACKGROUND: Musculoskeletal disorders (MSDs) are prevalent across the globe, and in India are the commonest causes of long-term pain and disability, affecting millions of people. As physiotherapy plays an important role in preventing and helping in recovering these MSDs. This study is aimed to determine the trend of musculoskeletal conditions among patients undergoing physiotherapy treatment at tertiary care hospital. In a tertiary setup, a particular trend of the disorder might help in formulating a new treatment program that will involve physiotherapy &amp; prevention strategies. PURPOSE – To study the prevalence of musculoskeletal conditions in patients undergoing physiotherapy at tertiary care hospital. MATERIALS AND METHODS: It was a retrospective observational study in a tertiary care setup. Trends of patients having different musculoskeletal disorders have been observed from January 2022 to January 2023. The Disorders were divided into traumatic and non-traumatic categories. After arranging the data condition-wise analysis was done and the percentage of each condition was calculated accordingly. A total of (n = 6413) patient’s one-year data was analysed for different musculoskeletal conditions. RESULTS: Results showed a majority of disorders that patients in the rural setup are experiencing are lower limb fractures accounting for 44.0%, low back pain at 31.12%, and neck pain at 21.25% of all conditions. CONCLUSION: There is a high prevalence of occupation-related musculoskeletal disorders comprising back pain and neck pain under a non-traumatic domain &amp; lower limb fracture under a traumatic domain in tertiary care hospital. Attempts should be made to educate the rural population about physiotherapy and prevention strategies related to increased work demands, to prevent trauma.

A retrospective epidemiological cohort study of ankle fractures in children and teenagers.

Ankle fracture is one of the most frequent pediatric lower-limb fractures and may result in serious complications. This study aimed to determine the epidemiology of ankle fractures, defining fracture types, treatments, and complications in a pediatric population below 16 years old. Medical records of all the ankle fracture patients treated in our hospital during 2004-2020 were retrospectively reviewed. Data regarding age, sex, mechanism of injury, fracture type, treatment modalities, and complications were collected. We examined records involving 328 children with 331 ankle fractures, with a ratio of 1:2 male per female. Mean annual prevalence was 24.3 per 100,000 children. Mean patient age was 11.2 ± 4.2 years, with 75.3% of them aged over 10 years. Sports activities accounted for the largest percentage of fractures (162 cases; 49.4%), followed by falls (67; 20.4%) and road traffic accidents (37; 11.3%). Physeal fractures were the most frequent type of lesion (223 cases). Most ankle fractures (60%) were managed using closed reduction and casting; for the remaining 40% of cases, fracture fixation was performed after closed or open reduction to correct the articular step-off and ensure the anatomical restoration of the physis. The main ankle fracture complication was premature growth arrest (12.1% of all physeal fractures). Pediatric ankle fractures primarily affect children older than 10 years. Most of these fractures were caused by sports injuries or low-energy trauma. The majority of these fractures are physeal, and the distal tibial physis is affected 10 times more frequently than the distal fibular physis. Level III.

Common comorbid and secondary conditions leading to hospitalization in multiple sclerosis patients in the United States

ObjectiveTo identify the burden of hospitalization and common primary admitting diagnoses among MS patients in the United States (US). BackgroundThe burden of hospitalizations and conditions leading to hospitalizations in MS patients in the US has not been well described. Design/methodsUsing the Nationwide Inpatient Sample for 2001–2010, all patients with principal or secondary diagnosis of MS were identified, and the principal admitting diagnoses were compared with that of non-MS patients. Trends in hospitalizations were studied in specific age groups (1–9 yrs, 10–19 yrs, 20–29 yrs, 30–39 yrs, 40–49 yrs, 50–59 yrs, 60–69 yrs,70–79 yrs, 80–84 yrs and ≥85 yrs), and population level rates were obtained and compared with non-MS patients to obtain rate ratios (RR) and odds ratios (OR). ResultsA total of 1,240,410 MS patients were identified representing 4 out of every 1000 US hospital admissions, with an estimated female/male ratio of 2.72/1. The median age for MS hospitalizations was 53 years (Interquartile range=18). The majority of all MS hospitalizations occurred in the 30–69-year age bracket (82.17 %). The average length of in-patient hospital stays for MS patients compared to the non-MS population was 5.8 vs. 4.5 days (p < 0.001), and more MS patients had Medicare insurance (50.36 % vs. 42.24 %, p < 0.001). Overall, conditions such as urinary tract infections (UTI) - (RR11.43, p < 0.001), septicemia (RR8.53, p < 0.001), pneumonia (RR2.84, p < 0.001), chronic skin ulcers (RR20.64, p < 0.001), and lower limb and femoral neck fractures (RR2.86, p < 0.001) were present with increased frequency among MS patients. Patterns of comorbidity varied markedly by age group. The estimated average annual in-hospital charges adjusted to 2010 dollars for all MS inpatient hospitalizations was 3 billion U.S. dollars. ConclusionsPatients with MS are admitted into hospital at a younger age, are hospitalized longer and consume more Medicare resources than the similar patients without MS in the general population. Infections account for a large proportion of MS-associated hospitalizations, from young adulthood onward. These findings are particularly significant in light of the increasing availability of disease modifying therapies with more potent immunosuppressive properties, as well as the accumulating data that systemic infection can drive MS relapses.