RESUMEN
BACKGROUND: The purpose of the study was to evaluate the mortality of patients who received Resuscitative Endovascular Balloon Occlusion of The Aorta (REBOA) in severe pelvic fracture with hemorrhagic shock. METHODS: The American College of Surgeon Trauma Quality Improvement Program (ACS-TQIP) database for the calendar years 2017-2019 was accessed for the study. The study included all patients aged 15 years and older who sustained severe pelvic fractures, defined as an injury with an abbreviated injury scale (AIS) score of ≥ 3, and who presented with the lowest systolic blood pressure (SBP) of < 90 mmHg. Patients with severe brain injury were excluded from the study. Propensity score matching was used to compare the patients who received REBOA with similar characteristics to patients who did not receive REBOA. RESULTS: Out of 3,186 patients who qualified for the study, 35(1.1%) patients received REBOA for an ongoing hemorrhagic shock with severe pelvic fracture. The propensity matching created 35 pairs of patients. The pair-matched analysis showed no significant differences between the group who received REBOA and the group that did not receive REBOA regarding patients' demography, injury severity, severity of pelvic fractures, lowest blood pressure at initial assessment and laparotomies. There was no significant difference found between REBOA versus no REBOA group in overall in-hospital mortality (34.3% vs. 28.6, P = 0.789). CONCLUSION: Our study did not identify any mortality advantage in patients who received REBOA in hemorrhagic shock associated with severe pelvic fracture compared to a similar cohort of patients who did not receive REBOA. A larger sample size prospective study is needed to validate our results. CASE-CONTROL RETROSPECTIVE STUDY: Level of Evidence IV.
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Oclusión con Balón , Fracturas Óseas , Huesos Pélvicos , Puntaje de Propensión , Resucitación , Choque Hemorrágico , Humanos , Choque Hemorrágico/etiología , Choque Hemorrágico/terapia , Choque Hemorrágico/mortalidad , Oclusión con Balón/métodos , Masculino , Femenino , Adulto , Huesos Pélvicos/lesiones , Persona de Mediana Edad , Resucitación/métodos , Estudios Retrospectivos , Fracturas Óseas/complicaciones , Fracturas Óseas/terapia , Fracturas Óseas/mortalidad , Procedimientos Endovasculares/métodos , Aorta/lesiones , Puntaje de Gravedad del Traumatismo , Escala Resumida de TraumatismosRESUMEN
BACKGROUND: Studies have confirmed that osteoporosis has been considered as one of the complications of diabetes, and the health hazards to patients are more obvious. This study is mainly based on the Taiwan National Health Insurance Database (TNHID). Through the analysis of TNHID, it is shown that the combined treatment of traditional Chinese medicine (TCM) medicine in patients of diabetes with osteoporosis (T2DOP) with lower related risks. METHODS: According to the study design, 3131 patients selected from TNHID who received TCM treatment were matched by 1-fold propensity score according to gender, age, and inclusion date as the control group. Cox proportional hazards analyzes were performed to compare fracture surgery, hospitalization, and all-cause mortality during a mean follow-up from 2000 to 2015. RESULTS: A total of 1055/1469/715 subjects (16.85%/23.46%/11.42%) had fracture surgery/inpatient/all-cause mortality of which 433/624/318 (13.83%/19.93%/10.16%) were in the TCM group) and 622/845/397 (19.87%/26.99%/12.68%) in the control group. Cox proportional hazards regression analysis showed that subjects in the TCM group had lower rates of fracture surgery, inpatient and all-cause mortality (adjusted HR = 0.467; 95% CI = 0.225-0.680, P<0.001; adjusted HR = 0.556; 95% CI = 0.330-0.751, P<0.001; adjusted HR = 0.704; 95% CI = 0.476-0.923, P = 0.012). Kaplan-Meier analysis showed that the cumulative risk of fracture surgery, inpatient and all-cause mortality was significantly different between the case and control groups (all log-rank p<0.001). CONCLUSION: This study provides longitudinal evidence through a cohort study of the value of integrated TCM for T2DOP. More research is needed to fully understand the clinical significance of these results.
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Hospitalización , Medicina Tradicional China , Osteoporosis , Humanos , Femenino , Masculino , Osteoporosis/mortalidad , Osteoporosis/complicaciones , Anciano , Hospitalización/estadística & datos numéricos , Persona de Mediana Edad , Taiwán/epidemiología , Fracturas Óseas/mortalidad , Fracturas Óseas/cirugía , Modelos de Riesgos Proporcionales , Anciano de 80 o más AñosRESUMEN
Importance: A high proportion of patients who sustain a fracture have multimorbidity. However, the association of multimorbidity with postfracture adverse outcomes, such as subsequent fractures and premature mortality, has not been widely explored. Objective: To examine the association of multimorbidity and self-rated health with subsequent fractures and mortality after fracture. Design, Setting, and Participants: This prospective cohort study included participants from New South Wales, Australia, in the Sax Institute's 45 and Up Study (n = 267â¯357). Participants were recruited from July 2005 to December 2009 and followed up from the date of the incident fracture until subsequent fracture, death, or the end of the study (April 2017), whichever occurred first, with questionnaire data linked to hospital admission and medication records. Data analysis was reported between March and September 2023. Exposures: Charlson Comorbidity Index (CCI) score and self-rated health (SRH). Main Outcomes and Measures: The main outcomes were subsequent fracture or mortality after an incident fracture. Associations between SRH measures and subsequent fracture and mortality were also assessed. All analyses were stratified by sex given the different fracture and mortality risk profiles of females and males. Results: Of 25â¯280 adults who sustained incident fractures, 16â¯191 (64%) were female (mean [SD] age, 74 [12] years) and 9089 (36%) were male (mean [SD] age, 74 [13] years). During a median follow-up time of 2.8 years (IQR, 1.1-5.2 years), 2540 females (16%) and 1135 males (12%) sustained a subsequent fracture and 2281 females (14%) and 2140 males (24%) died without a subsequent fracture. Compared with a CCI score of less than 2, those with a CCI score of 2 to 3 had an increased risk of subsequent fracture (females: hazard ratio [HR], 1.16 [95% CI, 1.05-1.27]; males: HR, 1.25 [95% CI, 1.09-1.43]) and mortality (females: HR, 2.19 [95% CI, 1.99-2.40]; males: HR, 1.89 [95% CI, 1.71-2.09]). Those with a CCI score of 4 or greater had greater risks of subsequent fracture (females: HR, 1.33 [95% CI, 1.12-1.58]; males: HR, 1.48 [95% CI, 1.21-1.81]) and mortality (females: HR, 4.48 [95% CI, 3.97-5.06]; males: HR, 3.82 [95% CI 3.41-4.29]). Self-rated health was also significantly associated with subsequent fracture and mortality. Those reporting the poorest health and quality of life had the highest subsequent fracture risks, and their mortality risks were even higher. Conclusions and Relevance: In this cohort study, both CCI and SRH measures were associated with increased risk of subsequent fractures and mortality after fracture, underscoring the importance of managing the care of patients with comorbidities who sustain a fracture.
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Fracturas Óseas , Multimorbilidad , Humanos , Masculino , Femenino , Anciano , Estudios Prospectivos , Fracturas Óseas/epidemiología , Fracturas Óseas/mortalidad , Nueva Gales del Sur/epidemiología , Persona de Mediana Edad , Anciano de 80 o más AñosRESUMEN
INTRODUCTION: Osteosarcopenia is an age-related syndrome characterized by the coexistence of osteoporosis and sarcopenia. Little is known about the clinical implications of osteosarcopenia among patients undergoing hemodialysis. This study investigated the prevalence of osteosarcopenia and its association with all-cause mortality and fractures in this population. MATERIALS AND METHODS: This retrospective cohort study included outpatients undergoing hemodialysis in Japan. Sarcopenia was defined according to the recommendations of the Asian Working Group for Sarcopenia 2019. Osteoporosis was defined as a T-score of the calcaneus bone < - 2.5. We divided patients into three groups: robust (no osteoporosis or sarcopenia), osteoporosis or sarcopenia alone (osteoporosis without sarcopenia or sarcopenia without osteoporosis), and osteosarcopenia (osteoporosis and sarcopenia). Cox proportional-hazard and negative binomial regression models were used to estimate the associations between osteosarcopenia and all-cause mortality and fractures. RESULTS: Among the 328 patients (mean age, 65.5 ± 11.3 years; men, 59.1%), the prevalence of osteosarcopenia was 22.9%. During the follow-up period (1972 person-years), 131 deaths and 113 fractures occurred. Patients with osteoporosis or sarcopenia alone (hazard ratio 1.36; 95% confidence interval 0.85-2.18) and osteosarcopenia (hazard ratio 2.13; 95% confidence interval, 1.23-3.68) showed a higher risk of all-cause mortality than the robust group. Similar results were observed for the risk of fractures in patients with osteosarcopenia. CONCLUSIONS: Patients undergoing hemodialysis showed a high prevalence of osteosarcopenia, and osteosarcopenia was associated with a poor prognosis in this patient population. Assessing osteosarcopenia may be useful for accurate prognostic stratification of patients undergoing hemodialysis.
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Osteoporosis , Diálisis Renal , Sarcopenia , Humanos , Sarcopenia/mortalidad , Sarcopenia/epidemiología , Sarcopenia/complicaciones , Masculino , Femenino , Anciano , Prevalencia , Estudios Retrospectivos , Persona de Mediana Edad , Osteoporosis/mortalidad , Osteoporosis/complicaciones , Osteoporosis/epidemiología , Fracturas Óseas/mortalidad , Fracturas Óseas/epidemiología , Fracturas Óseas/complicaciones , Japón/epidemiologíaRESUMEN
Background: Fragility fracture is associated with an increased risk of mortality, but mortality is not part of doctor-patient communication. Here, we introduce a new concept called 'Skeletal Age' as the age of an individual's skeleton resulting from a fragility fracture to convey the combined risk of fracture and fracture-associated mortality for an individual. Methods: We used the Danish National Hospital Discharge Register which includes the whole-country data of 1,667,339 adults in Denmark born on or before January 1, 1950, who were followed up to December 31, 2016 for incident low-trauma fracture and mortality. Skeletal age is defined as the sum of chronological age and the number of years of life lost (YLL) associated with a fracture. Cox's proportional hazards model was employed to determine the hazard of mortality associated with a specific fracture for a given risk profile, and the hazard was then transformed into YLL using the Gompertz law of mortality. Results: During the median follow-up period of 16 years, there had been 307,870 fractures and 122,744 post-fracture deaths. A fracture was associated with between 1 and 7 years of life lost, with the loss being greater in men than women. Hip fractures incurred the greatest loss of life years. For instance, a 60-year-old individual with a hip fracture is estimated to have a skeletal age of 66 for men and 65 for women. Skeletal Age was estimated for each age and fracture site stratified by gender. Conclusions: We propose 'Skeletal Age' as a new metric to assess the impact of a fragility fracture on an individual's life expectancy. This approach will enhance doctor-patient risk communication about the risks associated with osteoporosis. Funding: National Health and Medical Research Council in Australia and Amgen Competitive Grant Program 2019.
Osteoporosis is a 'silent disease' which often has no immediate symptoms but gradually weakens bones and makes them more likely to break. A bone fracture caused by osteoporosis in people over the age of 50 is linked to long-term health decline and in some cases, even early death. However, poor communication of the mortality risk to patients has led to a low uptake of treatment, resulting in a crisis of osteoporosis management. The impact of a fracture on life expectancy is typically conveyed to patients and the public in terms of probability (how likely something is to occur) or the relative risk of death compared to other groups. However, statements such as "Your risk of death over the next 10 years is 5% if you have suffered from a bone fracture" can be difficult to comprehend and can lead to patients underestimating the gravity of the risk. With the aim of devising a new way of conveying risks to patients, Tran et al. analyzed the relationship between fracture and lifespan in over 1.6 million individuals who were 50 years of age or older. The findings showed that one fracture was associated with losing up to 7 years of life, depending on gender, age and fracture site. Based on this finding, Tran et al. proposed the idea of 'skeletal age' as a new metric for quantifying the impact of a fracture on life expectancy. Skeletal age is the sum of the chronological age of a patient and the estimated number of years of life lost following a fracture. For example, a 60-year-old man with a hip fracture is predicted to lose an estimated 6 years of life, resulting in a skeletal age of around 66. Therefore, this individual has the same life expectancy as a 66-year-old person that has not experienced a fracture. Skeletal age can also be used to quantify the benefit of osteoporosis treatments. Some approved treatments substantially reduce the likelihood of post-fracture death and translating this into skeletal age could help communicate this to patients. For instance, telling patients that "This treatment will reduce your skeletal age by 2 years" is easier to understand than "This treatment will reduce your risk of death by 25%". Given the current crisis of osteoporosis management, adopting skeletal age as a new measure of how the skeleton declines after a fracture could enhance doctor-patient communication regarding treatment options and fracture risk assessment. Tran et al. are now developing an online tool called 'BONEcheck.org' to enable health care professionals and the public to calculate skeletal age. Future work should investigate the effectiveness of this new metric in conveying risk to patients, compared with current methods.
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Determinación de la Edad por el Esqueleto , Fracturas Óseas , Esperanza de Vida , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoporosis , Fracturas Osteoporóticas/complicaciones , Fracturas Osteoporóticas/mortalidad , Modelos de Riesgos Proporcionales , Determinación de la Edad por el Esqueleto/métodos , Fracturas Óseas/complicaciones , Fracturas Óseas/epidemiología , Fracturas Óseas/mortalidad , Dinamarca/epidemiología , AncianoRESUMEN
BACKGROUND: Clinical guidelines recommend low-molecular-weight heparin for thromboprophylaxis in patients with fractures, but trials of its effectiveness as compared with aspirin are lacking. METHODS: In this pragmatic, multicenter, randomized, noninferiority trial, we enrolled patients 18 years of age or older who had a fracture of an extremity (anywhere from hip to midfoot or shoulder to wrist) that had been treated operatively or who had any pelvic or acetabular fracture. Patients were randomly assigned to receive low-molecular-weight heparin (enoxaparin) at a dose of 30 mg twice daily or aspirin at a dose of 81 mg twice daily while they were in the hospital. After hospital discharge, the patients continued to receive thromboprophylaxis according to the clinical protocols of each hospital. The primary outcome was death from any cause at 90 days. Secondary outcomes were nonfatal pulmonary embolism, deep-vein thrombosis, and bleeding complications. RESULTS: A total of 12,211 patients were randomly assigned to receive aspirin (6101 patients) or low-molecular-weight heparin (6110 patients). Patients had a mean (±SD) age of 44.6±17.8 years, 0.7% had a history of venous thromboembolism, and 2.5% had a history of cancer. Patients received a mean of 8.8±10.6 in-hospital thromboprophylaxis doses and were prescribed a median 21-day supply of thromboprophylaxis at discharge. Death occurred in 47 patients (0.78%) in the aspirin group and in 45 patients (0.73%) in the low-molecular-weight-heparin group (difference, 0.05 percentage points; 96.2% confidence interval, -0.27 to 0.38; P<0.001 for a noninferiority margin of 0.75 percentage points). Deep-vein thrombosis occurred in 2.51% of patients in the aspirin group and 1.71% in the low-molecular-weight-heparin group (difference, 0.80 percentage points; 95% CI, 0.28 to 1.31). The incidence of pulmonary embolism (1.49% in each group), bleeding complications, and other serious adverse events were similar in the two groups. CONCLUSIONS: In patients with extremity fractures that had been treated operatively or with any pelvic or acetabular fracture, thromboprophylaxis with aspirin was noninferior to low-molecular-weight heparin in preventing death and was associated with low incidences of deep-vein thrombosis and pulmonary embolism and low 90-day mortality. (Funded by the Patient-Centered Outcomes Research Institute; PREVENT CLOT ClinicalTrials.gov number, NCT02984384.).
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Anticoagulantes , Aspirina , Quimioprevención , Fracturas Óseas , Heparina de Bajo-Peso-Molecular , Adulto , Humanos , Persona de Mediana Edad , Anticoagulantes/efectos adversos , Anticoagulantes/uso terapéutico , Aspirina/efectos adversos , Aspirina/uso terapéutico , Quimioprevención/métodos , Extremidades/lesiones , Fracturas Óseas/complicaciones , Fracturas Óseas/mortalidad , Hemorragia/etiología , Heparina de Bajo-Peso-Molecular/efectos adversos , Heparina de Bajo-Peso-Molecular/uso terapéutico , Fracturas de Cadera/complicaciones , Fracturas de Cadera/mortalidad , Huesos Pélvicos/lesiones , Ensayos Clínicos Pragmáticos como Asunto , Embolia Pulmonar/etiología , Embolia Pulmonar/prevención & control , Fracturas de la Columna Vertebral/complicaciones , Fracturas de la Columna Vertebral/mortalidad , Tromboembolia Venosa/etiología , Tromboembolia Venosa/prevención & control , Tromboembolia Venosa/tratamiento farmacológico , Trombosis de la Vena/etiología , Trombosis de la Vena/prevención & controlAsunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Embolia Pulmonar/tratamiento farmacológico , Aspirina/efectos adversos , Aspirina/uso terapéutico , Heparina de Bajo-Peso-Molecular/efectos adversos , Heparina de Bajo-Peso-Molecular/uso terapéutico , Fracturas Óseas/complicaciones , Fracturas Óseas/mortalidad , Pelvis/lesiones , Embolia Pulmonar/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto , Extremidades/lesiones , Tromboembolia Venosa/prevención & control , Tromboembolia Venosa/tratamiento farmacológico , Fracturas de Cadera/complicaciones , Fracturas de Cadera/mortalidadRESUMEN
In order to determine the main anatomopathological findings of Testudines necropsied in the Distrito Federal, all necropsy records performed at the "Laboratório de Patologia Veterinária" of the "Universidade de Brasília" (LPV-UnB) on Testudines during the period from January 2008 to July 2020 were reviewed. The 72 cases reviewed were grouped and classified according to species, sex, origin, season of occurrence, and diagnosis. In 69.44% of the cases the species was informed in the necropsy protocols, which included Phrynops geoffroanus (38%), Trachemys dorbigni (36%), Chelonoidis carbonaria (14%), Chelonoidis denticulata (10%) and Podocnemis expansa (2%). In 30.55% of the cases this parameter was not informed and were classified only as Testudines. In 41.66% of the cases the sex was informed, being female 22.22%, male 19.44%, and 58.33% were not informed. Of these animals 79.16% were from environmental agencies and 20.84% from zoos and/or guardians. In 70.83% of the animals analyzed they were directly related to the autumn and winter seasons, with June being the most frequent month (29.17%). The conclusive diagnosis was possible in 68.05% of the cases. The category of disorders caused by injurious agents (48.97%) was the most prevalent, followed by inflammatory disorders (32.65%) and nutritional and metabolic disorders (28.57%). The main diagnoses were carapace and/or plastron fracture with 30.61%, hepatic steatosis (20.40%) and pneumonia (10.22%). Most cases of carapace or plastron fracture and hepatic steatosis occurred in animals from environmental agencies.(AU)
Com o objetivo de determinar os principais achados anatomopatológicos de Testudines necropsiados no Distrito Federal, foram revisadas todas as fichas de necropsia realizadas no Laboratório de Patologia Veterinária da Universidade de Brasília (LPV-UnB) em Testudines, durante o período de janeiro de 2008 a julho de 2020. Os 72 casos revisados foram agrupados e classificados quanto à espécie, sexo, procedência, estação do ano de ocorrência e diagnóstico. Em 69,44% dos casos havia a espécie informada nos protocolos de necropsia, que incluíam Phrynops geoffroanus (38%), Trachemys dorbigni (36%), Chelonoidis carbonaria (14%), Chelonoidis denticulata (10%) e Podocnemis expansa (2%). Em 30,55% dos casos não tiveram esse parâmetro informado e foram classificados apenas como Testudines. Em 41,66% casos foi informado o sexo, sendo fêmea 22,22%, macho 19,44% e não informados 58,33%. Destes animais 79,16% eram de órgão ambiental e 20,84% de zoológicos e ou tutores. Em 70,83% dos animais analisados tiveram direta relação com as estações de outono e inverno, sendo o mês de junho o mais frequente (29,17%). O diagnóstico conclusivo foi possível em 68,05% dos casos. A categoria de distúrbios causados por agentes lesivos (48,97%) foi a mais prevalente, seguido por distúrbios inflamatórios (32,65%) e dos distúrbios nutricionais e metabólicos (28,57%). Os principais diagnósticos foram fratura de carapaça e ou plastrão com 30,61%, esteatose hepática (20,40%) e pneumonia (10,22%). A maior parte dos casos de fratura de carapaça ou plastrão e de esteatose hepática ocorreram em animais provenientes de órgão ambiental.(AU)
Asunto(s)
Animales , Neumonía/mortalidad , Tortugas/anatomía & histología , Tortugas/lesiones , Fracturas Óseas/mortalidad , Hígado Graso/mortalidad , Autopsia/veterinariaRESUMEN
In order to determine the main anatomopathological findings of Testudines necropsied in the Distrito Federal, all necropsy records performed at the "Laboratório de Patologia Veterinária" of the "Universidade de Brasília" (LPV-UnB) on Testudines during the period from January 2008 to July 2020 were reviewed. The 72 cases reviewed were grouped and classified according to species, sex, origin, season of occurrence, and diagnosis. In 69.44% of the cases the species was informed in the necropsy protocols, which included Phrynops geoffroanus (38%), Trachemys dorbigni (36%), Chelonoidis carbonaria (14%), Chelonoidis denticulata (10%) and Podocnemis expansa (2%). In 30.55% of the cases this parameter was not informed and were classified only as Testudines. In 41.66% of the cases the sex was informed, being female 22.22%, male 19.44%, and 58.33% were not informed. Of these animals 79.16% were from environmental agencies and 20.84% from zoos and/or guardians. In 70.83% of the animals analyzed they were directly related to the autumn and winter seasons, with June being the most frequent month (29.17%). The conclusive diagnosis was possible in 68.05% of the cases. The category of disorders caused by injurious agents (48.97%) was the most prevalent, followed by inflammatory disorders (32.65%) and nutritional and metabolic disorders (28.57%). The main diagnoses were carapace and/or plastron fracture with 30.61%, hepatic steatosis (20.40%) and pneumonia (10.22%). Most cases of carapace or plastron fracture and hepatic steatosis occurred in animals from environmental agencies.
Com o objetivo de determinar os principais achados anatomopatológicos de Testudines necropsiados no Distrito Federal, foram revisadas todas as fichas de necropsia realizadas no Laboratório de Patologia Veterinária da Universidade de Brasília (LPV-UnB) em Testudines, durante o período de janeiro de 2008 a julho de 2020. Os 72 casos revisados foram agrupados e classificados quanto à espécie, sexo, procedência, estação do ano de ocorrência e diagnóstico. Em 69,44% dos casos havia a espécie informada nos protocolos de necropsia, que incluíam Phrynops geoffroanus (38%), Trachemys dorbigni (36%), Chelonoidis carbonaria (14%), Chelonoidis denticulata (10%) e Podocnemis expansa (2%). Em 30,55% dos casos não tiveram esse parâmetro informado e foram classificados apenas como Testudines. Em 41,66% casos foi informado o sexo, sendo fêmea 22,22%, macho 19,44% e não informados 58,33%. Destes animais 79,16% eram de órgão ambiental e 20,84% de zoológicos e ou tutores. Em 70,83% dos animais analisados tiveram direta relação com as estações de outono e inverno, sendo o mês de junho o mais frequente (29,17%). O diagnóstico conclusivo foi possível em 68,05% dos casos. A categoria de distúrbios causados por agentes lesivos (48,97%) foi a mais prevalente, seguido por distúrbios inflamatórios (32,65%) e dos distúrbios nutricionais e metabólicos (28,57%). Os principais diagnósticos foram fratura de carapaça e ou plastrão com 30,61%, esteatose hepática (20,40%) e pneumonia (10,22%). A maior parte dos casos de fratura de carapaça ou plastrão e de esteatose hepática ocorreram em animais provenientes de órgão ambiental.
Asunto(s)
Animales , Fracturas Óseas/mortalidad , Hígado Graso/mortalidad , Neumonía/mortalidad , Tortugas/anatomía & histología , Tortugas/lesiones , Autopsia/veterinariaRESUMEN
BACKGROUND: Road Traffic crash injury is one of the main public health problems resulting in premature death and disability particularly in low-income countries. However, there is limited evidence on the crash fractures in Ethiopia. OBJECTIVE: The study was conducted to assess the magnitude of road traffic crash fractures and visceral injuries. METHODS: A hospital-based cross-sectional study was conducted on 420 fracture patients. Participants were randomly selected from Addis Ababa City hospitals. The study was carried out between November 2019 and February 2020. Data were collected using a questionnaire and record of medical findings. Multilevel logistic regression analysis was carried out. Ethical clearance was obtained from the Addis Ababa University, College of Health Sciences Institutional Review Board. Confidentiality of participants' information was maintained. RESULTS: The study found out that the majority 265 (63. 1%) of fracture cases were younger in the age group of 18 to 34 years. Males were more affected-311(74.0%). The mortality rate was 59(14.1%), of those 50(85.0%) participants were males. The major road traffic victims were pedestrians-220(52.4%), mainly affected by simple fracture type -105(53.3%) and compound fracture type-92(46. 7%). Drivers mainly suffered from compound fracture type -23 (59.0%). One hundred eighty-two (43.3%) of fracture patients had a visceral injury. Homeless persons who sit or sleep on the roadside had a higher risk of thoracic visceral injury compared to traveler pedestrians (AOR = 4.600(95%CI: 1.215-17.417)); P = 0.025. CONCLUSION: Visceral injury, simple and compound fractures were the common orthopedic injury types reported among crash victims. Males, pedestrians, and young age groups were largely affected by orthopedic fracture cases. Homeless persons who sited or slept on the roadside were significant factors for visceral injury. Therefore, preventing a harmful crash and growing fracture care should be considered to reduce the burden of crash fracture.
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Traumatismos Abdominales/epidemiología , Accidentes de Tránsito/estadística & datos numéricos , Fracturas Óseas/epidemiología , Personas con Mala Vivienda/estadística & datos numéricos , Traumatismos Abdominales/mortalidad , Accidentes de Tránsito/mortalidad , Adulto , Estudios Transversales , Etiopía/epidemiología , Femenino , Fracturas Óseas/mortalidad , Humanos , Masculino , Análisis Multinivel , Pobreza , Caracteres Sexuales , Adulto JovenRESUMEN
Background and purpose - Few studies have reported the mortality rate after skeletal fractures involving different locations, within the same population. We analyzed the 30-day and 1-year mortality rates following different fractures.Patients and methods - We included 295,713 fractures encountered in patients 16-108 years of age, registered in the Swedish Fracture Register (SFR) from 2012 to 2018. Mortality rates were obtained by linkage of the SFR to the Swedish Tax Agency population register. The standardized mortality ratios (SMR) at 30 days and 1 year were calculated for fractures in any location and for each of 27 fracture locations, using age- and sex-life tables from Statistics Sweden (www.scb.se).Results - The overall SMR at 30 days was 6.8 (95% CI 6.7-7.0) and at 1 year 2.2 (CI 2.2-2.2). The SMR was > 2 for 19/27 and 13/27 of the fracture locations at 30 days and 1 year, respectively. Humerus, femur, and tibial diaphysis fractures were all associated with high SMR, at both 30 days and 1 year.Interpretation - Patients sustaining a fracture had approximately a 7-fold increased mortality at 30 days and over 2-fold increased mortality at 1 year as compared with what would be expected in the general population. High mortality rates were seen for patients with axial skeletal and proximal extremity fractures, indicating frailty in these patient groups.
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Fracturas Óseas/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/mortalidad , Sistema de Registros , Suecia , Factores de Tiempo , Adulto JovenRESUMEN
BACKGROUND: Medial clavicle fractures are uncommon, occurring in older and multiply injured patients. The management of these fractures and the factors that predispose toward poor outcomes are controversial. Furthermore, the functional outcomes of treatment are not well characterized or correlated with fracture patterns. QUESTIONS/PURPOSES: (1) To determine minimum 1-year functional outcomes using QuickDASH scores and pain scores after medial clavicle fractures and (2) to identify factors associated with these outcome variables. METHODS: In an institutional review board-approved, retrospective study, we identified adult patients with medial clavicle fractures at two tertiary care referral centers in a single metropolitan area in the United States from January 2010 to March 2019. Our initial query identified 1950 patients with clavicle fractures, from which 74 adult patients with medial clavicle fractures and at least 1 year of follow-up were identified. We attempted to contact these eligible patients by telephone for functional outcomes and pain scores. Twenty-six patients were deceased according to the most recent Social Security Death Index data and public obituaries, three declined participation, and 14 could not be reached, leaving 42% of the total (31 of 74) and 65% (31 of 48) of living patients included in the analysis. Demographic characteristics, fracture characteristics, and clinical and radiographic union as assessed by plain radiography and CT were collected through record review. Twenty-nine patients were treated nonoperatively and two patients underwent open reduction internal fixation. Sixty-eight percent (21 of 31) of the included patients also had radiographic follow-up at least 6 weeks postoperatively; two patients had persistent nonunion at a mean of 5 ± 3 years after injury. Our primary response variable was the QuickDASH score at a minimum of 1 year (median [range] 5 years [2 to 10]). Our secondary response variable was the pain score on a 10-point Likert scale. A bivariate analysis was performed to identify factors associated with these response variables. The following explanatory variables were studied: age, gender, race, dominant hand injury, employment status, manual labor occupation, primary health insurance, social deprivation, BMI, diabetes mellitus, smoking status, American Society of Anesthesiologists physical status classification, Charlson Comorbidity Index, nonisolated injury, high-energy mechanism of injury, nondisplaced fracture, fracture comminution, superior-inferior fracture displacement, medial-lateral fracture shortening, and surgical treatment of the medial clavicle fracture. RESULTS: The mean QuickDASH score was 12 ± 15, and the mean pain score was 1 ± 1 at a mean of 5 ± 3 years after injury. The mortality rate of the cohort was 15% (11 of 74) at 1 year, 22% (16 of 74) at 3 years, and 34% (25 of 74) at 5 years after injury. With the numbers available, no factors were associated with the QuickDASH score or pain score, but it is likely we were underpowered to detect potentially important differences. CONCLUSION: Medial clavicle fractures have favorable functional outcomes and pain relief at minimum 1-year follow-up among those patients who survive the trauma, but a high proportion will die within 3 years of the injury. This likely reflects both the frailty of a predominantly older patient population and the fact that these often are high-energy injuries. The outcome measures in our cohort were not associated with fracture displacement, shortening, or comminution; however, our sample size was underpowered on these points, and so these findings should be considered preliminary. Further studies are needed to determine the subset of patients with this injury who would benefit from surgical intervention. LEVEL OF EVIDENCE: Level IV, therapeutic study.
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Clavícula/lesiones , Evaluación de la Discapacidad , Fracturas Óseas/terapia , Dimensión del Dolor/estadística & datos numéricos , Fracturas del Hombro/terapia , Anciano , Anciano de 80 o más Años , Tratamiento Conservador/mortalidad , Tratamiento Conservador/estadística & datos numéricos , Femenino , Fracturas Óseas/mortalidad , Estado Funcional , Humanos , Masculino , Persona de Mediana Edad , Reducción Abierta/mortalidad , Reducción Abierta/estadística & datos numéricos , Recuperación de la Función , Estudios Retrospectivos , Fracturas del Hombro/mortalidad , Resultado del TratamientoRESUMEN
AIM: Bone fragility is increasingly recognized as a relevant complication of type 2 diabetes (T2D) and diabetic patients with fragility fractures have higher mortality rates than non diabetic individuals or diabetic patients without fractures. However, current diagnostic approaches for fracture risk stratification, such as bone mineral density measurement or the use of risk assessment algorithms, largely underestimate fracture risk in T2D patients. A multidisciplinary expert panel was established in order to in order to formulate clinical consensus recommendations on bone health assessment and management of fracture risk in patients with T2D. DATA SYNTHESIS: The following key questions were addressed: a) which are the risk factors for bone fragility in T2D?, b) which diagnostic procedures can be currently used to stratify fracture risk in T2D patients?, c) which are the effects of antidiabetic treatments on bone?, and d) how to prevent and treat bone fragility in T2D patients? Based on the available data members of this panel suggest that the stratification of fracture risk in patients with diabetes should firstly rely on the presence of a previous fragility fracture and on the individual risk profile, with the inclusion of T2D-specific risk factors (namely T2D duration above 10 yrs, presence of chronic T2D complications, use of insulin or thiazolidinediones and persistent HbA1c levels above 8% for at least 1 year). Two independent diagnostic approaches were then suggested in the presence or the absence of a prevalent fragility fracture, respectively. CONCLUSIONS: Clinical trials in T2D patients at risk for fragility fractures are needed to determine the efficacy and safety of available antiresorptive and anabolic agents in this specific setting.
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Conservadores de la Densidad Ósea/uso terapéutico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Fracturas Óseas/prevención & control , Hipoglucemiantes/uso terapéutico , Osteoporosis/tratamiento farmacológico , Conservadores de la Densidad Ósea/efectos adversos , Consenso , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidad , Medicina Basada en la Evidencia , Fracturas Óseas/diagnóstico , Fracturas Óseas/etiología , Fracturas Óseas/mortalidad , Humanos , Hipoglucemiantes/efectos adversos , Osteoporosis/diagnóstico , Osteoporosis/etiología , Osteoporosis/mortalidad , Factores Protectores , Medición de Riesgo , Factores de Riesgo , Resultado del TratamientoRESUMEN
In the pandemic disease caused by SARS-CoV-2 virus, trauma surgery continued the management of patients with fractures. The purpose of the study is to evaluate mortality and morbidity in orthopedic trauma patients surgically treated with a diagnosis of COVID-19 infection, comparing them to a control group of COVID-19 negative. We retrospectively identified patients admitted to our Emergency Room from March 8th to May 4th 2020 (time frame corresponding to the first wave of the pandemic peak, one of the most severe in the world at that time) with a diagnosis of fracture that were subsequently surgically treated. We applied a dedicated pathway for the management of COVID-19 trauma patients allowed to perform an early surgery and short hospitalization. For each patient included demographics, clinical, laboratory, radiological data and type of treatment for COVID-19 infection were collected. Sixty-five (65) patients were identified. Of those, 17 (6 women and 11 men, mean age 63.41 years old, mean ASA grade 2.35) were COVID-19 positive (study group), while the others were control group (mean age 56.58 years old, mean ASA grade 2.21). In the study group, the preoperative laboratory tests showed leukocytosis in six and lymphopenia in 15 cases. Fourteen patients had a high level of C-reactive protein. Fifteen patients had an abnormal level of D-dimer. The mortality recorded was 5.8% and 4.1% in the study and control group respectively. Perioperative adverse events were registered in 5 cases (29.4%) in the study group and in 8 (16.6%) in the control group (p>0.05). Dedicated COVID-19 trauma pathway with the aim of an early surgery could be key for a better result in terms of mortality and morbidity. Age and ASA grade could represent independent risk factors for perioperative complications.
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COVID-19/complicaciones , Servicio de Urgencia en Hospital/estadística & datos numéricos , Fracturas Óseas/cirugía , Complicaciones Posoperatorias/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Proteína C-Reactiva/análisis , Estudios de Casos y Controles , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Fracturas Óseas/mortalidad , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , SARS-CoV-2/aislamiento & purificación , Factores de TiempoRESUMEN
BACKGROUND: Embolization is widely used for controlling arterial hemorrhage associated with pelvic fracture. However, the effect of a delay in embolization among hemodynamically stable patients at hospital arrival with a pelvic fracture is unknown. Therefore, our aim was to investigate the association between the time to embolization and mortality in hemodynamically stable patients at hospital arrival with a pelvic fracture. METHODS: A multicenter, retrospective cohort study was undertaken using data from the Japan Trauma Data Bank between 2004 and 2018. Hemodynamically, stable patients with a pelvic fracture who underwent an embolization within 3 h were divided into six groups of 30-min blocks of time until pelvic embolization (0-30, 30-60, 60-90, 90-120, 120-150, and 150-180 min). We compared the adjusted 30-day mortality rate according to time to embolization. RESULTS: We studied 620 hemodynamically stable patients with a pelvic fracture who underwent pelvic embolization within 3 h of hemorrhage. The median age was 68 (48-79) years and 55% were male. The median injury severity score was 26 (18-38). Thirty-day mortality was 8.9% (55/620) and 24-h mortality was 4.2% (26/619). A Cochran-Armitage test showed that a 30-min delay for embolization was associated with increased 30-day (p = 0.0186) and 24-hour (p = 0.033) mortality. Mortality within 0-30 min to embolization was 0%. The adjusted 30-day mortality rate increased with delayed embolization and was up to 17.0% (10.2-23.9) for the 150-180 min group. CONCLUSION: Delayed embolization was associated with increased mortality in pelvic fracture with hemodynamic stability at hospital arrival. When you decide to embolize pelvic fracture patients, the earlier embolization may be desirable to promote improved survival regardless of hemodynamics.
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Embolización Terapéutica/métodos , Fracturas Óseas/mortalidad , Hemorragia/mortalidad , Hemorragia/terapia , Huesos Pélvicos/lesiones , Tiempo de Tratamiento , Anciano , Hemodinámica , Humanos , Puntaje de Gravedad del Traumatismo , Japón , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND: Geriatric acetabular fractures are becoming more common due to demographic changes. Compared with proximal femoral fractures, surgical treatment is more complex and often does not allow full-weight-bearing. The aims of this study were to compare operatively treated acetabular and proximal femoral fractures with regard to (1) cumulative 1-year mortality, (2) perioperative complications, and (3) predictive factors associated with a higher 1-year mortality. METHODS: This institutional review board-approved comparative study included 486 consecutive surgically treated elderly patients (136 acetabular and 350 proximal femoral fractures). After matching, 2 comparable groups of 129 acetabular and 129 proximal femoral fractures were analyzed. Cumulative 1-year mortality was evaluated through Kaplan-Meier survivorship analysis, and perioperative complications were documented and graded. After confirming that the proportionality assumption was met, Cox proportional hazard modeling was conducted to identify factors associated with increased 1-year mortality. RESULTS: The acetabular fracture group had a significantly lower cumulative 1-year mortality before matching (18% compared with 33% for proximal femoral fractures, log-rank p = 0.001) and after matching (18% compared with 36%, log-rank p = 0.005). Nevertheless, it had a significantly higher overall perioperative complication rate (68% compared with 48%, p < 0.001). In our multivariable Cox regression analysis, older age, perioperative blood loss of >1 L, and wheelchair mobilization were associated with lower survival rates after acetabular fracture surgery. Older age and a higher 5-item modified frailty index were associated with a higher 1-year mortality rate after proximal femoral fractures, whereas postoperative full weight-bearing was protective. CONCLUSIONS: Despite the complexity of operative treatment and a higher complication rate after acetabular fractures in the elderly, the 1-year mortality rate is lower than that after operative treatment of proximal femoral fractures, even after adjustment for comorbidities. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Acetábulo , Fijación Interna de Fracturas , Fracturas Óseas , Fracturas de Cadera , Acetábulo/lesiones , Acetábulo/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/mortalidad , Fracturas Óseas/mortalidad , Fracturas Óseas/cirugía , Fracturas de Cadera/mortalidad , Fracturas de Cadera/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
This study sought to redefine the concept of fracture risk that includes refracture and mortality, and to transform the risk into "skeletal age". We analysed data obtained from 3521 women and men aged 60 years and older, whose fracture incidence, mortality, and bone mineral density (BMD) have been monitored since 1989. During the 20-year follow-up period, among 632 women and 184 men with a first incident fracture, the risk of sustaining a second fracture was higher in women (36%) than in men (22%), but mortality risk was higher in men (41%) than in women (25%). The increased risk of mortality was not only present with an initial fracture, but was accelerated with refractures. Key predictors of post-fracture mortality were male gender (hazard ratio [HR] 2.4; 95% CI, 1.79-3.21), advancing age (HR 1.67; 1.53-1.83), and lower femoral neck BMD (HR 1.16; 1.01-1.33). A 70-year-old man with a fracture is predicted to have a skeletal age of 75. These results were incorporated into a prediction model to aid patient-doctor discussion about fracture vulnerability and treatment decisions.
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Fracturas Óseas/epidemiología , Factores de Riesgo , Anciano , Anciano de 80 o más Años , Densidad Ósea , Femenino , Fracturas Óseas/mortalidad , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Nueva Gales del Sur/epidemiología , Modelos de Riesgos Proporcionales , Medición de RiesgoRESUMEN
BACKGROUND: Pelvic hemorrhage is potentially lethal despite homeostatic interventions such as pre-peritoneal packing (PP), resuscitative endovascular balloon occlusion of the aorta (REBOA), surgery, and/or angioembolization. REBOA may be used as an alternative/adjunct to PP for temporizing bleeding in patients with pelvic fractures. Our study aimed to compare the outcomes of REBOA and/or PP, as temporizing measures, in blunt pelvic fracture patients. We hypothesized that REBOA is associated with worsened outcomes. STUDY DESIGN: We performed a 2017 review of the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) and identified trauma patients with blunt pelvic fractures who underwent REBOA placement and/or PP before laparotomy and/or angioembolization. Propensity score matching was performed, adjusting for demographics, vitals, mechanism of injury, ISS, each body region-AIS, and pelvic fracture type. Outcomes were complication rates and mortality. RESULTS: A total of 156 patients (PP: 52; REBOA: 52; REBOA+PP: 52) were matched and included. Mean age was 43 ± 18 years, Injury Severity Score (ISS) was 28 (range 17-32), and 74% were males. Overall mortality was 42%. The 24-hour mortality (25% vs 14% vs 35%; p = 0.042), in-hospital mortality (44% vs 29% vs 54%; p = 0.034), and 4-hour pRBC units transfused (15 [9-23] vs 10 [4-19] vs 16 [9-27]; p = 0.017) were lower in the REBOA group. The REBOA group had faster times to both laparotomy (p = 0.040) and/or angioembolization (p = 0.012). There was no difference between the groups in acute kidney injury, lower limb amputations, or hospital and ICU length of stay among survivors. CONCLUSIONS: REBOA is a less invasive procedure compared with PP and is associated with improved outcomes. Further clinical trials are needed to define the optimal patient who will benefit from REBOA.
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Oclusión con Balón/métodos , Fracturas Óseas/terapia , Hemorragia/terapia , Técnicas Hemostáticas , Huesos Pélvicos/lesiones , Resucitación/métodos , Adulto , Aorta , Femenino , Fracturas Óseas/complicaciones , Fracturas Óseas/mortalidad , Hemorragia/etiología , Hemorragia/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Resucitación/mortalidad , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
INTRODUCTION: In trauma patients with pelvic fractures, computed tomography (CT) scans are a critical tool to evaluate life-threatening hemorrhage. Contrast extravasation, or "blush", on CT may be a sign of bleeding, prompting a consult for angiography and possible embolization. However, the utility of blush on CT is controversial. We sought to evaluate our experience with patients who sustained pelvic fractures and had blush on CT. METHOD: A retrospective review was performed for all patients with blunt pelvic fractures between January 1, 2017 and December 31, 2018. Demographic, clinical, radiographic, and injury data were obtained. Comparison of mortality, hospital length of stay (LOS), and intensive care unit (ICU) LOS was performed for 3 subgroups: angio versus no angio; embo versus no embo; prophylactic embo versus therapeutic embo. We also calculated the sensitivity, specify, positive predictive value (PPV), and negative predictive value (NPV) of CT blush to predict the need for embolization. RESULTS: 889 patients were found to have a blunt pelvic fracture. 51 patients had blush on CT scan. 29 (56.9%) underwent angiography. 17 (58.6%) of these 29 patients were found to have extravasation and were embolized. 12 patients had an angio with no extravasation, and 6 of these patients (50%) underwent prophylactic embolization. No significant difference was found for hospital LOS, ICU LOS, or mortality in our 3 groups. Sensitivity, specificity, PPV, and NPV for CT blush were 74%, 96%, 33%, 99%, respectively. CONCLUSION: Patients with active extravasation undergoing embolization had similar outcomes to patients without active extravasation. Blush on CT scan had low sensitivity and low PPV but high specificity and high NPV. Future studies need to include careful attention to the CT protocol utilized as well as patient selection.
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Embolización Terapéutica , Extravasación de Materiales Terapéuticos y Diagnósticos , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/terapia , Huesos Pélvicos/lesiones , Tomografía Computarizada por Rayos X , Adulto , Anciano , Medios de Contraste , Femenino , Fracturas Óseas/mortalidad , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
AIMS: Acetabular fractures in older adults lead to a high risk of mortality and morbidity. However, only limited data have been published documenting functional outcomes in such patients. The aims of this study were to describe outcomes in patients aged 60 years and older with operatively managed acetabular fractures, and to establish predictors of conversion to total hip arthroplasty (THA). METHODS: We conducted a retrospective, registry-based study of 80 patients aged 60 years and older with acetabular fractures treated surgically at The Alfred and Royal Melbourne Hospital. We reviewed charts and radiological investigations and performed patient interviews/examinations and functional outcome scoring. Data were provided by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Survival analysis was used to describe conversion to THA in the group of patients who initially underwent open reduction and internal fixation (ORIF). Multivariate regression analyses were performed to identify factors associated with conversion to THA. RESULTS: Seven patients (8.8%) had died at a median follow-up of 18 months (interquartile range (IQR) 12 to 25), of whom four were in the acute THA group. Eight patients (10%) underwent acute THA. Of the patients who underwent ORIF, 17/72 (23.6%) required conversion to THA at a median of 10.5 months (IQR 4.0 to 32.0) . After controlling for other factors, transport-related cases had an 88% lower rate of conversion to THA (hazard ratio (HR) 0.12, 95% confidence interval (CI) 0.02 to 0.91). Mean standardized Physical Component Summary Score (PCS-12) of the 12-Item Short Form Health Survey (SF-12) was comparable with the general population (age-/sex-matched) by 12 to 24 months. Over half of patients working prior to injury (14/26) returned to work by six months and two-thirds of patients (19/27) by 12 months. CONCLUSION: Patients over 60 years of age managed operatively for displaced acetabular fractures had a relatively high mortality rate and a high conversion rate to THA in the ORIF group but, overall, patients who survived had mean PCS-12 scores that improved over two years and were comparable with controls. Cite this article: Bone Joint J 2020;102-B(12):1735-1742.