Clement N D, Aitken S, Duckworth A D, McQueen M M, Court-Brown C M
Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK.
J Bone Joint Surg Br. 2012 Feb;94(2):231-6. doi: 10.1302/0301-620X.94B2.27381.
We present the prevalence of multiple fractures in the elderly in a single catchment population of 780,000 treated over a 12-month period and describe the mechanisms of injury, common patterns of occurrence, management, and the associated mortality rate. A total of 2335 patients, aged ≥ 65 years of age, were prospectively assessed and of these 119 patients (5.1%) presented with multiple fractures. Distal radial (odds ratio (OR) 5.1, p < 0.0001), proximal humeral (OR 2.2, p < 0.0001) and pelvic (OR 4.9, p < 0.0001) fractures were associated with an increased risk of sustaining associated fractures. Only 4.5% of patients sustained multiple fractures after a simple fall, but due to the frequency of falls in the elderly this mechanism resulted in 80.7% of all multiple fractures. Most patients required admission (> 80%), of whom 42% did not need an operation but more than half needed an increased level of care before discharge (54%). The standardised mortality rate at one year was significantly greater after sustaining multiple fractures that included fractures of the pelvis, proximal humerus or proximal femur (p < 0.001). This mortality risk increased further if patients were < 80 years of age, indicating that the existence of multiple fractures after low-energy trauma is a marker of mortality.
我们呈现了在一个为期12个月、有78万人口接受治疗的单一集水区内老年人多处骨折的患病率，并描述了损伤机制、常见发生模式、治疗方法以及相关死亡率。共有2335名年龄≥65岁的患者接受了前瞻性评估，其中119名患者（5.1%）出现了多处骨折。桡骨远端骨折（优势比（OR）5.1，p<0.0001）、肱骨近端骨折（OR 2.2，p<0.0001）和骨盆骨折（OR 4.9，p<0.0001）与发生相关骨折的风险增加有关。仅有4.5%的患者在简单跌倒后发生多处骨折，但由于老年人跌倒频率较高，这种机制导致了所有多处骨折的80.7%。大多数患者需要住院治疗（>80%），其中42%的患者不需要手术，但超过一半的患者在出院前需要更高水平的护理（54%）。发生包括骨盆、肱骨近端或股骨近端骨折在内的多处骨折后，一年的标准化死亡率显著更高（p<0.001）。如果患者年龄<80岁，这种死亡风险会进一步增加，这表明低能量创伤后出现多处骨折是死亡率的一个标志。
