Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, UK.
Bone Joint J. 2013 Sep;95-B(9):1255-62. doi: 10.1302/0301-620X.95B9.31112.
We describe the outcome of tibial diaphyseal fractures in the elderly (≥ 65 years of age). We prospectively followed 233 fractures in 225 elderly patients over a minimum ten-year period. Demographic and descriptive data were acquired from a prospective trauma database. Mortality status was obtained from the General Register Office database for Scotland. Diaphyseal fractures of the tibia in the elderly occurred predominantly in women (73%) and after a fall (61%). During the study period the incidence of these fractures decreased, nearly halving in number. The 120-day and one-year unadjusted mortality rates were 17% and 27%, respectively, and were significantly greater in patients with an open fracture (p < 0.001). The overall standardised mortality ratio (SMR) was significantly increased (SMR 4.4, p < 0.001) relative to the population at risk, and was greatest for elderly women (SMR 8.1, p < 0.001). These frailer patients had more severe injuries, with an increased rate of open fractures (30%), and suffered a greater rate of nonunion (10%). Tibial diaphyseal fractures in the elderly are most common in women after a fall, are more likely to be open than in the rest of the population, and are associated with a high incidence of nonunion and mortality.
我们描述了老年人（≥65 岁）胫骨骨干骨折的结果。我们前瞻性随访了 225 名老年患者的 233 例骨折，随访时间至少为 10 年。人口统计学和描述性数据来自前瞻性创伤数据库。苏格兰总登记处数据库获得了死亡率状况。老年人胫骨骨干骨折主要发生在女性（73%）和跌倒后（61%）。在研究期间，这些骨折的发生率下降，几乎减少了一半。120 天和 1 年未调整的死亡率分别为 17%和 27%，开放性骨折患者的死亡率显著更高（p < 0.001）。总体标准化死亡率（SMR）显著增加（SMR 4.4，p < 0.001），与危险人群相比，这在老年女性中更为明显（SMR 8.1，p < 0.001）。这些更脆弱的患者受伤更严重，开放性骨折的发生率更高（30%），且不愈合的发生率更高（10%）。老年人胫骨骨干骨折最常见于女性跌倒后，比其他人群更可能是开放性骨折，并且与高发生率的不愈合和死亡率相关。
