Hinds Richard M, Capo John T, Kakar Sanjeev, Roberson James, Gottschalk Michael B
Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA.
Department of Orthopedics, Mayo Clinic, Rochester, MN, USA.
Geriatr Orthop Surg Rehabil. 2017 Mar;8(1):30-33. doi: 10.1177/2151458516681636. Epub 2016 Dec 14.
Distal radius fractures (DRFs) are common geriatric fractures with the overall incidence expected to increase as the population continues to age. The purpose of this investigation was to compare the short-term complication rates in geriatric versus nongeriatric cohorts following osteosynthesis of DRFs.
The American Board of Orthopaedic Surgery (ABOS) part II database was queried for adult DRF cases performed from 2007 to 2013. Current Procedural Terminology codes were used to identify cases treated via osteosynthesis. Patient demographic information and reported complication data were analyzed. Comparisons between geriatric (age ≥65 years) and nongeriatric (age <65 years) patients were performed.
From 2007 to 2013, a total of 9867 adult DRFs were treated via osteosynthesis by ABOS part II candidates. Geriatric patients comprised 28% of the study cohort. Mean age of the geriatric and nongeriatric cohorts was 74 ± 7 and 46 ± 13 years, respectively. There was a greater proportion of female patients ( < .001) in the geriatric cohort as compared with the nongeriatric cohort. The geriatric cohort demonstrated higher rates of anesthetic complications ( = .021), iatrogenic bone fracture ( = .021), implant failure ( = .031), loss of reduction ( = .001), unspecified medical complications ( = .007), and death ( = .017) than the nongeriatric cohort. The geriatric cohort also showed lower rates of nerve palsy ( = .028) when compared with the nongeriatric cohort, though no differences in rates of secondary surgery were noted between the two cohorts.
Increased rates of complications related to poor bone quality and poor health status may be expected among geriatric patients following osteosynthesis of DRFs. However, geriatric and nongeriatric patients have similarly low rates of secondary surgery. Future studies are needed to delineate the economic, functional, and societal impact of geriatric DRFs treated via osteosynthesis.
桡骨远端骨折(DRF)是常见的老年骨折,随着人口持续老龄化,其总体发病率预计会上升。本研究的目的是比较老年与非老年人群桡骨远端骨折切开复位内固定术后的短期并发症发生率。
查询美国骨科医师学会(ABOS)第二部分数据库中2007年至2013年的成人桡骨远端骨折病例。使用当前手术操作术语代码识别通过切开复位内固定治疗的病例。分析患者人口统计学信息和报告的并发症数据。对老年(年龄≥65岁)和非老年(年龄<65岁)患者进行比较。
2007年至2013年,ABOS第二部分的考生共通过切开复位内固定治疗了9867例成人桡骨远端骨折。老年患者占研究队列的28%。老年和非老年队列的平均年龄分别为74±7岁和46±13岁。与非老年队列相比,老年队列中女性患者比例更高(P<0.001)。老年队列的麻醉并发症发生率(P = 0.021)、医源性骨折发生率(P = 0.021)、内固定失败发生率(P = 0.031)、复位丢失发生率(P = 0.001)、未明确的医疗并发症发生率(P = 0.007)和死亡率(P = 0.017)均高于非老年队列。与非老年队列相比,老年队列的神经麻痹发生率也较低(P = 0.028),不过两组之间二次手术率没有差异。
老年患者桡骨远端骨折切开复位内固定术后,与骨质差和健康状况差相关的并发症发生率可能会增加。然而,老年和非老年患者的二次手术率同样较低。需要进一步研究来阐明切开复位内固定治疗老年桡骨远端骨折的经济、功能和社会影响。