Zachariasen Kelly, Dart Bradley R, Ablah Elizabeth, Lightwine Kelly, Haan James
Department of Surgery, University of Kansas School of Medicine-Wichita, Kansas.
Department of Population Health, University of Kansas School of Medicine-Wichita, Kansas.
Kans J Med. 2020 May 21;13:101-105. eCollection 2020.
The purpose of this study was to identify additional injuries commonly seen with proximal humerus fractures experienced by patients 65 years or older and to evaluate discrepancies in the management of these patients with regard to provider type.
A retrospective review was conducted of all patients 65 years or older who sustained a proximal humerus fracture. Patient data collected included demographics, injury details, hospital course, and discharge destination.
Patients with a concomitant fracture (45.5%, n = 65) had a slightly higher Injury Severity Score (ISS; 8.3 ± 3.0 vs. 6.4 ± 3.0, p < 0.001) and experienced one additional death than those with an isolated fracture (54.5%, n = 78). Slightly more patients were managed by a trauma provider (51.7%, n = 74) than by a non-trauma provider (48.3%, n = 69). Those managed by a trauma provider sustained the most pelvic fractures (12.2% vs. 2.9%, p = 0.038), were more likely to be injured in a motor vehicle collision (8.1% vs. 0%, p = 0.005), had a higher ISS (8.0 ± 3.3 vs. 6.4 ± 2.8, p = 0.003), and had more imaging performed than those treated by a non-trauma provider. There was, however, no difference in operative rates, concomitant injuries, length of stay, or discharge disposition regarding provider type.
It is important to recognize proximal humerus fractures as a sign of fragility and to optimize hospital management of these patients.
本研究的目的是确定65岁及以上患者肱骨近端骨折常见的其他损伤，并评估不同医疗服务提供者类型在这些患者治疗管理方面的差异。
对所有65岁及以上肱骨近端骨折患者进行回顾性研究。收集的患者数据包括人口统计学信息、损伤细节、住院过程及出院去向。
伴有其他骨折的患者（45.5%，n = 65）损伤严重程度评分（ISS）略高（8.3±3.0 vs. 6.4±3.0，p < 0.001），且比单纯骨折患者多1例死亡（54.5%，n = 78）。由创伤科医生管理的患者（51.7%，n = 74）略多于非创伤科医生管理的患者（48.3%，n = 69）。由创伤科医生管理的患者骨盆骨折最多（12.2% vs. 2.9%，p = 0.038），更有可能在机动车碰撞中受伤（8.1% vs. 0%，p = 0.005），ISS更高（8.0±3.3 vs. 6.4±2.8，p = 0.003），且比非创伤科医生治疗的患者接受的影像学检查更多。然而，不同医疗服务提供者类型在手术率、伴随损伤、住院时间或出院处置方面没有差异。
将肱骨近端骨折视为脆弱性的标志并优化这些患者的医院管理很重要。
