Fracture patterns in patients with multiple fractures: the probability of multiple fractures and the most frequently ass
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ORIGINAL ARTICLE
Fracture patterns in patients with multiple fractures: the probability of multiple fractures and the most frequently associated regions Xaver Feichtinger1,2 · Roland Kocijan2 · Rainer Mittermayr1 · Andreas Baierl3 · Jakob Schanda1,2 · Robert Wakolbinger2 · Heinrich Resch2,4 · Christian Fialka1,4 · Christian Muschitz2 Received: 27 August 2018 / Accepted: 4 February 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Introduction Multiple fractures are of high clinical relevance, as a significant increase in mortality rate has been described. The purpose of this study was to evaluate differences in age and gender distribution in multiple fractures dependent on severity of trauma. Furthermore, affected anatomic regions and frequently associated fracture regions were investigated. Methods Patients who had sustained multiple fractures between 2000 and 2012 were included in this study. At hospital admission, patients were divided according to trauma severity (high- vs low-traumatic), gender, and age for demographic analysis. Fractures were grouped in anatomical regions, and multiple fracture event probabilities as well as frequently associated regions were calculated. Results In total, 25,043 patients at an age range of 0–100 years (5.8% of all fracture patients; 14,769 male and 10,274 female patients) who sustained 57,862 multiple fractures were included. The lumbar/thoracic spine, cervical spine, femoral shaft, skull, and pelvis showed a probability of more than 40% of the presence of further fractures in each high-traumatic fracture event. In high-traumatic fracture events, male patients were more affected (p 70) Total
Number of patients with fractures
Number of patients with multiple fractures
Percentage of patients with multiple fractures among all fracture patients
Male
Female
Total
Male
Female
Total
Male (%)
Female (%)
Total (%)
53,398 56,051 77,501 30,388 17,080 234,418
34,270 22,384 44,807 43,599 53,993 199,053
87,668 78,435 122,308 73,987 71,073 433,471
979 3011 6372 2938 1469 14,769
488 742 1869 2596 4579 10,274
1467 3753 8241 5534 6048 25,043
1.8 5.4 8.2 9.7 8.6 6.3
1.4 3.3 4.2 6.0 8.5 5.2
1.7 4.8 6.7 7.5 8.5 5.8
Gender Male vs female (all fractures) Male vs female (high-traumatic) Male vs female (low-traumatic) Fracture causes High-traumatic vs low-traumatic Age > 70 vs 0–15 > 70 vs 16–30 > 70 vs 31–53 > 70 vs 54–70
Differences (%)
95% CI
p value
1.14 2.54 − 1.03
[1.0; 1.3] [2.4; 2.7] [− 1.3; − 0.8]
70 years. CourtBrown et al. described a higher number of multiple fractures in female patients in all age groups of > 65 years [8]. In absolute terms, the results shown in this patient cohort are similar. However, this study presented a cross over regarding patients’ gender in the age group of 54–70 years. As changes in sex steroids over the lifespan are well known for both genders, they may also be the reason for the cross over in multiple fracture patients in this age group [22, 23]. Not only postmenopausal changes, but also pe
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