Open fractures in the elderly. The importance of skin ageing
Introduction
There is very little known about open fractures in the elderly. This is not surprising as two generations ago the average adult life expectancy in the United Kingdom was 44 years for males and 50 years for females [1]. Open fractures in patients ≥65 years would have been very rare and in fact they remain comparatively uncommon. A recent analysis of 6818 consecutive non-spinal adult fractures presenting to the Royal Infirmary of Edinburgh in a 1-year period showed that 1.9% of the fractures were open [2]. Analysis of the patients aged ≥65 years showed that only 1.1% of the fractures was open. In the super-elderly patients, aged ≥80 years, only 0.7% of the fractures were open.
Much of the literature regarding open fractures has come from Level I Trauma Centres which mainly treat high energy trauma [3], [4]. In recent years there has been interest in severe wartime open fractures which often result in amputation [5]. The literature simply does not deal with the whole spectrum of open fractures but given the increase in the number of fractures in the elderly and the relatively difficulty of treating many open fractures it seems important to understand the epidemiology of open fractures in the elderly. Improved knowledge may help to predict the numbers of open fractures in the elderly in the future and thereby facilitate treatment.
Section snippets
Materials and methods
Clinical information on all patients aged >15 years who presented to the Royal Infirmary of Edinburgh with an open fracture between 1995 and 2009 was collected and analysed [6]. Up to 2005 the information was collected prospectively and from 2006 to 2009 it was retrospectively collected from the hospital database. The Royal Infirmary is the only hospital treating orthopaedic trauma in the City of Edinburgh, Midlothian and East Lothian and therefore accurate epidemiological information can be
Results
In the 15-year study there were 2386 open fractures in adults aged >15 years. Four hundred and eighty-four (20.3%) fractures occurred in patients ≥65 years giving an overall incidence of 332.3/106/year. One hundred and sixty-eight occurred in males (34.7%) giving an incidence of 287.1/106/year and 316 were in females (65.3%) giving an incidence of 362.6/106/year. The equivalent figures for the super-elderly patients ≥80 years shows that there were 172 open fractures of which 35 (20.3%) were in
Discussion
This is the first study of the epidemiology of open fractures in the elderly. Most of the literature about open fractures comes from Level I Trauma Centres where younger patients with high energy fractures tend to be treated. As a result most surgeons believe that open fractures occur more commonly in younger patients but this study shows that the incidence of open fractures in patients aged ≥65 years is higher than in younger patients. We believe that the results apply to all first world
Conflict of interest
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Ethical permission
The ethical committee of the hospital decided that this study was audit and ethical permission was not required.
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