Elsevier

Injury

Volume 46, Issue 2, February 2015, Pages 189-194
Injury

Open fractures in the elderly. The importance of skin ageing

https://doi.org/10.1016/j.injury.2014.07.021Get rights and content

Abstract

Open fractures in the elderly are rare and there is little information about them. We have reviewed 484 open fractures in patients aged ≥65 years over a 15-year period and compared them with 1902 open fractures in patients <65 years treated in the same period. The incidence of open fractures increased significantly with age. The incidence of open fractures in patients aged <65 years was 296.6/106/year compared which increased to 332.3/106/year in patients aged ≥65 years and further still to 446.7/106/year in the super-elderly aged ≥80 years The fracture distribution curves show that males aged 15–19 years and females aged ≥90 years have a very similar incidence of open fractures. In males the incidence declines almost linearly, whereas in females there is a steady increase in fracture incidence with age until the 7th decade of life when the incidence rises sharply.

About 60% of open fractures in the elderly follow a fall and most fractures are caused by low energy injuries. Despite this there is a high incidence of Gustilo Type III fractures, particularly in females. The commonest open fractures in females are those of the distal radius and ulna, fingers, tibia and fibula and ankle, all fractures with subcutaneous locations. It has been shown that ageing alters the mechanical properties of skin and we believe that this accounts for the increased incidence of open fractures in elderly females which occurs about 1 decade after the post-menopausal increase in fracture incidence.

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.

References (21)

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