OTA 2013 Posters

Scientific Poster #23 Geriatric OTA 2013

Geriatric Fractures About the Hip: Divergent Patterns in the Proximal Femur and Acetabulum

Matthew P. Sullivan, MD; Keith D. Baldwin, MD, MPH; Derek J. Donegan, MD;
Samir Mehta, MD, PhD; Jaimo Ahn, MD, PhD;
Hospital of the University of Pennsylvania, Department of Orthopaedic Surgery,
Philadelphia, Pennsylvania, USA

Background/Purpose: Geriatric acetabular fractures are poorly understood injuries with considerable overlap between multiple orthopaedic subspecialties. They are a rapidly growing clinical problem with limited evidence-based management guidelines. These injuries often behave differently than higher-energy acetabular fractures seen in younger patients. Furthermore, unlike traditional geriatric hip fractures, which are managed by both generalists and specialists, geriatric acetabular fractures, when managed operatively, are most commonly treated by joint replacement and/or trauma specialists. The purpose of this study is to describe the epidemiologic trends, hospital course and financial aspects of geriatric acetabular fractures as compared to traditional fragility fractures about the hip.

Methods: From 1993 to 2010, the Nationwide Inpatient Sample (NIS) recorded over 600 million Medicare paid US hospital discharges. This retrospective study uses the NIS to compare Medicare patients with acetabular fractures (n = 87,771), pelvic fractures (n = 522,831), and subtrochanteric fractures (n = 170,872) to patients with traditional fractures about the hip (intertrochanteric and femoral neck, n = 3,495,742) with regard to annual trends in incidence, length of hospital stay, in-hospital mortality, transfers from acute care institutions, and hospital charges over an 18-year period.

Results: From 1993 to 2010, traditional hip fractures peaked in 1996 and declined by 25.7% by 2010. During the same 18-year period geriatric acetabular fractures increased by 67% (Spearman correlation value –0.835, P value <0.001). Hospital length of stay decreased by roughly 50% for all fractures types about the hip, including acetabular fractures. Hospital charges, after controlling for inflation, increased roughly 50% for all fracture types. Transfers from outside acute care hospitals declined closely for pelvic and subtrochanteric fractures when compared to traditional hip fractures (Pearson correlation 0.858, P value <0.001 and Pearson correlation 0.909, P value <0.001, respectively). Conversely, transfer from outside facilities continued to be elevated for acetabular fractures as compared to traditional hip fractures, which declined (Pearson correlation 0.357, P value = 0.21). In-house mortality declined with significant or near-significant correlations between acetabular, subtrochanteric, and pelvic fractures to traditional hip fractures.

Conclusion: Geriatric acetabular fractures are rapidly increasing in annual incidence while traditional hip fractures continue to decline. Reasons for these divergent patterns in fractures about the hip are unclear at this time. Furthermore, patients with these injuries are more likely to be transferred from their hospital of origin to another acute care institution, increasing costs and complications. This is likely related to their complexity and lack of consensus regarding optimal management. Given their rapidly rising annual incidence, geriatric acetabular fractures deserve closer attention and higher-quality evidence-based guidelines for treatment.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.