Session VI - Geriatrics

Injury Patterns in Older Female Trauma Patients Compared with Men and Younger Women

Paul Tornetta, III, MD; Edwin F. Hirsch, MD; Robert Howard, MD; Timothy McConnell, MD; Eric Ross, PhD, Boston Medical Center, Boston, MA

Introduction: As the population ages, the number of traumatically injured patients over 65 continues to rise. Previous studies have examined the overall mortality of the elderly trauma patient and the effect of premorbid conditions on mortality. The effect that postmenopausal bone quality may have on the skeletal injury patterns in older patients has not been evaluated. In light of the recent effort by the AAOS to highlight the problems of osteoporosis/osteopenia, we sought to determine if the skeletal injuries suffered by older women (65) differed from those of older men (65) or from younger women (45 - 64) based on mechanism of injury.

Materials and Methods: A database was generated looking at mechanism of injury, ISS, individual AIS, GCS, specific skeletal injury, and 40 specific injury patterns throughout the body. Patients were identified from the trauma registry at a level 1 medical center. All information was prospectively entered into this database and retrospectively reviewed. Skeletal injury entries were checked by 2 authors who reviewed the original and follow-up radiographs of all patients to confirm the injuries documented and to look for fractures that were not entered. All slip and fall injuries were excluded. The mechanisms included fall >15 feet, motor vehicle accident, and pedestrian struck by a motor vehicle. An independent statistician performed data analysis. Skeletal injury was stratified by body area as: pelvis/hip, femoral (shaft/subtrochanteric), knee (distal femur/tibial plateau), leg (tibia/ankle/foot), shoulder (clavicle/scapula/proximal humerus), arm (humerus/elbow), forearm (forearm/wrist/hand) to allow for statistical analysis. Patient groups included women 45 - 64, women 65 and men 65.

Results: There were 146 women and 173 men over 65 and 193 women between 45 and 64 in the study group. Chi square analysis of discreet variables revealed a significant difference in older women from older men (for all mechanisms) in only one area, forearm/wrist fractures. Twenty-two of 146 women and 7 of 173 men sustained these injuries (P = .004). Continuous variables were evaluated using t tests. For the groups taken as a whole, there were no statistically significant differences in ISS, GCS, or AIS. However, when the patient groups were stratified by injury mechanism several findings were significant. For the mechanism of motor vehicle to motor vehicle collision older women had a higher AIS for head / neck injury than did younger women (P = .04) but a lower AIS for abdominal injury (P = .04). Most interesting to the orthopaedist is that there was a very significant increase in extremity AIS in older women as compared with older men (P < .0001). Likewise, older women were more likely to sustain lower leg fractures than older men were (P = .004).

Discussion: Older individuals are more active than previous generations and living longer. With this continued activity comes risk of injury. While hip fractures have been well studied, the older patient sustaining a significant traumatic injury has not been well examined. In particular, lower bone density and osteoporosis may have an effect on the skeletal injuries suffered by older women. We attempted to assess this using age as criteria. In this pilot study we found an increase in extremity AIS for women over 65 as compared with men over 65 involved in motor vehicle accidents. Similarly, they had a higher rate of distal upper extremity injuries (forearm/wrist/hand) than their male counterparts when considering all mechanisms of injury. This preliminary finding indicates that the older female patient is at increased risk of skeletal injury than are men, given the same injury mechanism. Based on these findings, it is possible that osteoporosis may play a role in the type of skeletal injuries seen in older female trauma patients. The possibility that efforts to maintain bone density may lead to diminished injury in elderly female trauma patients exists and deserves attention.