Abstract:

Background: Open fracture is a serious orthopaedic injury that can lead to significant patient morbidity and mortality. There is limited data on the mortality risk for open compared to closed long bone fracture.
Methods: The Nationwide Inpatient Sample was used to identify all patients who were admitted with a long bone fracture in the United States between 1998 and 2010. Cox proportional hazards regression modeling was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) of mortality.
Results: After adjusting for age, gender, race, insurance, and comorbidities, the HR of mortality was 2.89 (95% CI, 2.56-3.28; p<0.001) for open compared to closed fracture. Stratified by anatomical site, the HR of mortality for open compared to fracture was 3.43 for femur (95% CI, 2.78-4.23; p<0.001), 2.81 for tibia or fibula (95% CI, 2.17-3.64; p<0.001), 2.54 for humerus (95% CI, 1.81-3.56; p<0.001), and 1.56 for radius or ulna (95% CI, 1.10-2.23; p=0.014).
Conclusions: This data suggests that open fracture carries a worse prognosis compared to closed fracture at the same anatomical site.

Authors:

Adam Adler, MD, Orthopaedic Resident, Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, Matthew R. Boylan, BS, Research Associate, Department of Orthopaedic Surgery and the Department of Epidemiology and Biostatistics, SUNY Downstate Medical Center, Brooklyn, NY, Carl Rosenberg, PhD, Clinical Assistant Professor, Department of Epidemiology and Biostatistics, SUNY Downstate School of Public Health, Brooklyn, NY, Robert Pivec, MD, Orthopaedic Resident, Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, Bhaveen H. Kapadia, MD, Orthopaedic Resident, Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, Vidushan Nadarajah, BA, Research Associate, Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, Qais Naziri, MD, Orthopaedic Resident, Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, Steven F. Harwin, MD, Chief of Adult Reconstruction and Total Joint Replacement, Department of Orthopaedic Surgery, Beth Israel Medical Center, New York, NY, Carl B. Paulino, MD, Program Director, Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY

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