Feature Article
Trends in Orthopedic Fracture and Injury Severity: A Level I Trauma Center Experience
Abstract
The purpose of this study was to define the trends in fracture complexity and overall injury severity of orthopedic trauma patients at a level I trauma center. A retrospective review of a prospectively collected trauma database was performed to determine the Injury Severity Score (ISS) and AO/OTA classification of the most common fractures among all patients presenting from 1995 to 1999 and from 2008 to 2012. Inclusion criteria were lower extremity fractures of the femur and tibia and pelvic fractures within the years of interest. Exclusion criteria were age younger than 18 years, pathologic fractures, and insufficient medical records to determine ISS or AO/OTA classification. The total number of fractures increased from 4869 between 1995 and 1999 to 5902 between 2008 and 2012. There was an increase in the percentage of lower extremity periarticular fractures (20.7% to 23.4%, P<.001) and the percentage of pelvic and acetabular fractures (32.7% to 39.9%, P<.001) and a decrease in the percentage of lower extremity extra-articular fractures (46.6% to 36.7%, P<.001). The ratios of tibial pilon and plateau fractures relative to extra-articular tibial fractures increased from 0.29 to 0.60 (P<.001) and from 0.49 to 0.81 (P<.001), respectively. The average ISS had increased from 2008 to 2012 compared with from 1995 to 1999 (19.2 vs 15.1, P<.001). The complexity of certain lower extremity fractures and the severity of injury of patients treated at this referral institution are high and continue to increase. As US health care economics continue to change, with provider and hospital reimbursements shifting toward a patient outcomes basis with potential penalties for complications and readmissions, hospitals and providers must recognize these trends. Trauma centers must continue to measure the complexity of fracture care provided to properly risk-stratify their patient population. [Orthopedics. 2018; 41(2):e211–e216.]
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