Geriatric Acetabular Fractures and Mortality

The geriatric population is a rapidly growing segment of society with longer life expectancies and more active lifestyles than previous generations. More and more geriatric patients are being seen with acetabular fractures, which can have a significant impact on the remainder of an elderly patient’s life.

In the April issue of JOT, Gary et al publish their results from 3 centers in “Effect of Surgical Treatment on Mortality After Acetabular Fracture in the Elderly: A Multicenter Study of 454 Patients.”  The authors conclude that the operative treatment of acetabular fractures does not increase or decrease mortality, once comorbidities are taken into account, and that the decision for operative versus nonoperative treatment of geriatric
acetabular fractures should not be justified based on the concern for increased or decreased mortality alone.  Also of note, the overall one-year mortality for geriatric acetabular fractures was 16%, which is lower than that for elderly patients with proximal femur fractures.

These findings are in line with previous studies, including a single center study by Bible et al (JOT March 2014) that found the 1-year mortality rates for elderly patients with isolated acetabular fractures are significantly lower than those reported previously for hip fractures and acetabular fractures with concurrent injuries.  The authors also found no significant differences in mortality rates between operative and nonoperative patients across all time points.

Please check out article by Gary et al in the April issue of JOT, and share your comments on the treatment of geriatric acetabular fractures.

Hassan R. Mir, MD, MBA, FACS

Editor | OsteoSynthesis – The JOT Online Discussion Forum

Cost Analysis of Clavicle Fixation

There has been an increase in the number of clavicle fractures that are treated operatively over the past decade.  While there is good literature to support that certain patterns may benefit from operative fixation, there is a sense from some in the orthopaedic trauma community that the pendulum has swung too far to the side of operative treatment.

In the April issue of JOT, authors from LSU look at another aspect of the debate in their paper “A Cost Analysis of Internal Fixation Versus Nonoperative Treatment
in Adult Midshaft Clavicle Fractures Using Multiple Randomized
Controlled Trials.”  The authors conclude that from the perspective of a single payer, initial nonoperative treatment of midshaft clavicle fractures followed by delayed surgery as needed is less costly than initial operative fixation.

In his invited commentary, Peter Althausen raises several significant concerns with the model that the authors utilize to come to their conclusions.  Some of the issues include cost allocation, only looking at the payer perspective and not the patient/society, and implant costs.  He goes on to state that cost analysis outcomes include much more than the initial cost to payers.

The authors offer a rebuttal to address each of the comments, to which Dr. Althausen offers an additional reply.  But the debate does not have to end there.  What do you think about the article?  How should we evaluate the value of fracture fixation with respect to costs?  Please share your comments below.

Hassan R. Mir, MD, MBA, FACS

Editor | OsteoSynthesis – The JOT Online Discussion Forum

OsteoSynthesis Launch!

Welcome to OsteoSynthesis – The JOT Online Discussion Forum.  The goal of this site is to allow for the discussion of articles and topics that are relevant to the field of orthopaedic traumatology.

Each month, we will highlight articles for discussion related to JOT content. However, the discussions can include multiple other issues and areas of interest.  The goal is for highly interactive discussions with multiple viewpoints in order for everyone to learn and enjoy.

Ultimately, the success of this site will depend upon YOUR active participation.  We welcome your comments and ideas for new topics and features.  Please feel free to contact me at Hmirwvu@aol.com.

Hassan R. Mir, MD, MBA, FACS

Editor | OsteoSynthesis – The JOT Online Discussion Forum