Patient Age Is Inversely Associated with Injury Counts Caused by Motor Vehicle Crashes.

Associations between age and fracture incidence, total number of fractures, and total number of injuries per occupant occurring in motor vehicle crashes were evaluated. An observational study of the Crash Injury Research and Engineering Network was conducted. Multivariable logistic regression and negative binomial models were used to relate age (2064, 65+ years) to fracture incidence, total number of fractures per occupant, and total number of injuries, adjusting for sex and change in vehicle velocity (deltav). Over 90% of occupants had at least one fracture for a total of 5,846 fracture injuries. The older age group experienced a 15% increase in the incidence of total injuries sustained compared to the younger group (Incident Rate Ratio = 1.15, 95% Confidence Interval = 1.081.23, p 0.0001). Older patients should be considered for polytrauma evaluation even with a lower energy motor vehicle crash. (Journal of Surgical Orthopaedic Advances 29(1):3639, 2020).

The Incidence and Risk Factors Associated With the Need for Fasciotomy in Tibia and Forearm Fractures: An Analysis of the National Trauma Data Bank.

OBJECTIVE: The aims of this study were to analyze a large national trauma database to determine the incidence of, risk factors for, and outcomes after a fasciotomy of the lower leg or forearm after fracture. METHODS: Data from the National Trauma Data Bank for the years 2004-2016 were analyzed, and we identified 301,351 patients with forearm fractures and 369,237 patients with tibial fractures. Risk factors, length of stay (LOS), and mortality were assessed to determine associations with an injury that required a fasciotomy. RESULTS: A total of 1.22% of the forearm fractures and 3.79% of the tibial fractures had a fasciotomy. Patients with a fasciotomy were more likely to have invasive procedures (P < 0.0001); have injuries resulting from machinery, motor vehicle collisions, and firearms (P < 0.0001); and smoke, use drugs, and/or alcohol (P < 0.05) compared with patients who did not undergo fasciotomies. Fasciotomy procedures were associated with longer LOS and higher mortality rate (P < 0.05). CONCLUSIONS: The incidence of a fasciotomy is less than 5% in tibia or forearm fractures. Patients who underwent fasciotomy have higher energy injuries, increased alcohol or drug use, higher rates of surgical interventions, and increased LOS. Furthermore, having a fasciotomy is associated with increased mortality rate. When counseling patients and evaluating surgeon/hospital performance, fasciotomies can serve as an indicator and modifier for a more complex trauma pathology. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.