High- Versus Low-Energy Acetabular Fracture Outcomes in the Geriatric Population

Introduction: High-energy mechanisms of acetabular fracture in the geriatric population are becoming increasingly common as older adults remain active later in life. This study compared outcomes for high- versus low-energy acetabular fractures in older adults. Materials and Methods: We studied outcomes of 22 older adults with acetabular fracture who were treated at a level-I trauma center over a 4-year period. Fourteen patients were categorized as low-energy mechanism of injury, and 8 were identified as a high-energy mechanism. We analyzed patient demographics with univariate logistic regressions performed to assess differences in high- and low-energy group as well as patient characteristics compared with surgical outcomes. Results: Most high-energy mechanisms were caused by motor vehicle collision (n = 4, 50.0%), with most having posterior wall fractures (50.0%). Among patient characteristics, the mechanism of injury, hip dislocation, fracture types, and fracture gap had the largest differences between energy groups effect size (ES: 2.45, 1.43, 1.36, and 0.83, respectively). The high-energy group was more likely to require surgery (odds ratio [OR] = 2.80, 95% CI: 0.26-30.70), develop heterotopic bone (OR = 4.33, 95% CI: 0.33-57.65), develop arthritis (OR = 3.60, 95% CI: 0.45-28.56), and had longer time to surgery (mean = 4.8 days, standard deviation [SD] = 5.8 days) compared to low-energy group (mean = 2.5 days, SD = 2.3 days). Discussion: The results of this case series confirm previous findings that patients with high-energy acetabular fractures are predominantly male, younger, and have fewer comorbidities than those who sustained low-energy fractures. Our results demonstrate that the majority of the high-energy fracture patients also suffered a concurrent hip dislocation with posterior wall fracture and experienced a longer time to surgery than the low-energy group. Conclusion: Geriatric patients who sustained high-energy acetabular fractures tend to have higher overall rates of complications, including infection, traumatic arthritis, and heterotopic bone formation when compared with patients with a low-energy fracture mechanism.

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Low energy fractures of the acetabulum

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x13814021680157 ◽

2014 ◽

Vol 96 (4) ◽

pp. 297-301 ◽

Cited By ~ 8

Author(s):

N Papadakos ◽

R Pearce ◽

MD Bircher

Keyword(s):

Acetabular Fracture ◽

High Energy ◽

Fracture Pattern ◽

Low Energy ◽

Acetabular Fractures ◽

Considerable Proportion ◽

Female Ratio ◽

Energy Mechanism ◽

Pattern Distribution ◽

Male To Female

Introduction Acetabular fractures due to high energy injuries are common and well documented; those secondary to low energy mechanisms are less well described. We undertook a retrospective study of the acetabular fracture referrals to our unit to evaluate the proportion of injuries resulting from a low energy mechanism. Methods A total of 573 acetabular fractures were evaluated from 1 January 2005 to 31 December 2008. The plain radiography and computed tomography of those sustaining a low energy fracture were assessed and the fracture patterns classified. Results Of the 573 acetabular fractures, 71 (12.4%) were recorded as being a result of a low energy mechanism. The male-to-female ratio was 2.4:1 and the mean patient age was 67.0 years (standard deviation: 19.1 years). There was a significantly higher number of fractures (p<0.001) involving the anterior column (with or without a posterior hemitransverse component) than in a number of previously conducted large acetabular fracture studies. Conclusions Our results demonstrate that low energy fractures make up a considerable proportion of acetabular fractures with a distinctly different fracture pattern distribution. With the continued predicted rise in the incidence of osteoporosis, life expectancy and an aging population, it is likely that this type of fracture will become increasingly more common, posing difficult management decisions and leading to procedures that are technically more challenging.

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A Survey of High- and Low-Energy Acetabular Fractures in Elderly Patients

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459319870426 ◽

2019 ◽

Vol 10 ◽

pp. 215145931987042 ◽

Cited By ~ 2

Author(s):

Evgeny Dyskin ◽

Brian W. Hill ◽

Michael T. Torchia ◽

Peter A. Cole

Keyword(s):

Elderly Patients ◽

Acetabular Fracture ◽

Injury Severity ◽

High Energy ◽

Low Energy ◽

Acetabular Fractures ◽

Male Predominance ◽

The Us ◽

Initial Hospital ◽

Comorbidity Index

Introduction: Geriatric patients represent 14% of acetabular fractures and are the fastest growing subset of patients affected by this injury in the US. Treatment outcomes have been reported as inferior to those achieved in younger patients after high-energy (HE) acetabular trauma. This study aimed to compare detailed demographic characteristics and clinical outcomes in elderly patients (≥65 years of age) treated in a tertiary North American trauma center for acetabular fractures after both high- and low-energy mechanisms of injury. Methods: Patients (≥65 years of age) diagnosed with an acetabular fracture were identified over a 7-year period. Patient and injury characteristics were extracted from our institutional trauma database. Length of stay, intervention, operative details, disposition, complications, readmissions, and mortality were analyzed. Results: One hundred nine patients were identified for inclusion. Low-energy mechanisms (simple falls) were found in 64 (58.7%) and HE mechanisms in 45 (41.3%) patients. The HE cohort was younger (74.6 vs 80.7 years; P < .001), had a higher male predominance (76% vs 56%; P = .10), a lower Charlson comorbidity index (1.29 ± 1.49 vs 2.16 ± 1.76; P = .01), and a higher injury severity score (19.90 ± 15.33 vs 6.46 ± 3.57; P < .001). Fracture patterns, described according to the Letournel-Judet classification, were similar between the 2 groups. Thirty-day mortality was significantly higher in the HE group (26.7% vs 3.1%; P < .001); however, the 1-year mortality rates were not statistically different (31.1% vs 25.0%; P = .20). Discussion: Patients with acetabular fractures sustained due to HE accidents demonstrate significantly higher 30-day mortality rate than patients with low-energy fractures, but similar mortality 1 year after the injury, despite having a much lower mean age and fewer comorbidities. Conclusion: Medical efforts made during initial hospital admission may have the biggest impact on survivorship following acetabular fracture.

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Discrimination of Low-Energy Acetabular Fractures from Controls Using Computed Tomography-Based Bone Characteristics

Annals of Biomedical Engineering ◽

10.1007/s10439-020-02563-4 ◽

2020 ◽

Vol 49 (1) ◽

pp. 367-381

Author(s):

Robel K. Gebre ◽

Jukka Hirvasniemi ◽

Iikka Lantto ◽

Simo Saarakkala ◽

Juhana Leppilahti ◽

...

Keyword(s):

Machine Learning ◽

Risk Factors ◽

Computed Tomography ◽

Femoral Head ◽

Acetabular Fracture ◽

Ct Images ◽

Low Energy ◽

Acetabular Fractures ◽

Operating Characteristics ◽

Femoral Neck Axis

AbstractThe incidence of low-energy acetabular fractures has increased. However, the structural factors for these fractures remain unclear. The objective of this study was to extract trabecular bone architecture and proximal femur geometry (PFG) measures from clinical computed tomography (CT) images to (1) identify possible structural risk factors of acetabular fractures, and (2) to discriminate fracture cases from controls using machine learning methods. CT images of 107 acetabular fracture subjects (25 females, 82 males) and 107 age-gender matched controls were examined. Three volumes of interest, one at the acetabulum and two at the femoral head, were extracted to calculate bone volume fraction (BV/TV), gray-level co-occurrence matrix and histogram of the gray values (GV). The PFG was defined by neck shaft angle and femoral neck axis length. Relationships between the variables were assessed by statistical mean comparisons and correlation analyses. Bayesian logistic regression and Elastic net machine learning models were implemented for classification. We found lower BV/TV at the femoral head (0.51 vs. 0.55, p = 0.012) and lower mean GV at both the acetabulum (98.81 vs. 115.33, p < 0.001) and femoral head (150.63 vs. 163.47, p = 0.005) of fracture subjects when compared to their matched controls. The trabeculae within the femoral heads of the acetabular fracture sides differed in structure, density and texture from the corresponding control sides of the fracture subjects. Moreover, the PFG and trabecular architectural variables, alone and in combination, were able to discriminate fracture cases from controls (area under the receiver operating characteristics curve 0.70 to 0.79). In conclusion, lower density in the acetabulum and femoral head with abnormal trabecular structure and texture at the femoral head, appear to be risk factors for low-energy acetabular fractures.

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Repeat posterior wall acetabular fracture-dislocation: High-energy trauma as a ‘second hit phenomenon’

Trauma Case Reports ◽

10.1016/j.tcr.2019.100215 ◽

2019 ◽

Vol 22 ◽

pp. 100215

Author(s):

Burton D. Dunlap ◽

Ryan T. Voskuil ◽

Brandon Cincere ◽

Peter J. Nowotarski

Keyword(s):

Acetabular Fracture ◽

Posterior Wall ◽

High Energy ◽

Fracture Dislocation ◽

High Energy Trauma ◽

Second Hit

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Ruminal Microbiota and Fermentation in Response to Dietary Protein and Energy Levels in Weaned Lambs

Animals ◽

10.3390/ani10010109 ◽

2020 ◽

Vol 10 (1) ◽

pp. 109 ◽

Cited By ~ 2

Author(s):

Xiaokang Lv ◽

Kai Cui ◽

Minli Qi ◽

Shiqin Wang ◽

Qiyu Diao ◽

...

Keyword(s):

Growth Performance ◽

Energy Levels ◽

High Energy ◽

Metabolizable Energy ◽

Low Energy ◽

Dietary Energy ◽

Ruminal Fermentation ◽

Protein Levels ◽

Energy Group ◽

Low Energy Diet

Supplying sufficient nutrients, such as dietary energy and protein, has a great effect on the growth and rumen development of ruminants. This study was conducted to evaluate the effects of dietary energy and protein levels on growth performance, microbial diversity, and structural and physiological properties of the rumen in weaned lambs. A total of 64 two-month-old Hu lambs were randomly allotted to 2 × 2 factorial arrangements with four replicates and with four lambs (half male and half female) in each replicate. The first factor was two levels of dietary metabolizable energy (ME) density (ME = 10.9 MJ/Kg or 8.6 MJ/Kg), and the second factor was two levels of dietary crude protein (CP) content (CP = 15.7% or 11.8%). The trial lasted for 60 days. A low dietary energy level restrained the growth performance of lambs (p < 0.05). The ruminal concentration of acetate and the ratio of acetate to propionate increased but the propionate concentration decreased significantly with the low energy diet. However, the rumen morphology was not affected by the diet energy and protein levels. Moreover, a low energy diet increased ruminal bacterial diversity but reduced the abundance of the phylum Proteobacteria (p < 0.05) and genus Succinivibrionaceae_uncultured (p < 0.05), which was associated with the change in ruminal fermentation phenotypes. By indicator species analysis, we found three indicator OTUs in the high energy group (Succinivibrionaceae_uncultured, Veillonellaceae_unclassified and Veillonellaceae_uncultured (p < 0.01)) and two indicator OTUs in the low energy group (Bacteroidales_norank and Lachnospiraceae_uncultured (p < 0.01)). In conclusion, these findings added new dimensions to our understanding of the diet effect on rumen microbial community and fermentation response, and are of great significance for establishing the optimal nutrient supply strategy for lambs.

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Serum Level of Parathyroid Hormone, Alkaline Phosphatase, Calcium and Ionized Calcium After Forearm Fractures

QJM ◽

10.1093/qjmed/hcab104.004 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ahmed Mohamed Morsi ◽

Tameem Mohamed Shafik ◽

Ahmed Kamal Mohamed Hassan

Keyword(s):

Alkaline Phosphatase ◽

Parathyroid Hormone ◽

Fracture Healing ◽

Normal Level ◽

High Energy ◽

Low Energy ◽

Ionized Calcium ◽

Forearm Fractures ◽

Energy Group ◽

Pth Level

Abstract Background During the last two decades, our understanding of fracture healing has evolved rapidly. Bone is one of the few body tissues that can heal without forming a fibrous scar and, as such, the process of fracture healing recapitulates bone development and may be considered a form of tissue regeneration. The complex cell and tissue proliferation and differentiation processes involved in fracture healing are regulated by growth factors, inflammatory cytokines, antioxidants, hormones, amino acids, and other nutrients. Objective: To identify changes in serum level of calcium, ionized calcium, alkaline phosphatase and parathyroid hormone according to mode of trauma (low and high energy) in forearm fractures and their role in fracture healing. Patients and Methods 50 Patients with forearm fracture were prospectively recruited from the Accident and Emergency Department of Trauma Surgery, El Zaitoun specialized hospital within 48 hours of sustaining the fracture. Patients included in the study were asked to avoid calcium supplementation during fracture healing. Results Mean PTH was elevated in both groups at Day 1 with low energy group was insignificantly higher than high energy group, whereas after 8 weeks mean PTH level decreased in both groups but in low energy group mean PTH level was significantly higher than high energy group. Mean ALP level increased in both groups at Day 1 whereas in low energy group it was insignificantly higher than that of high energy group, After 8 weeks mean ALP level insignificantly decreased to normal level in both groups. Mean serum calcium level was below normal level in both groups where it was insignificantly higher in high energy group than that of low energy group which increased after 8 weeks in both groups but remained elevated in high energy than low energy group. Mean serum ionized calcium level was below normal level at Day 1 in both groups whereas it was insignificantly higher in high energy group than low energy group which after 8 weeks increased in both groups but remained elevated in high energy group than low energy group. Conclusion Serial monitoring of these physiological markers reflect the actual status of bone resorption, and bone formation respectively over a short period. Thus, they can be used as an adjunct to clinical and radiological evidence of fracture healing.

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High-Energy Diet at Antepartum Decreases Insulin Receptor Gene Expression in Adipose Tissue of Postpartum Dairy Cows

Bulletin of the Veterinary Institute in Pulawy ◽

10.2478/bvip-2013-0037 ◽

2013 ◽

Vol 57 (2) ◽

pp. 203-207 ◽

Cited By ~ 4

Author(s):

Zhigang Zhang ◽

Jianguo Wang ◽

Ruifeng Gao ◽

Weiqian Zhang ◽

Xinwei Li ◽

...

Keyword(s):

Gene Expression ◽

Adipose Tissue ◽

Insulin Receptor ◽

Dairy Cows ◽

High Energy ◽

Low Energy ◽

Control Group ◽

Insulin Receptor Gene ◽

Energy Group ◽

Low Energy Diet

Abstract The objective of the study was to determine expression of gene of insulin receptor (INSR) in adipose tissue of postpartum dairy cows fed diets containing different amounts of energy at the antepartum period. Healthy pregnant dairy cows (n=45) on 21st d of the antepartum were divided into three groups differing in diet composition, namely: control group fed a normal diet, high energy group fed a high energy diet, and low energy group fed a low energy diet. Twenty-one days after parturition, INSR gene expression in adipose tissue was determined by internally controlled reverse transcriptase PCR. The level of INSR mRNA in adipose tissues of cows fed the high energy diet was substantially lower than that in cows fed normal or low energy diets. A relatively higher level of INSR mRNA in the adipose tissue of cows fed low energy diet may be beneficial for gluconeogenesis and lipogenesis, which can relieve an energy negative balance. Reduced level of INSR mRNA in adipose tissue of cows fed high energy diet indicates that the response to insulin has significantly decreased.

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Pediatric Hip Dislocation with Posterior Wall Acetabular Fracture: A Case Report

HSS Journal ® ◽

10.1007/s11420-014-9407-7 ◽

2014 ◽

Vol 10 (3) ◽

pp. 280-285

Author(s):

Michael M. Khair ◽

Christopher S. Smith ◽

David L. Helfet

Keyword(s):

Case Report ◽

Acetabular Fracture ◽

Hip Dislocation ◽

Posterior Wall

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Beyond Hip Fracture: Orthopaedic Trauma in an Aging America

Innovation in Aging ◽

10.1093/geroni/igaa057.851 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 265-266

Author(s):

Lisa Reider ◽

Joseph Levy ◽

Andrew Pollak

Keyword(s):

Older Adults ◽

Motor Vehicle ◽

Traumatic Injury ◽

Fragility Fractures ◽

High Energy ◽

Census Bureau ◽

Low Energy ◽

Study Cohort ◽

Treatment Pathways ◽

The Impact

Abstract Trauma related death and disability is common among working-age Americans, however the impact on older adults is consequential and increasing. Fractures are the most common traumatic injury diagnosis among Medicare beneficiaries, and though fragility fractures continue to be an important health problem, recent data indicate an increase in high-energy fractures. The purpose of this study was to produce national incidence estimates among US men and women ≥ 65 years using data from the 2003-2014 National Inpatient Sample (NIS). The study cohort included hospitalizations involving upper and/or lower extremity fractures which were further classified by mechanism as high or low energy using external cause of injury codes. Incidence was computed using survey weights provided by NIS, and population estimates from the Census Bureau. The incidence of high-energy fractures increased from 744.1/100,000 persons (95%CI: 681.1–807.1) in 2003 to 821.4/100,000 (95%CI: 795.0 – 874.8) in 2014 in women, and from 359.1/100,000 (95%CI: 331.4–386.8) to 408.2/100,000 (95%CI: 394.–809.2) in men. Over 80% were motor vehicle related. The greatest increase was among those ≥ 85 (1,856.4/100,000 to 2,126.3/100,000 in women; 1,069.1/100,000 to 1,215.1/100,000 in men). Simultaneously, the incidence of low-energy fractures declined: 748.4/100,000 (95%CI: 687.5–809.2) to 443.8/100,000 (95%CI: 423.5 -464.1) in women, and 310.6/100,000 (95%CI: 285 – 336.2) to 206.3/100,000 (95%CI: 196.5 - 216) in men. Results suggest that fractures commonly seen in younger adults will be seen more frequently in older age. It is therefore essential to establish treatment pathways to optimize outcomes for the growing number of injured older adults.

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