Fractures requiring inpatient care-incidence and post-fracture mortality

Hip fractures have been extensively studied with regard to both incidence and post-fracture mortality. However, limited data exist on the incidence of fractures – other than hip fractures – requiring inpatient care, even though they account for considerable morbidity and healthcare costs. Moreover, previous research on post-fracture mortality has focused on older age groups, although the highest number of potential years of life is lost when a young person dies. This thesis is based on register data of nearly 6000 patients older than 15 years who were treated on the trauma ward of Central Finland Hospital (CFH) between 2002 and 2008. The purpose was to investigate the incidence of all fractures requiring inpatient care. In addition, the post-fracture mortality and causes of death were determined for all patients hospitalized for extremity fracture treatment. We also investigated the post-fracture mortality and causes of death of the youngest age group (16-30 years) separately to determine whether mortality in this group differs from the expected mortality. During the study period 3277 women and 2708 men sustained 3750 and 3030 fractures, respectively. The incidence of all fractures was 4.9 per person-year (95% CI: 4.8 to 5.0). Fractures of the hip, ankle, wrist, spine, and proximal humerus comprised two-thirds of all fractures requiring hospitalization. A total of 929 women and 753 men sustained at least one upper extremity fracture, and 2081 women and 1486 men at least one lower extremity fracture. The standardized mortality ratio (SMR) of all fracture patients was 1.83 (95% CI: 1.75 to 1.91); 1.65 (95% CI: 1.56 to 1.75) for women and 2.56 (95% CI: 2.09 to 2.43) for men. We found that the combined proportion of ankle (17%) and wrist (9%) fractures was equal to that of hip fractures (27%). Although the mortality after lower extremity fractures generally was higher than after upper extremity fractures, in men the 4.50 (95% CI: 3.31 to 6.11) SMR after proximal humerus fractures was even higher than the 3.0 (95% CI: 2.7 to 3.3) SMR after hip fractures. Altogether 724 patients (72.5% men), aged 16 to 30 years, were hospitalized for treatment of a fracture in CFH between 2002 and 2008. Ankle, tibia, spine, forearm, and wrist constituted the five most common fracture sites. The SMR of all patients, aged 16 to 30 years, was 6.17 (95% CI: 4.29 to 8.88). In this age group, there were no deaths during the treatment period that were associated with the index fracture. Suicide (28%) and intoxication (24%) were the leading primary causes of death. Our results suggest that in some young adults who had received in-patient fracture care, an underlying, undiagnosed, serious mental illness may have been present, potentially explaining the high SMR. Health professionals should consider the possibility of a severe, undiagnosed mental illness when treating young adults hospitalized for a fracture.