Super Elderly Patients with Distal Radius Fractures: A Register Based Study Evaluating Mortality

Background:With a rapidly ageing population, the number of wrist fractures will rise dramatically in the super-elderly (>80 years) group. In previous published studies regarding mortality after wrist fractures elderly are often defined using a rather wide age-span, the threshold has been set to somewhere between 50-70 years. However, elderly defined as a group this way is probably too imprecise. Differences between a 50- and an 80-year-old patient hypothetically exist regarding expectations, demands and prerequisites for a successful outcome. Our aim was to evaluate the short- and long-term mortality after a distal radius fracture in the super elderly. We also wanted to correlate overall survival to non-fracture related factorsMethods:Patients were extracted from the Lund prospective distal radius fracture register. Included patients were 80 years or older at the time of fracture and were having their fracture between 2010-2012. 1- and 5-year death rates were calculated and compared to the age- and gender adjusted standard Swedish population. Cox regression analyses were performed to calculate the hazard ratios for overall survival related to the non-fracture related factors: comorbidity, according to the Charlson comorbidity index (1), independence (living independently in their own home, living with home assistance, or living in a nursery home), use of walking aid as well as medication.Results:The overall 1-year mortality was 5.0 % (n=12/240), compared to an expected age- and gender adjusted 1-year mortality of 11% (n=113/1000) in the Swedish standard population (95% CI 0.20-0.68). The overall 5-year mortality was 48% (n=115/240), compared to an expected value of 56.5% (n=565/1000), (95% CI 0.69-1.01). Patient autonomy had the highest impact on mortality. Living in a nursery home had the poorest prognosis (HR 3.2 95% CI 1.8-5.6).Discussion:Our study analyzes the mortality rate in the super-elderly DRF patients as a separate group and our main finding was, quite surprisingly, that the super elderly patients with wrist fractures had a substantially lower mortality 1 year after fracture compared to the age matched standard population. One can speculate if a distal radius fracture is an indicator of a more active lifestyle or a better balance and a functioning reflex system enabling the patient to fall on the extended wrist instead of landing on e.g. hip or shoulder.It becomes apparent that age alone is a rather inexact tool for triaging the super elderly to offer the best possible treatment. The patients range from healthy independent patients with high demands and high expectations to dependent patients with dementia, unlikely to cooperate in strenuous rehab. Therefore, an individualized treatment protocol appears to be necessary for the superelderly.Conclusions:This study analyzes the 1- and 5-year mortality rate in the super-elderly distal radius fracture patients. Our main finding was that the super elderly patients had a substantially lower mortality one year after fracture compared to the age and gender matched standard population.(1) Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis . 1987, 40: 373-83.