The epidemiology of hospitalised wrist fractures in older people, New South Wales, Australia
Introduction
Wrist fractures are common among older people with a lifetime risk in women of about 15%, which is as high as that for a hip fracture or a clinically evident vertebral fracture [1]. Wrist fractures often result from a fall and are highly related to concurrent osteoporosis [2], [3]. Whilst the prognosis is relatively good in younger people, older people sustaining wrist fractures suffer a number of complications including temporary alteration in their ability to function which can be sufficient to preclude independent living, poor reduction and subsequent mal-union of the fracture, carpal tunnel syndrome, reflex sympathetic dystrophy and post-traumatic arthritis [4]. As result, they often fail to regain full mobility of the wrist joint, with up to half of cases losing some function permanently [5].
Wrist fractures have also been shown to be a predictor of more serious fractures, such as hip and vertebral fractures in older people [6], with one study indicating an 11-fold increase in the risk of vertebral fractures among men following a first distal forearm fracture [7]. Complications following a wrist fracture can contribute to a decreased quality of life and eventually to premature death in older people. A cohort study of people aged 65+ years reported that seven-year survival rates, after a distal radius fracture, was 20% lower than those expected for individuals of the same age and gender in standard populations, with men twice as likely to die as women [8].
In this study, we examine the epidemiology and trends in wrist fracture admissions to public and private acute hospitals in NSW between July 1993 and June 2003 using routinely collected hospital separations statistics. The analysis provides valuable information that can be used to plan prevention interventions, to assess the burden of this type of fracture and to allocate adequate resources for the management of wrist fractures in acute settings.
Section snippets
Materials and methods
Data analysed in this study were obtained from the Inpatient Statistics Collection (ISC) and cover all inpatient separations, also referred to as hospital discharges, from acute public and private hospitals in New South Wales (NSW) between 1993–1994 and 2003–2004. The ISC is a financial year collection from 1 July to 30 June of the following year. Hospitals are required to submit details for every inpatient and for every episode of care. An episode of care ends by either the patient ending a
Results
Over the period July 1993 to June 2003, there were 31,190 admissions of patients aged 50 years and over to NSW acute hospitals for wrist fractures. The majority of cases (83.6%) occurred in women aged 50 years and over. Almost all cases (97%) were distal forearm fractures with carpal fractures making up the rest. Colles' fractures (fracture of the lower end of radius with dorsal angulation) represented more than half (56%) of wrist fractures in women and just over 39% in men (Table 1).
During
Discussion
This study shows that the majority of wrist fractures requiring hospitalisation occur in women with a greater than four-fold higher age-standardised hospitalisation rate than that found in men. This gender difference is considered to be related to the impact of osteoporosis on the risk of this type of fracture [2]. Whilst both men and women lose bone mass as result of aging, the rate of loss is quicker and much more pronounced in women [11], [12]. It is estimated that, in those aged over 50
Conclusions
The study found a modest increase in age-standardised hospitalisation rates for wrist fractures in people aged 50 years between July 1993 and June 2003. This, however, was paralleled by a substantial rise in the number of hospitalisations for wrist fractures and this is likely to continue into the future imposing considerable burden on health care services. Whilst a fall remains the main mechanism of wrist fractures in older people, high energy mechanisms, including transport crashes, are
Acknowledgments
Both C. Finch and S. Lord are supported by National Health and Medical Research Council Principal Research Fellowships. S. Boufous is supported by the Injury Risk Management Research Centre, with core funding provided by the NSW Department of Health, the NSW Roads and Traffic Authority and the Motor Accidents Authority. The authors wish to thank the Centre for Epidemiology and Research at the NSW Health Department for providing the data analysed in this study.
References (27)
- et al.
Survival among elderly patients after fractures of the distal radius
J Hand Surg Am
(2002) Forearm fracture
Bone
(1996)- et al.
Fractures in the elderly: epidemiology and demography
Bailliere's Clin Endocrinol Metab
(2000) - et al.
Secondary osteoporosis and the risk of vertebral deformities in women
Bone
(1999) - et al.
Fracture of the distal forearm: epidemiological developments in the period 1971–1995
Injury
(1998) - et al.
The increasing burden of pelvic fractures in older people, New South Wales, Australia
Injury
(2005) - et al.
Accuracy of ICD-9-CM codes in hospital morbidity data, Victoria: implications for public health research
Aust N Z J Public Health
(1997) - et al.
Lifetime risks of hip, Colles', or vertebral fracture and coronary heart disease among white postmenopausal women
Arch Intern Med
(1989) - et al.
Colles' fracture of the wrist as an indicator of underlying osteoporosis in postmenopausal women: a prospective study of bone mineral density and bone turnover rate
Osteoporos Int
(1998) - et al.
Which fractures are associated with low appendicular bone mass in elderly women? The Study of Osteoporotic Fractures Research Group
Ann Intern Med
(1991)