Gender-Based Frailty in Multiple Orthopedic Fractures

Area of Science:

• Geriatric Trauma
• Orthopedic Surgery
• Geriatric Medicine

Background:

• The 5-factor modified frailty index (mFI-5) is a prognostic tool for complications and mortality.
• Its association with injury severity in ground-level falls, specifically femur vs. combined femur-humerus fractures, is not well-established.

Purpose of the Study:

• To investigate the association between the mFI-5 and the risk of combined femur-humerus fractures versus isolated femur fractures in geriatric patients following ground-level falls.
• To identify predictors of combined femur-humerus fractures in this population.

Main Methods:

• Retrospective analysis of the 2017-2018 American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database.
• Inclusion of patients with femur fractures (n=190,836) and combined femur-humerus fractures (n=5054).
• Multivariate analysis to assess predictors of fracture patterns.

Main Results:

• Gender was the only statistically significant predictor for combined femur-humerus fractures versus isolated femur fractures (OR 1.69, 95% CI [1.65, 1.74], P < .001).
• The mFI-5 was not found to be a significant predictor of combined femur-humerus fractures in this cohort.
• Existing literature shows mFI-5 predicts adverse events, but this study questions its predictive power for specific injury patterns.

Conclusions:

• The mFI-5 may not be a reliable tool for predicting the extent of injury (combined femur-humerus vs. isolated femur fractures) in geriatric patients after ground-level falls.
• Gender appears to be a more significant factor in determining combined femur-humerus fractures.
• The mFI-5 might overestimate disease-specific risk factors rather than overall frailty, potentially diminishing its predictive utility for specific fracture patterns.