Outcomes After Implementation of a Fragility Fracture Pathway in Ground Level Falls.

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Geriatric Medicine

Background:

• Fragility fractures, resulting from low-energy mechanisms, contribute to significant patient morbidity and mortality.
• A level I trauma center implemented a dedicated fragility fracture program to manage these injuries.
• The program involves trauma surgery clearance followed by medical service admission and orthopedic consultation.

Purpose of the Study:

• To review the implementation and impact of a fragility fracture program at a level I trauma center.
• To compare patient demographics and outcomes before and after the program's implementation.

Main Methods:

• A comparative study analyzed data from 1137 patients (564 pre-implementation, 573 post-implementation).
• Key outcome measures included deep vein thrombosis/pulmonary embolism, mortality, hospice disposition, nonoperative rate, ICU admission, time to surgery (TTS), and length of stay (LOS).
• Statistical analyses compared cohorts based on demographics and outcomes.

Main Results:

• The post-implementation cohort had higher injury severity scores and different fracture locations.
• Trauma admissions decreased significantly post-implementation (21.5% to 1.8%).
• Length of stay (LOS) increased from 114 to 124 hours, and time to surgery (TTS) increased from 15 to 18 hours, though both remained within guidelines.

Conclusions:

• Pathway implementation did not correlate with changes in morbidity or mortality.
• Slight increases in TTS and LOS were observed, potentially due to external factors like COVID-19 or demographic shifts.
• Decreased trauma admissions indicate successful adherence to the new fragility fracture pathway, warranting further investigation into optimizing such programs.