J. M. Nadaud1, E. R. Heidel2, B. J. Daley2, C. L. McKnight2 1University of Tennessee Health Science Center, College Of Medicine, Memphis, TN, USA 2University of Tennessee Medical Center, Department Of Surgery, Knoxville, TN, USA
Introduction:
Fragility fractures are the result of a low energy mechanism and are associated with significant mortality and morbidity. We examined the outcomes after implementation of a fragility fracture program at a level 1 academic trauma center. The pathway involves emergency department clearance for other traumatic injuries and admission by a medical service with orthopedic consultation for fracture care.
Methods:
The pathway was initiated in 2021 and all patients with an isolated fragility fracture proximal to the ankle/wrist were included in this study, with patient cohorts two years before (PRE) and two years after (POS). Demographic and outcome data was collected and analyzed by Chi Squares and Tukey Hinges statistical calculations using SPSS version 29. Demographics include age, gender, fracture location, injury severity score (ISS), and American Society of Anesthesiologists (ASA) score. Measured outcomes include DVT/PE, hospital mortality, disposition to hospice, non-operative rate, unplanned ICU admission, time to surgery (TTS), length of stay (LOS). Admission service was also recorded. Significance was assigned at a p < 0.05.
Results:
There were 1137 patients in the study – 564 PRE and 573 POS. POS patients had a slightly higher ISS (p = 0.003) and different fracture location (p < 0.017), but all other demographics were not significantly different. There was a significant decrease in trauma admission after implementation of the pathway (p < 0.001; PRE: 21.5% and POS: 1.8%). No significant differences were seen in any outcome measures except for an increase in LOS (p < 0.001; median PRE: 114 hours and POS: 124 hours) and TTS (p < 0.001; median PRE: 15 hours 7 minutes and POS: 18 hours 57 minutes).
Conclusion:
Implementation of a fragility pathway did not affect morbidity or mortality. Although TTS did increase, it remained under the 48-hour recommendation without increased complications. We did find increased LOS as opposed to other studies, possibly a reflection of COVID 19 effect or higher POS ISS. There was also a significant drop in trauma as the admitting service, demonstrating adherence to the fragility pathway protocols. Overall, these findings highlight the need for further investigation to better understand the impact of the fragility fracture program but support a fragility pathway’s capability to maintain high quality care.
