• Long-Term Consequences of Major Extremity Trauma: A Pilot Study.

      Castillo, Renan C; Carlini, Anthony R; Chaffee, Trisha; Bosse, Michael J; O'Toole, Robert V; Kleweno, Conor P; McKinley, Todd O; Agel, Julie; Higgins, Thomas F; Morshed, Saam; et al.
      Limited data are available on the longer-term physical and psychosocial consequences after major extremity trauma apart from literature on the consequences after major limb amputation. The existing literature suggests that although variations in outcome exist, a significant proportion of service members and civilians sustaining major limb trauma will have less than optimal outcomes or health and rehabilitation needs over their life course. The proposed pilot study will address this gap in current research by locating and consenting METRC participants with the period of 5-7 years postinjury, identifying potential participation barriers and appropriate use of incentives, and conducting the follow-up examination at several data collection sites. The resulting data will inform the primary objective of refining and developing specific hypotheses to determine the design, scope, and feasibility of the main long-term consequences of major extremity trauma. Three METRC enrollment centers will contact past participants to achieve the goal of completing an interview, select patient-reported outcomes, perform a medical record review, and conduct an in-person clinic visit that will consist of a physical examination, blood draw, and x-ray of the study injury area. If successful, it will be possible to design studies to further examine these effects and develop future therapeutic interventions.
    • National trends in extremity fracture hospitalizations among older adults between 2003 and 2017

      Reider, Lisa; Pollak, Andrew; Wolff, Jennifer L; Magaziner, Jay; Levy, Joseph F (Blackwell Publishing, 2021-06-01)
      Background: Fractures in late life are highly consequential for health, services use, and spending. Little is known about trends in extremity fracture hospitalizations among older adults in the United States. Design: Retrospective longitudinal cohort study. Setting: The 2003–2017 National Inpatient Sample (NIS), a representative sample of U.S. community hospitals. Participants: Hospitalized adults aged 65 and older with a diagnosis of upper or lower extremity fracture. Measurements: Incidence of extremity fracture hospitalization and mortality, using NIS discharge and trend weights, and population denominators derived from the U.S. Census Bureau. Incidence was reported separately for men and women by age, fracture diagnosis, and injury mechanism. Weighted linear regression was used to test for significant trends over time. Results: Incidence of extremity fracture hospitalizations declined in both women (15.7%, p trend < 0.001) and men (3.2%, p trend < 0.001) between 2003 and 2017. This trend was primarily attributed to a decline in low energy femur fractures which accounted for 65% of all fracture hospitalizations. Among older adults with an extremity fracture hospitalization, mortality declined from 5.1% in 2003 to 3.3% in 2017 in men, and from 2.6% to 1.9% in women (p trend < 0.001). High energy fractures were due to falls (53%), motor vehicle accidents (34%), and other high impact injuries (13%). Overall, 12% of extremity fracture hospitalizations were attributed to high-energy injuries: increases were observed among men ages 65–74 (20%; p trend < 0.001) and 75–84 (10%; p trend = 0.013), but not among women of any age. Conclusion: Observed declines in the incidence of extremity fracture hospitalizations and related mortality are encouraging. However, increasing incidence of fracture hospitalization from high energy injuries among men suggests that older adults with complex injuries will be seen with more prevalence in the future. © 2021 The Authors.
    • New and Renewed Directions for the Major Extremity Trauma and Rehabilitation Consortium.

      Castillo, Renan C; Reider, Lisa; O'Toole, Robert V (Lippincott Williams and Wilkins, 2022-01)