Abstract Background Overall outcomes in open lower limb fractures (OLLF) have significantly improved following the adoption of BOAST4 guidelines, however these do not account for differences between age groups. With an ageing population and resulting shift in trauma demographics, there is a need to understand how outcomes differ across age cohorts. Methods A retrospective analysis was performed of all patients presenting with an OLLF to a UK major trauma centre from January 2020–March 2024. Patients were grouped as elderly (≥65 years) or non-elderly (16–65 years). Data collected included demographics, mechanisms of injury, injury characteristics, operative management and outcomes. Results 691 fractures were analysed, of which 19.5% were in elderly patients. The ≥65 group had a higher proportion of females (77.3 versus 26%, P 0.0001) and more comorbidities (mean 1.1 versus 0.2, P 0.001). Low-energy falls accounted for 75.9% of fractures in the elderly and only 24.5% of the non-elderly (P 0.001), who were more likely to suffer trauma from road traffic accidents (49.3 versus 17.3%, P 0.0001). Older patients had a higher proportion of Gustilo-Anderson grade 3A injuries (39.1 versus 25.5%, P = 0.006). Though bony fixation techniques differed significantly, soft tissue reconstruction methods and their outcomes were comparable across groups. Elderly patients had longer median hospital stays (17 versus 9 days, P 0.001) and greater excess stay due to discharge planning delays. Conclusions Elderly OLLF patients differ in demographics, mechanisms, comorbidities which we believe should be reflected in management. Incorporating orthogeriatric principles into trauma pathways may improve outcomes and resource use in this growing population.
Biosse-Duplan et al. (Sun,) studied this question.