Patients with femoral or distal forearm fracture in Germany: a prospective observational study on health care situation and outcome

BACKGROUND: Distal radius and proximal femoral fractures are typical injuries in later life, predominantly due to simple falls, but modulated by other relevant factors such as osteoporosis. Fracture incidence rates rise with age. Because of the growing proportion of elderly people in Western industrialized societies, the number of these fractures can be expected to increase further in the coming years, and with it the burden on healthcare resources. Our study therefore assessed the effects of these injuries on the health status of older people over time. The purpose of this paper is to describe the study method, clinical parameters of fracture patients during hospitalization, mortality up to one and a half years after discharge in relation to various factors such as type of fracture, and to describe changes in mobility and living situation. METHODS: Data were collected from all consecutive patients (no age limit) admitted to 423 hospitals throughout Germany with distal radius or femoral fractures (57% acute-care, femoral and forearm fractures; 43% rehabilitation, femoral fractures only) between January 2002 and September 2003. Polytrauma and coma patients were excluded. Demographic characteristics, exact fracture location, mobility and living situation, clinical and laboratory parameters were examined. Current health status was assessed in telephone interviews conducted on average 6–7 months after discharge. Where telephone contact could not be established, at least survival status (living/deceased/date of death) was determined. RESULTS: The study population consisted of 12,520 femoral fracture patients (86.8% hip fractures), average age 77.5 years, 76.5% female, and 2,031 forearm fracture patients, average age 67.6 years, 81.6% female. Women's average age was 6.6 (femoral fracture) to 10 years (forearm fracture) older than men's (p < 0.0001). Only 4.6% of femoral fracture patients experienced changes in their living situation post-discharge (53% because of the fracture event), although less than half of subjects who were able to walk without assistive devices prior to the fracture event (76.7%) could still do so at time of interview (34.9%). At time of interview, 1.5% of subjects were bed-ridden (0.2% before fracture). Forearm fracture patients reported no change in living situation at all. Of the femoral fracture patients 119 (0.95%), and of the forearm fracture patients 3 (0.15%) died during hospital stay. Post-discharge (follow-up one and a half years) 1,463 femoral fracture patients died (19.2% acute-care patients, 8.5% rehabilitation patients), but only 60 forearm fracture patients (3.0%). Ninety percent of femoral fracture deaths happened within the first year, approximately 66% within the first 6 months. More acute-care patients with a pertrochanteric fracture died within one year post-discharge (20.6%) than patients with a cervical fracture (16.1%). CONCLUSION: Mortality after proximal femoral fracture is still alarmingly high and highest after pertrochanteric fracture. Although at time of interview more than half of femoral fracture patients reported reduced mobility, most patients (96%) attempt to live at home. Since forearm fracture patients were on average 10 years younger than femoral fracture patients, forearm fractures may be a means of diagnosing an increased risk of later hip fractures

Comparisons of Calculated Respiratory Tract Deposition of Particles Based on the Proposed NCRP Model and the New ICRP66 Model

Task Groups of the National Council on Radiation Protection and Measurements (NCRP) and the International Commission on Radiological Protection (ICRP) have independently revised respiratory tract dosimetry models of inhaled radioactive aerosols. Both models contain modules for calculating inhaled particle deposition. In this report, the deposition of particles in the respiratory tract was calculated based on both the NCRP and the ICRP66 models, under the same particle size distribution, lung volume, and breathing conditions. The results indicate that the largest discrepancy between the two models is for ultrafine particles, where the ICRP66 model predicts a lower tracheobronchial deposition and a higher pulmonary deposition than the NCRP model. This difference is attributed to the fact that the ICRP66 model does not take into account the enhanced diffusional deposition due to the effect of the entrance configuration of a bifurcation. This may have significant implications on dose estimates of inhaled ultrafine particles, including radon and radon progeny. © 1996 Taylor &amp; Francis Group, LLC

Implications of the dosimetric model for the respiratory system on limits for intakes of radionuclides by workers (ICRP Publication 30).

While evaluating respiratory tract kinetic models, we have encountered a number of problems with the recently published ICRP Dosimetric Model for the Respiratory System. Some of those to be discussed are the following.The assumption that the nasopharyngeal (N-P) region can be ignored, despite considerable evidence of significant retention in the N-P region and of pathological effects.Treatment of the tracheobronchial tree (T-B), the pulmonary (P) region and the pulmonary lymph nodes (PLN) as one combined organ for calculating dose.The lack of deposition estimates for very small particles (&lt;0.1 μm dia.) and the use of a probit scale for percentage deposition.Use of the aerodynamic equivalent diameter of particles beyond the range of applicability of the model and the desirability of defining an appropriate 'equivalent deposition diameter' suitable for the whole range of particle sizes of interest.Treatment of components of inhaled mixtures as if they are independent in regard to both deposition and clearance characteristics.Limitations of the currently used rigid solubility classifications (D, W or Y) of inorganic compounds in estimating retention and disposition of deposited particles. © 1982 British Occupational Hygiene Society

Implications of the dosimetric model for the respiratory system on limits for intakes of radionuclides by workers (ICRP Publication 30).

While evaluating respiratory tract kinetic models, we have encountered a number of problems with the recently published ICRP Dosimetric Model for the Respiratory System. Some of those to be discussed are the following.The assumption that the nasopharyngeal (N-P) region can be ignored, despite considerable evidence of significant retention in the N-P region and of pathological effects.Treatment of the tracheobronchial tree (T-B), the pulmonary (P) region and the pulmonary lymph nodes (PLN) as one combined organ for calculating dose.The lack of deposition estimates for very small particles (&lt;0.1 μm dia.) and the use of a probit scale for percentage deposition.Use of the aerodynamic equivalent diameter of particles beyond the range of applicability of the model and the desirability of defining an appropriate 'equivalent deposition diameter' suitable for the whole range of particle sizes of interest.Treatment of components of inhaled mixtures as if they are independent in regard to both deposition and clearance characteristics.Limitations of the currently used rigid solubility classifications (D, W or Y) of inorganic compounds in estimating retention and disposition of deposited particles. © 1982 British Occupational Hygiene Society