Outcomes of conservatively managed traumatic thoracic vertebral and rib fractures in older adults at a major trauma centre

Abstract

Background

Fractures of the thoracic spine and rib cage frequently occur simultaneously in older trauma patients. The impact of rib fractures in the setting of thoracic spine fractures, and whether multiple thoracic spine fractures is associated with outcomes, remain unclear. This study aimed to evaluate the outcomes associated with either (i) multiple rib fractures or (ii) multi-level thoracic spine fractures in older adults with at least one thoracic spine fracture.

Methods

We conducted a retrospective cohort study to identify patients aged ≥65 years with at least one non-operatively managed thoracic spine fracture managed at an Australian Major Trauma Service between 2016 and 2021. Patients were divided into four groups based on injury profile – single-level or multi-level thoracic spine fractures, either with (R+) or without (R−) concurrent multiple rib fractures. Multi-variable regression was used to evaluate the association of rib fractures and multi-level thoracic spine fractures (controlling for the reciprocal injury and demographic variables) with outcomes. Outcomes included hospital length of stay (LOS), discharge destination, 6-month residential status and 12-month mortality.

Results

In total, 409 patients had at least one non-operatively managed thoracic spine fracture. A total of 121 (29.6%) had multi-level thoracic spine fractures, and 98 (24.2%) had multiple rib fractures. After adjusting for associated factors and the presence of multiple rib fractures, multi-level thoracic spine fractures were associated with a 21% increase in hospital LOS (geometric mean 1.21, 95% confidence interval (CI) 1.05–1.40, p = 0.005) and more than double the odds of 12-month mortality (odds ratio 2.6, 95% CI 1.3–5.2, p = 0.008). In contrast, multiple rib fractures were not associated with any measured outcomes, even with the influence of multi-level thoracic spine fractures controlled for.

Conclusion

Multi-level thoracic spine fractures, irrespective of the presence of multiple rib fractures, were associated with an increase in hospital LOS and 12-month mortality in older adults with at least one thoracic spine fracture.