During the study period, 1436 patients with DRFs (1005 F, 431 M; mean age 40.62 years) were admitted to the ED. There were 609 (42.4%) and 827 (57.6%) pediatric and adult patients, respectively. The study group was composed of 827 patients (579 F, 248 M; mean age 60.23 years; SD 16.65 years) since the pediatric population was not considered in the present study.
In the same period, 11,961 fractures in 12,054 adult patients were diagnosed. Maxillofacial or head fractures were not considered in the present study. DRFs represented 6.9% of the overall fractures in adult population.
Several associations with other fractures were found: in 12 cases DRF was bilateral (1.4%), and in 130 (15.9%) cases DRF was associated with ulnar styloid process fracture, in 67 (8.1%) cases with distal ulnar fracture, in 35 (4.2%) cases with scaphoid fracture, in 11 (1.3%) patients with ulnar diaphysis, in 13 (1.5%) cases with olecranon fracture, in 11 (1.3%) cases with proximal humerus fracture, and in 24 (2.9%) cases with femoral neck fracture. In 75 (9.1%) cases, an association with costal fracture was detected.
The mean age of females at the time of fracture was significantly higher than that of males [mean age 65.42 years (SD 13.18 years) in females and 48.11 years (SD 17.62 years) in males; p < 0.01]. Left side was most frequently involved (56.1%).
Figure 1 shows the yearly distribution of DRFs in both genders according to a 2-month classification period. Regarding the period of the year, 305 DRFs (37.5%) were observed in the warmer months (May to August) and 272 (33.4%) in the colder months (November to February). No significant differences were found (p = 0.85).
Figure 2 shows the distribution of different trauma mechanism considering the different periods of the year; low-energy trauma occurring outside home was found to be the major cause of DRF throughout the year. Figure 3 shows the distribution of different trauma mechanisms according to gender. A statistically significant difference was found between gender in all trauma mechanisms except for 6. (p < 0.01). In both genders, trauma mechanism 2 was more frequent (59.4% F; 31.9% M; p < 0.01). The second most frequent mechanism in females was 1 (low-energy trauma at home; 32.6%), while in males it was 3 (sports trauma; 20.6%).
A bimodal distribution of fracture mechanisms was found in males when considering the patient’s age. A high-energy mechanism of fracture (3 and 4) was found in 21% (n = 52) of males aged 18–45 years, and a low-energy mechanism (1 and 2) was observed in 39.9% (n = 99) of males aged > 45 years. In females, mechanism 2 prevails in every age group.
Figure 4 shows the distribution of different trauma mechanisms according to the different days of the week. Low-energy trauma occurring outside home was found to be the major cause of DRFs during every day. No significant differences between gender were observed when the day in which DRFs occurred was considered (p = 0.027).
According to the AO/OTA classification system, Table 1 presents the different fractures patterns. The mean κ value for the intraobserver reliability assessment was 0.89 (95% CI 0.81–0.99), and according to the Landis and Koch criteria, it was considered as almost perfect agreement. The mean κ value for interobserver reliability was 0.67 (95% CI 0.59–0.75), and it was considered as substantial agreement according to the Landis and Koch criteria [21, 24].
The most frequent fracture group according to AO/OTA was the complete articular fracture (64.3%); however, the most frequent DRF type was 2R3A2.2. Figures 5, 6, 7 and 8 show the different distribution of DRF patterns according to gender. 2R3A2.2 was the most frequent fracture type in females (24.9%), while it was 2R3C2.1 in males (20.6%).
A post-hoc analysis of the standardized residues of the chi-square test with Bonferroni correction demonstrated a significant difference between genders in terms of extraarticular (p < 0.001) and partial fractures (p < 0.001), but no difference was found for complete ones.
A significant correlation between all trauma mechanisms (from 1 to 6) and different fracture patterns (complete, partial, and extraarticular) was found (p < 0.001).
Considering the association between different pattern of DRFs and the different periods of the year (two-classification month), no significant differences were found. No significant association between fracture type and days of the week was found (p = 0.76).
The mean age of patients with extraarticular fractures (mean age 61.75 years; SD 18.18 years) was higher than those with complete (mean age 59.84 years; SD 15.67 years) and partial fractures (mean age 55.26 years; SD 18.31 years). Furthermore, considering different fracture patterns and patient age groups, a statistically significant difference was found (p < 0.001).
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