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The Geographic Incidence and Treatment Variation of Common Fractures of Elderly Patients

Dr. Sporer is Assistant Professor, Department of Orthopaedic Surgery, Rush Medical College, Winfield, IL. Dr. Weinstein is Chairman and Professor, Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, and Professor, Dartmouth Medical School and the Center for the Evaluative Clinical Sciences, Dartmouth College, Hanover, NH. Dr. Koval is Professor, Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Sporer, Dr. Weinstein, and Dr. Koval.

Supported in part by NIAMS #U01-AR45444-01A1, the Robert Wood Johnson Foundation, the American Academy of Orthopaedic Surgeons, and the American Hospital Association.

Reprint requests: Dr. Sporer, Rush Medical College, 25 N Winfield Road, Winfield, IL 60190.

Fractures of the hip, wrist, proximal humerus, and ankle frequently are observed among the elderly patient population in the United States. The Medicare patient population has shown dramatic geographic variation in the rates of these common fractures, with an increased incidence observed throughout the Southeast. Treatment (surgical versus nonsurgical) is also highly variable and dependent on the geographic location but not necessarily on the type of injury. Whereas regional variation in medical treatment may be attributed to variations in practice patterns, the etiology behind the dramatic variations in fractures is less well-defined and is likely multifactorial, related to environmental, occupational, genetic, or nutritional factors.

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