high-trauma versus low-trauma fracture

Q: What are high and low trauma fractures?

Answer: High-trauma and low-trauma fractures are conventionally differentiated based on the force to which the bone is subjected, or by assuming that the level of force is high enough to break any normal bone.

• High-trauma fractures usually occur from motor vehicle accidents (MVA), sports, or falls.
• Low-trauma fractures, also known as fragility fractures, occur due to minimal trauma in weakened bones. 

Clinical implication: This classical differentiation has been questioned by many critics as patients with low Bone Mineral Density (BMD) also increase the risk of high-trauma fractures. Most high-trauma fractures are usually excluded from observational and osteoporosis trials, which may bias the studies due to erroneous selection criteria.

#trauma

#orthopedics

References:

1. Khosla S. High-trauma fractures and bone mineral density. JAMA 2007; 298:2418.

2. Sanders KM, Pasco JA, Ugoni AM, et al. The exclusion of high trauma fractures may underestimate the prevalence of bone fragility fractures in the community: the Geelong Osteoporosis Study. J Bone Miner Res 1998; 13:1337.

3. Leslie WD, Schousboe JT, Morin SN, Martineau P, Lix LM, Johansson H, McCloskey EV, Harvey NC, Kanis JA. Fracture risk following high-trauma versus low-trauma fracture: a registry-based cohort study. Osteoporos Int. 2020 Jun;31(6):1059-1067. doi: 10.1007/s00198-019-05274-2. Epub 2020 Mar 16. PMID: 32173782; PMCID: PMC7115893.