Court-Brown and Caesar analyzed 5,953 adult fractures at a single Scottish trauma unit in 2000. The study asks: how many fracture types are truly osteoporotic, and what does the actual distribution of adult fractures look like? It is the foundational epidemiologic reference for adult fracture patterns in the modern era.
The fragility fracture workup used to start and stop with four sites: spine, distal radius, proximal femur, and proximal humerus. Court-Brown's data show that framework captures less than half the picture — 14 fracture types meet epidemiologic criteria for predominantly osteoporotic, accounting for 42% of all fractures treated.
When you see a bi-malleolar ankle fracture, a femoral shaft fracture, a distal humerus fracture, an olecranon fracture, or a pelvic fracture in a patient over 60, treat it as an osteoporotic event. Screen bone density, optimize anti-resorptive therapy, and arrange a falls assessment. The same protocol you trigger for a hip fracture.
Ankle fracture subtype matters for secondary prevention. Bi-malleolar and tri-malleolar patterns carry a Type E (osteoporotic) distribution, while supra-syndesmotic fractures carry a Type C (young patient) distribution. Calling it 'an ankle fracture' and moving on will cause you to miss secondary prevention in a meaningful subset of patients.
A femoral shaft fracture in a patient over 60 requires an oncologic and metabolic workup, not just a nail. The average age of this injury shifted from 44 to 68 in a single decade. Assuming high-energy trauma will cause you to miss the underlying diagnosis.
Court-Brown and Caesar analyzed 5,953 adult fractures at a single Scottish trauma unit in 2000. The study asks: how many fracture types are truly osteoporotic, and what does the actual distribution of adult fractures look like? It is the foundational epidemiologic reference for adult fracture patterns in the modern era.
The fragility fracture workup used to start and stop with four sites: spine, distal radius, proximal femur, and proximal humerus. Court-Brown's data show that framework captures less than half the picture — 14 fracture types meet epidemiologic criteria for predominantly osteoporotic, accounting for 42% of all fractures treated.
When you see a bi-malleolar ankle fracture, a femoral shaft fracture, a distal humerus fracture, an olecranon fracture, or a pelvic fracture in a patient over 60, treat it as an osteoporotic event. Screen bone density, optimize anti-resorptive therapy, and arrange a falls assessment. The same protocol you trigger for a hip fracture.
Ankle fracture subtype matters for secondary prevention. Bi-malleolar and tri-malleolar patterns carry a Type E (osteoporotic) distribution, while supra-syndesmotic fractures carry a Type C (young patient) distribution. Calling it 'an ankle fracture' and moving on will cause you to miss secondary prevention in a meaningful subset of patients.
A femoral shaft fracture in a patient over 60 requires an oncologic and metabolic workup, not just a nail. The average age of this injury shifted from 44 to 68 in a single decade. Assuming high-energy trauma will cause you to miss the underlying diagnosis.