ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
The fourth column in thoracic vertebral fractures: concomitant thoracic cage injuries and mortality in 27,814 inpatient cases from the german national DRG database.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposePopulation-level data on fourth column fractures and prognostic implications remain lacking. This study aimed to characterise the epidemiology of thoracic vertebral fractures in Germany, including the prevalence of fourth column injuries and geriatric patients, comorbidity burden and the in-hospital mortality across distinct fracture populations.
methodsA Nationwide cross-sectional administrative inpatient data analysis of all adult thoracic vertebral fracture cases (ICD-10-GM S22.0x/S22.1) from the 2024 German Diagnosis Related Groups database was conducted across three groups: thoracic spine group (n = 27,315), geriatric subgroup (≥ 75 years; n = 16,276), and fourth column group with concomitant sternal fracture (n = 499). Data were provided by the German Institute for the Hospital Remuneration System.
resultsAmong 27,814 cases 63.0% were female and 58.5% aged ≥ 75 years. Fourth column fractures (1.8%) defined a mechanistically distinct entity: male predominance (57.7%), younger age distribution (≥ 75 years: 30.3% vs. 59.0%), prolonged hospitalisation (14.7 vs. 10.1 days) and comorbidity burden (PCCL ≥ 3: 59.3% vs. 11.7%). Mortality in the thoracic spine group was 2.00%, rising to 2.89% in patients aged ≥ 75 years, accounting for 86.1% of all deaths. In geriatric subgroup, mortality was dominated by acute organ-failure: cardiac arrest (OR = 51.74), sepsis (OR = 42.96) and respiratory insufficiency (OR = 14.67). In thoracic spine group, concomitant thoracic cage injuries were associated with elevated mortality: haemothorax (OR = 5.73) and serial rib fractures (≥ 4 ribs, OR = 3.31).
conclusionsFourth column fractures constitute a mechanistically distinct high-energy injury entity, while in the geriatric thoracic spine fracture population, mortality is governed by vulnerability rather than fracture severity, suggesting that frailty assessment may be of value and risk-stratified clinical pathways.
Indexed as
Identifiers
42667345What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.