Academic Forensic Pathology

Accidental femur fractures in older adults are a public health concern with a considerably high rate of mortality and morbidity. We performed a retrospective review of all deaths reported to the Connecticut Office of Chief Medical Examiner (OCME) over a 5-year period that involved a femur fracture resulting from a ground-level fall. Data on cause of death, contributing conditions, age, ethnicity, sex, comorbidities, and interval between surgery and death were extracted. There were 470 deaths caused by a hip fracture due to a ground-level fall. The majority were woman (n = 312 or 66.1%) and White (n = 435 or 95.8%). The median age of the study population was 89 years (interquartile range [IQR] = 83-94). The locations of the falls were predominantly in homes (59.8%) or skilled nursing facilities (SNFs) (26.8%). Complications following surgery occurred with 259 (87.2%) of the 297 patients who underwent surgical repair. Contributing conditions to death occurred in 76.1% of patients (n = 359), with the most common being heart disease, dementia, chronic obstructive pulmonary, and diabetes mellitus (DM). The median survival interval after injury was 9 days (IQR = 4-21 days). The Area Deprivation Index (ADI) was not associated with sex, race, medical conditions determined to have contributed to death, whether the patient underwent surgery, or with any surgical complication. This study demonstrates the important role of medicolegal death investigation in producing accurate death certifications that can inform stakeholders about risk factors and comorbidities that may enhance the overall management of hip fractures in an ageing population.

Gossypibomas, or retained surgical sponges, are rare and potentially life-threatening complications in modern medicine. They are most commonly the result of emergency abdominal or gynecological surgeries but can occur in any surgery where sponges are used intraoperatively. They can remain in the body for years following surgery and pose a risk for migration and subsequent complications. This case describes an abdominal gossypiboma in a 90-year-old woman, first identified more than a decade after a salpingo-oophorectomy. Migration into her colon eventually caused bowel obstruction and resulted in death. Intentional underreporting of gossypibomas is a major problem that limits knowledge of the condition and hinders their prevention.