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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A 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                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200927,315), geriatric subgroup (\u2265\u200975 years;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200916,276), and fourth column group with concomitant sternal fracture (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009499). Data were provided by the German Institute for the Hospital Remuneration System.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 27,814 cases 63.0% were female and 58.5% aged\u2009\u2265\u200975 years. Fourth column fractures (1.8%) defined a mechanistically distinct entity: male predominance (57.7%), younger age distribution (\u2265\u200975 years: 30.3% vs. 59.0%), prolonged hospitalisation (14.7 vs. 10.1 days) and comorbidity burden (PCCL\u2009\u2265\u20093: 59.3% vs. 11.7%). Mortality in the thoracic spine group was 2.00%, rising to 2.89% in patients aged\u2009\u2265\u200975 years, accounting for 86.1% of all deaths. In geriatric subgroup, mortality was dominated by acute organ-failure: cardiac arrest (OR\u2009=\u200951.74), sepsis (OR\u2009=\u200942.96) and respiratory insufficiency (OR\u2009=\u200914.67). In thoracic spine group, concomitant thoracic cage injuries were associated with elevated mortality: haemothorax (OR\u2009=\u20095.73) and serial rib fractures (\u2265\u20094 ribs, OR\u2009=\u20093.31).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Fourth 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00586-026-10327-2","type":"journal-article","created":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T05:38:28Z","timestamp":1787981908000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The fourth column in thoracic vertebral fractures: concomitant thoracic cage injuries and mortality in 27,814 inpatient cases from the german national DRG database"],"prefix":"10.1007","author":[{"given":"Josina","family":"Straub","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Ardelt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Reinhard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Addisu","family":"Mesfin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Arias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nike","family":"Walter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Alt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Popp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siegmund","family":"Lang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,29]]},"reference":[{"key":"10327_CR1","doi-asserted-by":"publisher","first-page":"6984","DOI":"10.1038\/s41598-023-31654-0","volume":"13","author":"S Lang","year":"2023","unstructured":"Lang S, Walter N, Freigang V et al (2023) Increased incidence of vertebral fractures in German adults from 2009 to 2019 and the analysis of secondary diagnoses, treatment, costs, and in-hospital mortality. 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