Early Operative Versus Nonoperative Treatment of Fragility Fractures of the Pelvis: A Propensity-Matched Multicenter Study

Osterhoff, Georg; Noser, Jonas; Held, Ulrike; Werner, Clément M. L.; Pape, Hans-Christian; Dietrich, Michael

doi:10.1097/bot.0000000000001584

Cited by 49 publications

(52 citation statements)

References 20 publications

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“…The patients requiring surgery for FFP are geriatric patients with a median age of 78 years, they were mostly frail, often reported a fall from standing height, and presented with multiple comorbidities. Seventy-two percent had an ASA of 3 or higher, which is more than in previous studies with 49–68% 1 , 13 , 24 . Half of the patients had two or more comorbidities.…”

Section: Discussionmentioning

confidence: 49%

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Trans-sacral bar osteosynthesis provides low mortality and high mobility in patients with fragility fractures of the pelvis

Wagner

Kisilak

Porcheron

et al. 2021

Sci Rep

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Operative treatment of osteoporosis-associated fragility fractures of the pelvis (FFP) and the sacrum is advocated with immobilizing or longstanding pain, fracture progression and displacement. We analyzed clinical outcomes regarding mobility, quality of life, and mortality of patients with FFP treated with trans-sacral bar (TB) osteosynthesis through S1. Demographics, clinical data, and operation-related data of patients with an FFP treated with TB were acquired from chart review. We assessed mortality, quality of life (EQ-5D), mobility, and residential status at follow-up. Seventy-nine females and six males with a median age of 78.0 years (IQR 73–84) were included, median follow-up was 3.2 years. Medical complications during hospitalization occurred in 28%. Operative revision was carried out in 15% of patients. One-year survival was 90.4%, this was associated with shorter preoperative and total length of stay in hospital (p 0.006 and 0.025, respectively). At follow-up, 85% lived at home and 82% walked with or without walking aid. Higher EQ-5D was reached with higher mobility status and living at home (p < 0.001 and < 0.001, respectively). TB osteosynthesis is an adequate and reliable method for fixation of FFP in the posterior pelvic ring to ensure timely mobilization. Shorter preoperative and total length of stay had lower mortality rates, advocating a standardized management protocol to limit time delay to operative therapy. Patients treated with TB osteosynthesis had low 1-year mortality of less than 10%.

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Section: Discussionmentioning

confidence: 49%

“…In conservative treatment, the rate of medical complications is 20–53% 1 , 26 , 27 . Operatively treated patients tend to have less medical complications (13–28%) 16 , 24 , 28 , 29 . We confirmed lower complication rates with surgery (28%).…”

Section: Discussionmentioning

confidence: 99%

Trans-sacral bar osteosynthesis provides low mortality and high mobility in patients with fragility fractures of the pelvis

Wagner

Kisilak

Porcheron

et al. 2021

Sci Rep

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“…Our group has also described, that CG may be useful due to standardization, as achieved by standard operating protocols [18], mobility protocols, and development of special protocols for those with comorbidities and multiple injury scenarios [11,22,23].…”

Section: Introductionmentioning

confidence: 99%

The effect of geriatric comanagement (GC) in geriatric trauma patients treated in a level 1 trauma setting: A comparison of data before and after the implementation of a certified geriatric trauma center

Halvachizadeh

Gröbli²,

Berk

et al. 2021

PLoS ONE

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Introduction Improvements in life expectancy imply that an increase of geriatric trauma patients occurs. These patients require special attention due to their multiple comorbidity issues. The aim of this study was to assess the impact of the implementation of geriatric comanagement (GC) on the allocation and clinical outcome of geriatric trauma patients. Methods This observational cohort study aims to compare the demographic development and the clinical outcome in geriatric trauma patients (aged 70 years and older) before and after implementation of a certified geriatric trauma center (GC). Geriatric trauma patients admitted between January 1, 2010 and December 31, 2010 were stratified to group pre-GC and admissions between January 1, 2018 and December 31, 2018 to Group post-GC. We excluded patients requiring end-of-life treatment and those who died within 24 h or due to severe traumatic brain injury. Outcome parameters included demographic changes, medical complexity (measured by American Society of Anaesthesiology Score (ASA) and Charlson Comorbidity Index (CCI)), in-hospital mortality and length of hospitalization. Results This study includes 626 patients in Group pre-GC (mean age 80.3 ± 6.7 years) and 841 patients in Group post-GC (mean age 81.1 ± 7.3 years). Group pre-GC included 244 (39.0%) males, group post-GC included 361 (42.9%) males. The mean CCI was 4.7 (± 1.8) points in pre-GC and 5.1 (± 2.0) points in post-GC (p <0.001). In Group pre-GC, 100 patients (16.0%) were stratified as ASA 1 compared with 47 patients (5.6%) in Group post-GC (p <0.001). Group pre-GC had significantly less patients stratified as ASA 3 or higher (n = 235, 37.5%) compared with Group post-GC (n = 389, 46.3%, p <0.001). Length of stay (LOS) decreased significantly from 10.4 (± 20.3) days in Group pre-GC to 7.9 (±22.9) days in Group post-GC (p = 0.011). The 30-day mortality rate was comparable amongst these groups (pre-GC 8.8% vs. post-GC 8.9%). Conclusion This study appears to support the implementation of a geriatric trauma center, as certain improvements in the patient care were found: Despite a higher CCI and a higher number of patients with higher ASA classifications, Hospital LOS, complication rates and mortality did were not increased after implementation of the CG. The increase in the case numbers supports the fact that a higher degree of specialization leads to a response by admitting physicians, as it exceeded the expectable trend of demographic ageing. We feel that a larger data base, hopefully in a multi center set up should be undertaken to verify these results.

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“…Even though prospective clinical studies are still lacking, we do see that patients who have undergone oedema-sensitive imaging profit from surgical management [8]. In their study, Osterhoff et al demonstrated that patients who were not mobilised within 3-5 days and then underwent early surgical stabilisation, presented a higher mortality and complication rate within one year, although long-term survival was better after two years [28]. However, this raises the question of whether the higher mortality rate within the first year was due to the surgical management and its possible complications or in the initial immobilisation during those three to five days.…”

Section: Increased Rate Of Surgical Management Of Ffp Type II Fracturmentioning

confidence: 99%

Fragility Fractures of the Pelvic Ring – Does the Evidence of Oedema Lead us to More Surgeries?

et al. 2020

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Introduction The choice of therapy for fragility fractures of the pelvis (FFP) is largely determined by the diagnosed fracture morphology. It is now unclear whether the change in diagnostic options – sensitive detection of fracture oedema in the sacrum using MRI and dual-energy computed tomography (DECT) – has an impact on the therapeutic consequences. The aim of this retrospective study was therefore to evaluate the change in the diagnostics used and the resulting therapy regimen in our patient population. Materials and Methods We performed a monocentric-retrospective analysis of 196 patients with a fragility fracture of the pelvis in our clinic (national TraumaZentrum® DGU and SAV approval) in the period from 2008 to 2017. We examined changes in epidemiology, diagnostics/classification and therapy of the pelvic ring fractures treated by us. Results The diagnostic procedures used are subject to a clear change towards oedema detection using MRI and DECT. The graduation has changed towards more severe forms of fracture after FFP. There is now also an increasing proportion of patients treated by surgery (2008 – 2009: 5.3% vs. 2015 – 2017: 60.3%). Conclusion We were able to show that the introduction of sensitive diagnostic procedures coincided with a higher classification of the fractures. It is also noteworthy that the increase in operations is not only due to a higher degree of classification; also in relative terms, more patients are operated on within type FFP II.

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Early Operative Versus Nonoperative Treatment of Fragility Fractures of the Pelvis: A Propensity-Matched Multicenter Study

Cited by 49 publications

References 20 publications

Trans-sacral bar osteosynthesis provides low mortality and high mobility in patients with fragility fractures of the pelvis

Trans-sacral bar osteosynthesis provides low mortality and high mobility in patients with fragility fractures of the pelvis

The effect of geriatric comanagement (GC) in geriatric trauma patients treated in a level 1 trauma setting: A comparison of data before and after the implementation of a certified geriatric trauma center

Fragility Fractures of the Pelvic Ring – Does the Evidence of Oedema Lead us to More Surgeries?

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