Mid-term follow-up after surgical treatment of fragility fractures of the pelvis

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

doi:10.1016/j.injury.2018.09.017

Cited by 36 publications

(40 citation statements)

References 18 publications

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“…In our data the mean hospital stay until surgery was 6.7 days (SD 5.1) and the mean hospital stay overall was 21.2 days (SD 7.7), which goes in line with other studies, where the mean hospital stay varies from 13 to 23.7 days [16,31,33,34,36].…”

Section: Discussionsupporting

confidence: 92%

“…Similar to other studies we found a mean age of about 79 (60-99) years with a predominance of women, which constituted 90% of our collective [16,[30][31][32][33][34][35][36].…”

Section: Discussionsupporting

confidence: 91%

“…Analysing the FFP classifications that led to the surgical procedure we found data similar to Noser et al, whereas the patient collective of Eckhardt et al consisted more from FFP 4 than FFP 3 fractures [30,31].…”

Section: Discussionsupporting

confidence: 57%

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Minimally invasive posterior locked compression plate osteosynthesis shows excellent results in elderly patients with fragility fractures of the pelvis

Schmerwitz¹,

Jungebluth²,

Lehmann³

et al. 2020

Eur J Trauma Emerg Surg

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Purpose Fragility fractures of the pelvis (FFP) are common in older patients. We evaluated the clinical outcome of using a minimally invasive posterior locked compression plate (MIPLCP) as therapeutic alternative. Methods 53 Patients with insufficiency fractures of the posterior pelvic ring were treated with MIPLCP when suffering from persistent pain and immobility under conservative treatment. After initial X-ray, CT-scans of the pelvis were performed. In some cases an MRI was also performed to detect occult fractures. Postoperatively patients underwent conventional X-ray controls. Data were retrospectively analyzed for surgical and radiation time, complication rate, clinical outcome and compared to the literature. Results Patients (average age 79.1 years) underwent surgery with operation time of 52.3 min (SD 13.9), intra-operative X-ray time of 9.42 s (SD 9.6), mean dose length product of 70.1 mGycm (SD 57.9) and a mean hospital stay of 21.2 days (SD 7.7). 13% patients (n = 7) showed surgery-related complications, such as wound infection, prolonged wound secretion, irritation of the sacral root or clinically inapparent screw malpositioning. 17% (n = 9) showed postoperative complications (one patient died due to pneumonia 24 days after surgery, eight patients developed urinal tract infections). 42 patients managed to return to previous living situation. 34 were followed-up after a mean period of 31.5 (6–90) months and pain level at post-hospital examination of 2.4 (VAS) with an IOWA Pelvic Score of 85.6 (55–99). Conclusion We showed that MIPLCP osteosynthesis is a safe surgical alternative in patients with FFP 3 and FFP 4. This treatment is another way of maintaining a high level of stability in the osteoporotic pelvic ring with a relatively low complication rate, low radiation and moderate operation time and a good functional outcome.

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Section: Discussionsupporting

confidence: 92%

“…Similar to other studies we found a mean age of about 79 (60-99) years with a predominance of women, which constituted 90% of our collective [16,[30][31][32][33][34][35][36].…”

Section: Discussionsupporting

confidence: 91%

See 1 more Smart Citation

Minimally invasive posterior locked compression plate osteosynthesis shows excellent results in elderly patients with fragility fractures of the pelvis

Schmerwitz¹,

Jungebluth²,

Lehmann³

et al. 2020

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

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“…pneumonia and urinary tract infections), thromboembolic events, postoperative delirium and duration of the hospitalization. Those patients that had survived were contacted by phone and a modified Majeed Score was obtained to assess functional outcome at final follow-up 13,16,17 .…”

Section: Outcomementioning

confidence: 99%

“…Operative treatment is thought to reduce pain and to facilitate mobilization in patients with FFPs 11,12 . Even though complications and overall mortality remain high among geriatric patients with a FFP when treated operatively 13 , a benefit of surgical over non-operative treatment with regard to mortality has been suggested 14 .…”

Section: A C C E P T E D Introductionmentioning

confidence: 99%

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

Osterhoff

Noser

Held

et al. 2019

Journal of Orthopaedic Trauma

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OBJECTIVE To compare early operative treatment with non-operative treatment of fragility fractures of the pelvis regarding mortality and functional outcome. DESIGN Retrospective SETTING:: Two trauma centers PATIENTS AND METHODS:: 230 consecutive patients 60 years of age or older with an isolated low-energy fracture of the pelvis and with a follow-up of at least 24 months. In center 1, treatment consisted of a non-operative attempt and early operative fixation if mobilization was not possible. In center 2, all patients were treated non-operatively. MAIN OUTCOME MEASUREMENTS Primary outcome was mortality. Secondary outcomes were in-hospital complications. Patients that survived were contacted by phone and a modified Majeed Score was obtained to assess functional outcome at final follow-up RESULTS:: At final follow-up (mean 61 months, SD 24), 105/230 (45.7 %) patients had died. One year after the initial hospitalization 34/148 patients (23%, 95% CI: 17% to 31%) of the ear1y operative group and 14/82 patients (17%, 95% CI 10% to 27%) of the non-operative group had died (p=0.294). Non-operative treatment had a protective effect on survival during the first two years (hazard ratio of the non-linear effect: 2.86, 95% CI 1.38 to 5.94, p<0.001). Patients in the early operative treatment group who survived the first two years, had a better long-term survival. The functional outcome at the end of follow-up as measured by a modified Majeed score was not different between the two groups (early operative: 66.1, SD 12.6 vs. non-operative: 65.7, SD 12.5, p=0.910). CONCLUSION Early operative fixation of patients who cannot be mobilized within three to five days was associated a higher mortality rate and complication rate at 1 year but with a better long-term survival after more than two years. Hence, patients with a life expectancy of less than 2 years may not benefit from surgery with regard to survival. LEVEL OF EVIDENCE III. Michael (2019). Early operative versus non-operative treatment of fragility fractures of the pelvis -a propensity matched multicenter study. Journal of Orthopaedic Trauma, 33(11):e410-e415. Abstract Objective: To compare early operative treatment with non-operative treatment of fragility fractures of the pelvis regarding mortality and functional outcome. Design: Retrospective Setting: Two trauma centers Patients and Methods: 230 consecutive patients 60 years of age or older with an isolated low-energy fracture of the pelvis and with a follow-up of at least 24 months. In center 1, treatment consisted of a non-operative attempt and early operative fixation if mobilization was not possible. In center 2, all patients were treated non-operatively. Main Outcome Measurements: Primary outcome was mortality. Secondary outcomes were in-hospital complications. Patients that survived were contacted by phone and a modified Majeed Score was obtained to assess functional outcome at final follow-up Results: At final follow-up (mean 61 months, SD 24), 105/230 (45.7 %) patients had died.One year after the initial hospitaliz...

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Refracture and mortality following hospitalization for severe osteoporotic fractures: The Fractos Study

et al. 2021

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Severe osteoporotic fractures (hip, proximal humerus, pelvic, vertebral and multiple rib fractures) carry an increased risk of mortality. This retrospective cohort study in the French national healthcare database aimed to estimate refracture and mortality rates after severe osteoporotic fractures at different sites, and to identify mortality‐related variables. A total of 356,895 patients hospitalized for severe osteoporotic fracture between 2009 and 2014 inclusive were analyzed. The cohort was followed for 2 to 8 years up to the study end or until the patient died. Data were extracted on subsequent hospitalizations, refracture events, treatments, comorbidities of interest and survival. Time to refracture and survival were described using Kaplan‐Meier analysis by site of fracture and overall. Mortality risk factors were identified using a Cox model. Hip fractures accounted for 60.4% of the sample (N = 215,672). In the 12 months following fracture, 58,220 patients (16.7%) received a specific osteoporosis treatment, of whom 21,228 were previously treatment‐naïve. The 12‐month refracture rate was 6.3% (95% confidence interval [CI], 6.2%–6.3%), ranging from 4.0% (95% CI, 3.7%–4.3%) for multiple rib fractures to 7.8% (95% CI, 7.5%–8.1%) for pelvic fractures. Twelve‐month all‐cause mortality was 12.8% (95% CI, 12.7%–12.9%), ranging from 5.0% (95% CI, 4.7%–5.2%) for vertebral fractures to 16.6% (95% CI, 16.4%–16.7%) for hip fractures. Osteoporosis‐related mortality risk factors included fracture site, previous osteoporotic fracture (hazard ratio 1.21; 95% CI, 1.18–1.23), hip refracture (1.74; 95% CI, 1.71–1.77), and no prior osteoporosis treatment (1.24; 95% CI, 1.22–1.26). Comorbid cancer (3.15; 95% CI, 3.09–3.21) and liver disease (2.54; 95% CI, 2.40–2.68) were also strongly associated with mortality. In conclusion, severe osteoporotic fractures, including certain non‐hip nonvertebral fractures, carry a high burden in terms of mortality and refracture risk. However, most patients received no anti‐osteoporotic treatment. The findings emphasize the importance of better management of patients with severe fractures, and of developing effective strategies to reduce fracture risk in patients with osteoporosis. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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Mid-term follow-up after surgical treatment of fragility fractures of the pelvis

Cited by 36 publications

References 18 publications

Minimally invasive posterior locked compression plate osteosynthesis shows excellent results in elderly patients with fragility fractures of the pelvis

Minimally invasive posterior locked compression plate osteosynthesis shows excellent results in elderly patients with fragility fractures of the pelvis

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

Refracture and mortality following hospitalization for severe osteoporotic fractures: The Fractos Study

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