Mobility and mortality of 340 patients with fragility fracture of the pelvis

Yoshida, Masahiro; Tajima, Kazuyoshi; Saito, Yuki; Sato, Koji; Uenishi, Norimichi; Iwata, Mitsunaga

doi:10.1007/s00068-020-01481-3

Cited by 32 publications

(19 citation statements)

References 18 publications

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“…Most patients (70%) in our study were able to walk within six weeks post injury, but some required a walking aid either temporarily or permanently. This is similar to the study by Rommens with 75% of patients being mobile at discharge [ 19 ], but in contrast to a study by Yoshida et al who found that only 34% maintained gait ability at one year as measured by the Majeed score [ 20 ]. All patients from whom a DXA was available had osteoporosis or osteopenia.…”

Section: Discussionsupporting

confidence: 88%

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What is the long-term clinical outcome after fragility fractures of the pelvis? - A CT-based cross-sectional study

Banierink

Duis

Prijs

et al. 2022

Injury

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Background: Recently, Rommens and Hoffman introduced a CT-based classification system for fragility fractures of the pelvis (FFP). Although fracture characteristics have been described, the relationship with clinical outcome is lacking. The purpose of this study was to get insight into the type of treatment and subsequent clinical outcome after all types of FFP.Methods: A cross-sectional cohort study was performed including all elderly patients ( ≥ 65 years) with a CT-diagnosed FFP, between 2007-2019 in two level 1 trauma centers. Data regarding treatment, mortality and clinical outcome was gathered from the electronic patient files. Patients were asked to complete patient-reported outcome measures (PROMs) regarding physical functioning (SMFA) and quality of life (EQ-5D). Additionally, a standardized multidisciplinary treatment algorithm was constructed.Results: A total of 187 patients were diagnosed with an FFP of whom 117 patients were available for follow-up analysis and 58 patients responded. FFP type I was most common (60%), followed by type II (27%), type III (8%) and type IV (5%). Almost all injuries were treated non-operatively (98%). Mobility at six weeks ranged from 50% (type III) to 80% type II). Mortality at 1 year was respectively 16% (type I and II), 47% (type III) and 13% (type IV). Physical functioning (SMFA function index) ranged from 62 (type III and IV) to 69 (type II) and was significantly decreased (P = < 0.001) compared to the age-matched general population. Quality of life was also significantly decreased, ranging from 0.26 (type III) to 0.69 (type IV).Conclusions: FFP type I and II are most common. Treatment is mainly non-operative, resulting in good mobility after six weeks, especially for patients with FFP type I and II. Mortality rates at one year were substantial in all patients. Physical functioning and quality of life was about 20-30% decreased compared to the general population.

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Section: Discussionsupporting

confidence: 88%

“…Similar to FFP type I, most patients (80%) were able to walk within six weeks after the injury. Yoshida et al found that only 42% of patients maintained gait ability one year after FFP type II [ 20 ]. Mortality at one year was 16% in our study, similar to the 14-17% reported previously [26][27][28].…”

Section: Discussionsupporting

confidence: 84%

What is the long-term clinical outcome after fragility fractures of the pelvis? - A CT-based cross-sectional study

Banierink

Duis

Prijs

et al. 2022

Injury

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“…Recent data from Japan suggest that non-operative treatment is feasable with good functional outcome. Other authors published promising results after operative treatment [11][12][13][14]. Most publications focus on small patient cohorts or one specific operative technique.…”

Section: Introductionmentioning

confidence: 99%

Operative treatment of fragility fractures of the pelvis is connected with lower mortality. A single institution experience

et al. 2021

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Background Fragility fractures of the pelvis (FFP) represent an increasing clinical entity. Until today, there are no guidelines for treatment of FFP. In our center, recommendation for operative treatment was given to all patients, who suffered an FFP type III and IV and to patients with an FFP type IIwith unsuccessful non-operative treatment. We performed a retrospective observational study and investigated differences between fracture classes and management alternatives. We hypothetized that operative treatment may reduce mortality. Materials and methods The medical charts and radiographs of 362 patients were analysed. Patient demographics, FFP-classification, length of hospital stay (LoS), type of treatment, general and surgery-related complications, mortality, Short Form-8 physical component score (SF-8 PCS) and mental component score (SF-8 MCS), Parker Mobility Score (PMS) and Numeric Rating Scale (NRS) were documented. Results 238 patients had FFP type II and 124 FFP type III and IV. 52 patients with FFP type II (21.8%) and 86 patients with FFP type III and IV (69.4%) were treated operatively (p<0.001). Overall mortality did not differ between the fracture classes (p = 0.127) but was significantly lower in the operative group (p<0.001). Median LoS was significantly higher in FFP type III and IV (p<0.001) and in operated patients (p<0.001). There were more in-hospital complications in patients with FFP type III and IV (p = 0.001) and in the operative group (p = 0.006). More patients of the non-operative group were mobile (p<0.001) and independent (p<0.001) at discharge. Half of the patients could not return in their living environment.203 of the 235 surviving patients (86%) answered the questionnaires after a mean follow-up time of 38 months. SF-8 PCS, SF-8 MCS and PMS did not differ between the fracture classes and treatment groups. Pain perception was higher in the operated group (p = 0.013). Conclusion In our study, we observed that operative treatment of FFP provides low mortality rates, although LoS and in-hospital complications were higher in the operative group. At discharge, the non-operative group was more mobile and independent. At follow up, quality of life and mobility were comparable between the groups. Further prospective studies are needed to clarify the impact of operative treatment of FFP on mortality and functional outcome.

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“…To date, there is no consensus on indications for and type of surgical treatment of FFP. Several authors describe large series of patients with reasonable results after non-operative treatment [9,11,12], whereas other authors report on good outcome after operative treatment [13][14][15][16][17]. This manuscript presents and critically analyses the results of operative treatment of 140 patients with FFP, depending on FFP-classification and invasivity of surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

Operative treatment of fragility fractures of the pelvis: a critical analysis of 140 patients

Rommens

Hofmann

Kraemer

et al. 2021

Eur J Trauma Emerg Surg

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Background Fragility fractures of the pelvis (FFP) are a clinical entity with an increasing frequency. Indications for and type of surgical treatment are still a matter of debate. Purpose This retrospective study presents and critically analyses the results of operative treatment of 140 patients with FFP. Setting Level-I trauma center. Materials and methods Demographic data, comorbidities, FFP-classification, type of surgical stabilization (percutaneous (P-group) versus open procedure (O-group)), length of hospital stay (LoS), general in-hospital complications, surgery-related complications, living environment before admission, mobility and destination at discharge were retracted from the medical and radiographic records. Patients were asked participating in a survey by telephone call about their quality of life. SF-8 Physical Component Score (PCS) and SF-8 Mental Component Score (MCS) were calculated as well as the Parker Mobility Score (PMS) and the Numeric Rating Scale (NRS). Results Mean age was 77.4 years and 89.3% of patients were female. 92.1% presented with one comorbidity, 49.3% with two or more comorbidities. Median length of hospital stay was 18 days, postoperative length of hospital stay was 12 days. 99 patients (70.7%) received a percutaneous operative procedure, 41 (29.3%) an open. Patients of the O-group had a significantly longer LoS than patients of the P-group (p = 0.009). There was no in-hospital mortality. There were significantly more surgery-related complications in the O-group (43.9%) than in the P-group (19.2%) (p = 0.006). Patients of the O-group needed more often surgical revisions (29.3%) than patients of the P-group (13.1%) (p = 0.02). Whereas 85.4% of all patients lived at home before admission, only 28.6% returned home at discharge (p < 0.001). The loss of mobility at discharge was not influenced by the FFP-classes (p = 0.47) or type of treatment (p = 0.13). One-year mortality was 9.7%. Mortality was not influenced by the FFP-classes (p = 0.428) or type of treatment (p = 0.831). Median follow-up was 40 months. SF-8 PCS and SF-8 MCS were moderate (32.43 resp. 54.42). PMS was 5 and NRS 4. Follow-up scores were not influenced by FFP-classes or type of treatment. Conclusion Patients with FFP, who were treated operatively, suffered from a high rate of non-lethal general, in-hospital complications. Open surgical procedures induced more surgery-related complications and surgical revisions. Mental and physical follow-up scores are low to moderate. Condition at follow-up is not influenced by FFP-classes or type of treatment. Indications for operative treatment of FFP must be critically examined. Surgical fixation should obtain adequate stability, yet be as less invasive as possible. The advantages and limitations of different surgical techniques have to be critically evaluated in prospective studies.

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Mobility and mortality of 340 patients with fragility fracture of the pelvis

Cited by 32 publications

References 18 publications

What is the long-term clinical outcome after fragility fractures of the pelvis? - A CT-based cross-sectional study

What is the long-term clinical outcome after fragility fractures of the pelvis? - A CT-based cross-sectional study

Operative treatment of fragility fractures of the pelvis is connected with lower mortality. A single institution experience

Operative treatment of fragility fractures of the pelvis: a critical analysis of 140 patients

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