Outcome and 2-Year Survival Rate in Elderly Patients With Lateral Compression Fractures of the Pelvis

Höch, Andreas; Özkurtul, Orkun; Pieroh, Philipp; Josten, Christoph; Böhme, Jörg

doi:10.1177/2151458516681142

Cited by 74 publications

(118 citation statements)

References 28 publications

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“…A therapy that could reduce pain after FFPs, accelerate mobilization and improve gait would therefore have a major beneficial effect on survival. Indeed, and in line with previous studies this study found a better survival in operatively treated patients in the long run 14 .…”

Section: Discussionsupporting

confidence: 92%

“…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%

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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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Section: Discussionsupporting

confidence: 92%

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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“…Bei älteren Patienten mit Frakturverdacht ist nach Bagatellunfällen eine CT primär vorzuziehen [84]. Insbesondere bei diesen häufig multimorbiden Patienten sind komplikationsträchtige längere Liegezeiten zu vermeiden [85], sodass eine rasche Diagnostik mit Darstellung der Frakturkonfiguration anzustreben ist [86].…”

Section: Diskussionunclassified

Imaging of Sacral Stress and Insufficiency Fractures

Spiegl¹,

Schnake

Osterhoff

et al. 2018

Z Orthop Unfall

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Fractures of the os sacrum without relevant trauma history are defined as stress or insufficiency fractures and often affect the anterior pelvis. Sacral insufficiency fractures are associated with osteoporosis and occur under physiological load. In contrast, sacral stress fractures are caused by mechanical overloading. Diagnostic confirmation is delayed in many of these patients. Thus, MRI and/or CT should be performed early. Fracture stability should be evaluated by CT. MRI is the better approach to rule out fractures and is highly sensitive. It is indicated in young patients and in patients with non-specific lumbosacral pain. Nuclear imaging techniques are viable alternatives in patients with a contraindication for MRI.

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“…Die häufigste Frakturmorphologie bei Erstvorstellung der Patienten ist eine laterale Kompressionsverletzung mit partieller transalarer Sakrumfraktur im Sinne einer ventralen Kortikalisimpression. In den eigenen Daten und in einer Auswertung des Beckenregisters der AG-Becken der DGU zeigt sich, dass über 90 % der osteoporotischen Sakrumfrakturen mit einer vorderen Beckenringfraktur einhergehen [12]. Diese Frakturen zählen bei unilateraler Sakrumfraktur zum Typ FFP II oder Typ B 2.1 nach AO und können konservativ behandelt werden.…”

Section: Diagnostikunclassified

“…Gleichzeitig wurde in der Untersuchung bei 18 % der Patienten ein Versagen der konservativen Therapie festgestellt und eine sekundäre operative Maßnahme indiziert. Die zwei-Jahres-Mortalität lag hingegen bei den operativ therapierten Patienten mit 18 % signifikant niedriger [12].…”

Section: Vorteile Der Operativen Versorgungunclassified

Sakruminsuffizienzfrakturen: operativ/konservativ

Josten

Höch²

2017

Die Wirbelsäule

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Zusammenfassung Sakruminsuffizienzfrakturen, als Resultat einer krankhaft ver?nderten Knochenstruktur und einem meist stattgehabten Bagatelltrauma, nehmen aufgrund des demographischen Wandels deutlich zu. Nicht nur die steigende Lebenserwartung und die damit steigende Pr?valenz an Osteoporose, sondern auch eine bessere Diagnostik und Sensibilisierung scheinen zu einem Anstieg der Inzidenz zu f?hren. Resultierende, meist tieflumbale Schmerzen f?hren zu einer Einschr?nkung der Mobilit?t und einhergehender Einschr?nkung der Selbstst?ndigkeit. Ziele der Therapie sollten eine rasche Schmerzreduktion und Mobilisierung der Patienten sein, um Begleitkomplikationen zu minimieren. Kann dies auch bei nicht dislozierten FFP II-Frakturen nach Rommens unter konservativer Therapie nicht zeitnah erreicht werden, sollte die Indikation zur prim?ren operativen Stabilisierung gro?z?gig gestellt werden. H?ufig kann selbst unter ad?quater konservativer Therapie ein schleichender Prozess hin zu einer h?hergradigen Instabilit?t beobachtet werden, welche mit einer zunehmenden Immobilisierung der Patienten einher geht. Gerade partielle osteoporotischer Sakrumfrakturen k?nnen durch perkutane operative Verfahren ausreichend stabilisiert werden, um eine Frakturheilung zu gew?hrleisten. Bei h?hergradigen Frakturtypen bis hin zur spinopelvinen Dissoziation besteht, trotz meist deutlich erh?htem perioperativem Risiko, eine klare Indikation zur operativen Versorgung. Vorliegende Daten unterst?tzen die Annahme, dass eine operative Versorgung durch die erbrachte Stabilit?t zu einer besseren Mobilisation und Frakturheilung f?hrt und damit die Mortalit?t gesenkt werden kann.

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Outcome and 2-Year Survival Rate in Elderly Patients With Lateral Compression Fractures of the Pelvis

Cited by 74 publications

References 28 publications

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

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

Imaging of Sacral Stress and Insufficiency Fractures

Sakruminsuffizienzfrakturen: operativ/konservativ

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