BackgroundPelvic osteoporotic fractures (POFs) are often associated with considerable morbidity and mortality mainly as a result of infections and cardiovascular events. Patients usually need prolonged institutionalization, rehabilitation, and follow-up, with a high rate of dependency and cost. The most common sites of POFs include the pubic rami, sacrum, ilium, and acetabulum. Combined pubic rami (PROFs) and sacral osteoporotic fractures (SOFs) have been reported, mostly in retrospective studies, describing the mechanism of injury and incidence. The aim of this study was to evaluate the association between PROFs and SOFs and to assess the effect of combined PROFs and SOFs on patients’ mobility, discharge destination, and length of stay.Materials and methodsWe prospectively studied 67 patients with low-impact PROFs and/or SOFs. There were 54 (80.4%) female and 13 (19.6%) male patients, and the average age was 87.5 (range 65–96) years. All patients were assessed by the fracture liaison service. Patients had magnetic resonance imaging or bone scan when there was history of low back pain following the injury or lumbosacral tenderness on clinical examination.ResultsThe mean length of stay for all patients was 45 (±35) days. Mortality rate was 10.4%. A significant relationship was found between low back pain and a positive finding of sacral fracture. Patients with combined PROFs and SOFs showed significantly longer length of stay than those with isolated PROFs.ConclusionsThe presence of low back pain and tenderness in patients who had low-impact pelvic injuries was highly suggestive of the presence of an associated SOF. There was a high association between sacral and PROFs. The length of stay of patients with PROFs associated with sacral osteoporotic fractures was significantly longer than that of patients with PROFs only. Therefore, we recommend considering the high association between SOFs and PROFs in planning the management and rehabilitation of patients with POFs.
In-hospital mortality rates in this patient group are similar to those seen for hip fractures, yet pelvic fractures in older people receive relatively little in the way of attention or funding. Guidelines to improve the management of such fractures in older people are important to improve care while in hospital, reduce time spent in hospital and reduce the impact on independent living.
There were significantly (P < 0.01) more male than female farmers (73 vs. 27%) with a mean age of 63 years (ranging from 13 to 87 years). Average number of out-patient visits related to the injury was 3.6. Injuries involving livestock resulted in the majority of accidents (P < 0.05) with a significant rise in the number of visits with increasing age (P < 0.01) with older patients having more severe injuries. Soft tissue injuries and fractures were commonly encountered. Complex fractures were the slowest injury to heal requiring eight subsequent out-patient visits.
Abstracts / Injury Extra 42 (2011) 95-169 clinical outcome were recorded and analysed. Health-related quality-of-life was assessed using the EuroQol-5D and sexual function using the international index of erectile function and the female sexual function index. Patients were asked to fill the questionnaires twice (once documenting their state prior to their injury and the second time recording their state after the injury). The minimum follow up was 12 months (range 12-30).Results: Out of 85 patients that met the inclusion criteria, 67 patients (24 females) with a mean age of 44 years (19-65) consented to participate in this study. Their mean ISS was 25 (9-58), while 5 (7.4%) had isolated fractures. There was shown to be a significant decrease in quality-of-life (p < 0.0001) and sexual function (p < 0.0001). The decrease was significant in all 5 EQ5D domains with mobility, usual activities, and pain as the most significantly affected (p < 0.0001). 50.7% (34) patients reported a significant (p < 0.0001) decrease in their post-injury sexual function score (55.5% males, 47.8% females). Linear regression showed urinary tract injury to be an independent risk factor for sexual dysfunction (p < 0.0001), while a Mann-Whitney U-test identified that the PFX severity (VS-AP3-LC3-CMI vs. LC1-LC2-AP1-AP2-ILBL) correlated to sexual dysfunction (p = 0.0463).Conclusion: Both genders, irrespective of age subgroups, suffering a PFX severe enough to undergo surgery, are at risk of a significant decrease of their quality of life and sexual function. The presence of certain fracture types and urinary tract injuries can be used as predictors of late morbidity and early multidisciplinary management.Intent: To assess the accuracy of circumferential pelvic binder positioning and its effect on diastasis reduction of unstable pelvic ring fractures.Methods: Accuracy of binder position. Patients were identified by a retrospective review of all pelvic radiographs performed at a military hospital between January 2008 and July 2010. Patients were included if there were visible metallic coils of the binder buckle. Patients were grouped according to the vertical level of the buckle, relative to an index line between the widest points of both trochanters (level A > 60 mm superior, level B -60 mm superior to 50 mm inferior and level C > 50 mm inferior, relative to the index line respectively). Binder position and diastasis reduction. All radiographs and CT images from the first part of the study were assessed to identify the presence of any pelvic fracture. Diastasis reduction was measured in patients with Anterior-Posterior Compression grades II and III, or Combined Mechanical Injuries.Results: We identified 172 radiographs with a visible pelvic binder. The binder was positioned over the greater trochanters in 49% of radiographs. In the patients with fractures, the mean pelvic diastasis gap was 22 mm less when the pelvic binder was positioned over the greater trochanters compared to level A (p < 0.01).Conclusions: This report is the first to hig...
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