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.
We present a case report of an 86-year-old lady with pubic ramus and sacral insufficiency fractures who developed extra-vesical bladder rupture following displacement of the pubic ramus fracture, a very unusual complication.
BackgroundVitamin D plays a key role in osteoporosis and also contributes to sarcopenia, muscle weakness, fatigue and depression. Patients with COPD are likely to be at higher risk of Vitamin D deficiency due to reduced mobility especially outdoors, with previous studies in the London area demonstrating prevalence rates around 60%.1 However, within our population group in the North East of England, little is known about the prevalence of Vitamin D deficiency.AimsTo identify the prevalence of serum 25-hydroxyvitamin D (25(OH)-D) deficiency in patients admitted with an acute exacerbation of COPD.MethodWe identified 50 patients admitted with an exacerbation of COPD. Data on demographics and prescription of vitamin D supplementation was recorded. 25(OH)-D titres were measured.Results50 patients included, mean age 73.6 years (age range 45–95 years). 44% of patients were prescribed vitamin D supplementation (95% of supplementation was in the form of combined calcium and vitamin D). Overall 62% of patients were found to have low 25(OH)-D titres. Of those not taking vitamin D supplementation, only 14% of patient had sufficient 25(OH)-D titres (≥50 nmol/L). 11% were 25(OH)-D insufficient (30–50 nmol/L), 57% were 25(OH)-D deficient (8–30 nmol/L) and 18% were profoundly deficient (<8 nmol/L). Of those patients taking vitamin D supplementation, 68% were found to have sufficient 25(OH)-D titres, whilst 32% still had inadequate 25(OH)-D highlighting potential issues with compliance or insufficient replacement.ConclusionsWe have demonstrated a very high prevalence of vitamin D deficiency amongst our patients with COPD, with 86% of our patients having inadequate vitamin D titres who were not on vitamin D supplementation. This is leading them to increased exposure to the risks of vitamin D deficiency, including the impact on bone health in at already ‘at-risk’ population. In response to this, locally we are now measuring 25(OH)-D titres routinely on patients with COPD and prescribing vitamin D supplementation when indicated, forming part of our new multisystem, comprehensive, holistic assessment of COPD patients.ReferenceJoliffe, et al. Prevalence, determinants and clinical correlates of Vitamin D deficiency in patients with chronic obstructive pulmonary disease in London, UK., 2017. J Steroid Biochem Mol Biochem.
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