Admission for osteoporotic pelvic fractures and predictors of length of hospital stay, mortality and loss of independence

Marrinan, Sarah; Pearce, Mark S.; Jiang, Xiyi; Waters, S.; Shanshal, Yousif

doi:10.1093/ageing/afu123

Cited by 56 publications

(47 citation statements)

References 7 publications

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“…Most of these fractures are stable and can be successfully treated by non-operative treatment 4 . However, all-cause mortality and in-hospital complications reported for nonoperative treatment of FFP can be as high as from hip fractures [5][6][7] . Hence, especially percutaneous surgical techniques have been suggested as a valuable alternative to nonoperative treatment [8][9][10] .…”

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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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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“…The cause of an insufficiency fracture of the pelvis is usually a disturbed bone strength and biology in the sense of osteoporosis [4][5][6].Physiological bone resorption occurs in the course of aging. Main risk factors are age [1][2][3] and female gender [1][2][3], in addition to rheumatoid arthritis with corticosteroid therapy [7], condition after radiotherapy [8], bone metabolic diseases, long-term immobilization, vitamin D deficiency [9], nicotine abuse, organ transplantation and diabetes mellitus type 1 [9].…”

Section: Risk Factors For Insufficiency Fractures Of the Pelvic Ringmentioning

confidence: 99%

Modified Therapy Concepts for Fragility Fractures of the Pelvis after additional MRI

Graul

Marintschev

Hackenbroch

et al. 2019

Preprint

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Background Fractures of the pelvic ring in elderly patients have increased in frequency over time. These injuries are associated with a high morbidity and have a socio-economic impact. The diagnostic procedures and their influence of therapy decisions are still controversial.Methods In a retrospective study, we investigate the value of additional MRI examination on therapy decision of fragility fractures of the pelvis. The evaluation of all patients with pelvic fractures without adequate trauma and with performed CT and MRI from 2010 to 2017 was conducted at three large German hospitals. The imaging procedure took place within a maximum interval of 4 weeks. After evaluation of the imaging, the resulting therapeutic consequences either based on CT alone or on CT and MRI were reviewed by experienced pelvic surgeons. Furthermore, a measurement of Hounsfield units as an indicator of reduced bone density was recorded in the L5 vertebra.Results Of 754 patients with pelvic injuries, 67 (age 80 +/- 9.7 years, f: m 54:13) could be included in the study. The detection of vertical fractures in CT (n = 40 unilateral, n = 11 bilateral) could be increased by the additional MRI (n = 44 unilateral, n = 23 bilateral). A horizontal fracture component was identified in CT in 9.0% (n = 6) vs. MRI in 25.4% (n = 17) of the cases. An anterior pelvic ring injury was detected in 71.6% (n = 44; 4x bilateral) in CT, in 80.6% in MRI (n = 50, 4 bilateral). Additive MRI imaging increased the decision rate for surgical therapy from 20.9% (n = 14) to 31.3% (n = 21). In 90.0% of the patients (n = 60) a reduced bone density in the L5 vertebra was measured.Conclusions The results of this study further support the value of bone marrow detection by MRI diagnostics (or dual source CT which showed promising initial results) for the detection of pelvic ring fractures. For the first time, the study identifies an additional therapeutic consequence by an increased rate of surgical procedures.

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“…Osteoporosis accounts for most pelvic fractures, but patients with malignancy are also at risk. The incidence of pelvic fractures has been estimated to be between 25–92 per 100,000 per year . Pelvic fractures are rarely treated surgically, and conservative strategies include rest and oral analgesia .…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of pelvic fractures has been estimated to be between 25–92 per 100,000 per year . Pelvic fractures are rarely treated surgically, and conservative strategies include rest and oral analgesia . Undisplaced fractures of the sacrum are also often managed conservatively, with analgesia and physiotherapy as the mainstay of treatment .…”

Section: Introductionmentioning

confidence: 99%

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Sacral plexus catheter analgesia in a patient with traumatic sacral fractures and Tarlov cysts

Ireland

Womack

Foley

2019

Anaesthesia Reports

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Summary We report the use of a sacral plexus catheter for continuous local anaesthetic infusion in a patient with a unilateral sacral ala fracture following a fall from a horse. Although sacral plexus blockade has been well described for lower limb surgery, an ultrasound‐guided continuous catheter technique for conservatively managed fractures has not been described. Despite appropriate oral analgesia, the patient reported severe pain, particularly in the right gluteal region, which meant she was unable to sit upright or take deep breaths. A sacral plexus catheter was inserted with ultrasound guidance and an initial bolus of 30 ml levobupivicaine 0.25% was delivered followed by infusion of 8 ml.h−1 levobupivicaine 0.125%. Daily follow‐up and assessment were provided by the acute pain team. We judged the procedure to be a success as measured by an improvement in mobilisation, deep breathing, cough and patient satisfaction.

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Admission for osteoporotic pelvic fractures and predictors of length of hospital stay, mortality and loss of independence

Cited by 56 publications

References 7 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

Modified Therapy Concepts for Fragility Fractures of the Pelvis after additional MRI

Sacral plexus catheter analgesia in a patient with traumatic sacral fractures and Tarlov cysts

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