Combined pubic rami and sacral osteoporotic fractures: a prospective study

Abstract

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.

Pelvic fractures: epidemiology, consequences, and medical management

“…Mortality rates of osteoporotic pelvic fractures during hospitalization are high, similar to those seen for hip fractures: Marrinan et al [16 && ] reported an in-patient mortality rate of 9%, in agreement with Alnaib et al [17] who observed an in-hospital mortality rate of 10.5%. Within 3 months of fracture, mortality rate ranged from 7.1 to 13% [16 && ,18].…”

“…Also from this point of view, osteoporotic pelvic fractures are severe; in most studies, a large majority of patients admitted for pelvic fracture previously lived at home and were independent. However, at time to discharge nearly half of them have to go to a nursing home, community rehabilitation bed or required continuous bed care [10,17]. For example, in the study of Marrinan et al [16 && ], on admission to hospital, 89% of patients lived independently, but at the point of discharge from hospital, this figure dropped to 64% and the odds of changing from independent to institutionalized accommodation were significantly associated with age and length of hospital stay.…”

Minimal Invasive Surgical Treatment of Fragility Fractures of the Pelvis

“…This, upon reversion, means that more than 80% of patients with FFP had a posterior pelvic ring injury. It therefore is recommended that every patient with an FFP receives a pelvic CT-scan so that the severity of the injury is not underestimated (19)(20)(21).…”

Psoas abscess secondary to haematoma after a fall causing multiple osteoporotic fractures

“…They are associated with high in-hospital mortality (104–14%5) and complication rates (20% to 50%6), as well as long average admission time (185 to 454 days). Many patients do not return to their premorbid independence 7.…”