Functional and return to work outcomes following major trauma involving severe pelvic ring fracture

Abstract

Background: There is limited evidence describing the long-term outcomes of severe pelvic ring fractures. The aim of this study was to describe the longer term independent living and return to work outcomes following severe pelvic ring fracture. Methods: Adult survivors to discharge from two major trauma centres with AO/Tile type B and C fractures were followed up at 6, 12 and 24-months post-injury to capture functional (Glasgow Outcome Scale-Extended [GOS-E]) and return to work data. Multivariable, mixed effects models were used to identify predictors of outcome. Results: A total of 111 of 114 (97%) cases were followed up. The mean (SD) age of participants was 41.9 (18.9) years, 77% were male, 81% were transport-related and 90% were multi-trauma patients. Further, 11% were managed conservatively, 10% with external fixation and 79% with open reduction and internal fixation. At 24 months, 77% were living independently (GOS-E > 4) and 59% had returned to work. Higher Injury Severity Scores (ISS) were associated with lower risk-adjusted odds of return to work (P = 0.04) and independent living (P = 0.06). Post-operative infection was associated with living independently (P = 0.02). Conclusion: Despite the severity of the injuries sustained, 77% of severe pelvic ring fracture patients were living independently and 59% had returned to work, 2-years post-injury. Fracture type and management were not key predictors of outcome. Large-scale multi-centre studies are needed to fully understand the burden of severe pelvic ring fractures and to guide clinical management.

Recovery and Return to Work After a Pelvic Fracture

“…In our study, more than one-third were motorcyclists and most received high-energy forces. Although most studies consider the unstable and partial unstable PRF, in our study all types of PRFs have been examined as high-energy trauma, showing that RTW and job loss frequencies were similar to those reported in contemporary literature [21], [22], [23], [24], [26]. Regarding the patients who have sustained a type C PRF in our study, only 33.3% have returned to their previous job in a mean follow-up of 7 years, whereas other studies show a higher percentage [17], [20].…”

“…Those engaged in the same sport activity as that prior to the accident and had higher Majeed scores at any time also had a higher possibility of reporting full RTW. Studies have analyzed possible prognostic factors for RTW such as the number of body areas affected or associated injuries [23], [24], [29]. Job type has been reported as the main prognostic factor of RTW after PRF [23], although in our study we have estimated physical and psychological strain prior to the accident and we found a relation only with psychological strain, i.e., injured individuals with lower strain prior to any accident had a borderline significantly higher possibility not to be fully RTW, possibly because of lower engagement.…”

“…The unemployment rate after PRF has been estimated to be between 16% and 28%, whereas 23% of patients were forced to change jobs [17], [20], [23]. The injury severity score and job type are considered strong prognostic factors of RTW [22], [23], [24]. A reduction in intensity and frequency of sport activity after combined injuries of the pelvic ring and lower extremities have also been reported [25].…”

“…Several studies have examined the outcomes of PRF, but only a few studies have investigated the predictive factors in relation to RTW after PRF [14], [20], [22], [23], [24], [26]. The aim of this study was firstly to monitor recovery and RTW after any type of PRF due to high-energy trauma in previously productive up to middle-aged individuals in a long-term follow-up, and secondly to explore the predictive factors possibly related to RTW.…”

Passive Hydrotherapy WATSU® for Rehabilitation of an Accident Survivor: A Prospective Case Report

“…High-impact events as, e.g., vehicle accidents can result in severe traumata like fractures of the pelvis [25] which lead to extremely time-consuming rehabilitation processes [26,27]. The complexity of the condition is pronounced, and even after excellent osseous restoration, patients often suffer considerable pain as well as impairments in their physical and mental quality of life [28,29,30].…”