Implementation of a standardized protocol to manage elderly patients with low energy pelvic fractures: can service improvement be expected?

Kanakaris, Nikolaos K.; Greven, Tess; West, Robert; Vugt, A.B. van; Giannoudis, Peter V.

doi:10.1007/s00264-017-3567-2

Cited by 20 publications

(17 citation statements)

References 28 publications

(38 reference statements)

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“…With approximately 3–8% of all fractures, pelvic fractures are rather rare 1 . The most important trauma mechanism for a pelvic ring fracture in young patients is a high energy trauma, while in older patients most pelvic ring fractures are caused by a low energy trauma 2 . However, because of the ageing society the incidence for pelvic ring fractures is constantly increasing 3 , 4 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of pelvic C-clamp and pelvic binder for emergency stabilization and bleeding control in type-C pelvic ring fractures

Audretsch

Mader

Bahrs

et al. 2021

Sci Rep

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Severe bleeding is the major cause of death in unstable pelvic ring fractures. Therefore, a quick and efficient emergency stabilization and bleeding control is inevitable. C-clamp and pelvic binder are efficient tools for temporary bleeding control, especially from the posterior pelvic ring. Yet the C-clamp requires more user knowledge, training and equipment. However, whether this makes up for a more efficient bleeding control, is still under debate. Patients with a type-C pelvic ring fracture were identified from the German Pelvic Registry (GPR) and divided into three groups of 40 patients (1. no emergency stabilization, 2. pelvic binder, 3. C-clamp). The matching occurred according to the parameters age, gender, initial RR and initial HB. Complication—and mortality rates were compared especially regarding bleeding control. Regarding ISS and fracture dislocation there was no difference. The use of the C-clamp resulted in more complications, a higher mortality rate due to severe bleeding and more blood transfusions were admitted. Moreover the pelvic binder was established noticeably faster. However, the C-clamp was more often rated as effective. There is no evidence of advantage comparing the C-clamp to the pelvic binder, regarding bleeding control in type-C pelvic ring fractures. In fact, using the pelvic binder even showed better results, as the time until established bleeding control was significantly shorter. Therefore, the pelvic binder should be the first choice. The C-clamp should remain a measure for selected cases only, if an adequate bleeding control cannot be achieved by the pelvic binder.

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Section: Introductionmentioning

confidence: 99%

Comparison of pelvic C-clamp and pelvic binder for emergency stabilization and bleeding control in type-C pelvic ring fractures

Audretsch

Mader

Bahrs

et al. 2021

Sci Rep

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“…26 Mobility is also decreased after these injuries with as few as 51% of patients successfully returning to their pre-fracture mobility status. 1,19,22 In-patient mortality following a low-energy pelvic ring fracture is reportedly as high as 10%. 17,29 One-year mortality ranges from 9.5% 32 to as high as 27% 22,28 (Tables 1 and 2).…”

Section: Patient Outcomesmentioning

confidence: 99%

“…1,19,22 In-patient mortality following a low-energy pelvic ring fracture is reportedly as high as 10%. 17,29 One-year mortality ranges from 9.5% 32 to as high as 27% 22,28 (Tables 1 and 2). Patients who do survive and recover are also at significant risk for future low-energy fractures.…”

Section: Patient Outcomesmentioning

confidence: 99%

Low-Energy Pelvic Ring Fractures: A Care Conundrum

Abernathy

Schroder

Bohn

et al. 2021

Geriatr Orthop Surg Rehabil

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Introduction: A need exists for improved care pathways for patients experiencing low-energy pelvic ring fractures. A review of the current literature was performed to understand the typical patient care and post-acute rehabilitation pathway within the US healthcare system. We also sought to summarize reported clinical outcomes worldwide. Significance: Low-energy pelvic ring fracture patients usually do not qualify for inpatient admission, yet they often require post-acute rehabilitative care. The Center for Medicare and Medicaid Services’ (CMS) 3-day rule is a barrier to obtaining financial coverage of this rehabilitative care. Results: Direct admission of some patients to post-acute care facilities has shown promise with decreased cost, improved patient outcomes, and increased patient satisfaction. Secondary fracture prevention programs may also improve outcomes for this patient population. Conclusions: Post-acute care innovation and secondary fracture prevention should be prioritized in the low-energy pelvic fragility fracture patient population. To demonstrate the effect and feasibility of these improved care pathways, further studies are necessary.

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“…By studying a process, improvements can be applied to the most appropriate aspect of the process and outcomes can be evaluated and measured. For example, the outcomes of the patients with calcaneal fractures can be ensured [10], the risk of bleeding of hip fracture patients taking clopidrogel can be estimated [11], the use of antiosteoporotic medication in elderly patients with fragility pelvic fractures can be classified [12], and traditional treatments in trauma can be revisited [13][14][15][16][17][18].…”

Section: Orthopaedic Trauma Research In Healthcarementioning

confidence: 99%

Quality, cost and outcomes measures in orthopaedic healthcare

Mauffrey

Mavrogenis

2017

International Orthopaedics (SICOT)

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In the era of patient-centred healthcare, good quality medical practice represents an intervention resulting in outcomes that match patients' expectations. However, good quality healthcare is not without a cost, and outcomes measurement is complex and flawed by the multiple layers that exist and define such measurements. To meet the financial challenges faced in the healthcare industry, healthcare organizations are striving to control operational costs. Costing is essential to maximize the resources available to the healthcare providers and increase the services offered to patients. Still, patients' expectations in healthcare continue to increase; patients' expectations are diverse, and subject to variability in space (culture, religion, education, social status, profession, secondary gains) and time. Understanding and adequate management of patients' expectations can enhance their satisfaction level, improve outcomes and decrease liability. In this setting, assessment of outcomes has become increasingly more important in the healthcare industry. This editorial paper discusses the quality and cost of healthcare, the expectations and variances of patients, and the measurements of outcomes for patient-centred care into existing health care systems (Figs. 1 and 2). Quality and cost of healthcareDebate over healthcare often focuses on two key issues: quality and cost. Quality problems may not be the result of Fig. 1

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Implementation of a standardized protocol to manage elderly patients with low energy pelvic fractures: can service improvement be expected?

Cited by 20 publications

References 28 publications

Comparison of pelvic C-clamp and pelvic binder for emergency stabilization and bleeding control in type-C pelvic ring fractures

Comparison of pelvic C-clamp and pelvic binder for emergency stabilization and bleeding control in type-C pelvic ring fractures

Low-Energy Pelvic Ring Fractures: A Care Conundrum

Quality, cost and outcomes measures in orthopaedic healthcare

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