Isolated Pubic Ramus Fractures Are Serious Adverse Events for Elderly Persons: An Observational Study on 138 Patients with Fragility Fractures of the Pelvis Type I (FFP Type I)

Abstract

Background: Fractures of the pubic ramus without involvement of the posterior pelvic ring represent a minority of fragility fractures of the pelvis (FFP). The natural history of patients suffering this FFP Type I has not been described so far. Material and methods: All patients, who were admitted with isolated pubic ramus fractures between 2007 and mid-2018, have been reviewed. Epidemiologic data, comorbidities, in-hospital complications, and one-year mortality were recorded. Of all surviving patients, living condition before the fracture and at follow-up was noted. Mobility was scored with the Parker Mobility Score, quality of life with the European Quality of Life 5 Dimensions 3 Level (EQ-5D-3L), subjective sensation of pain with the Numeric Rating Scale (NRS). Results: A consecutive series of 138 patients was included in the study. There were 117 women (84.8%) and 21 men (15.2%). Mean age was 80.6 years (SD 8.6 years). 89.1% of patients presented with comorbidities, 81.2% of them had cardiovascular diseases. Five patients (4%) died during hospital-stay. Median in-hospital stay was eight days (2–45 days). There were in-hospital complications in 16.5%, urinary tract infections, and pneumonia being the most frequent. One-year mortality was 16.7%. Reference values for the normal population of the same age are 5.9% for men and 4.0% for women. One-year mortality rate was 22.2% in the patient group of 80 years or above and 8.8% in the patient group below the age of 80. The rate of surviving patients living at home with or without assistance dropped from 80.5% to 65.3%. The median EQ-5D-Index Value was 0.62 (0.04–1; IQR 0.5–0.78). Reference value for the normal population is 0.78. Average PMS was 4 and NRS 3. Within a two-year period, additional fragility fractures occurred in 21.2% and antiresorptive medication was taken by only 45.2% of patients. Conclusion. Pubic ramus fractures without involvement of the posterior pelvis (FFP Type I) are serious adverse events for elderly persons. During follow-up, there is an excess mortality, a loss of independence, a restricted mobility, and a decreased quality of life. Pubic ramus fractures are indicators for the need to optimize the patient’s general condition.

Trans-sacral bar osteosynthesis provides low mortality and high mobility in patients with fragility fractures of the pelvis

“…We confirmed the low 1-year mortality after surgical treatment of FFP (10–12%) 13 , 29 compared to conservative treatment (17–23%) 1 , 4 , 6 , 25 , 27 , 33 . Elderly with a pelvic fracture show an increased mortality 4 .…”

“…Especially patients undergoing surgery had delayed presentation with a median of 14 days 3 . There is an excessive mortality 4 with a 1-year mortality is as high as 17–30% 1 , 4 – 6 , similar to the 1-year mortality in hip fractures in elderly (19–33%) 7 , 8 . Surgically treated patients with an FFP had a lower mortality 5 .…”

What is the long-term clinical outcome after fragility fractures of the pelvis? - A CT-based cross-sectional study

“…All patients with isolated anterior pelvic ring fractures (FFP type I) were treated non-operatively, which reflects current recommendations [ 4 ] and is in line with a recent study by Rommens et al who evaluated 138 patients with FFP type I of which 98.6% was treated non-operatively [ 19 ]. Most patients (70%) in our study were able to walk within six weeks post injury, but some required a walking aid either temporarily or permanently.…”

Operative treatment of fragility fractures of the pelvis is connected with lower mortality. A single institution experience

“…FFP are serious adverse event for elderly persons. Mortaility rate is 3 times as high as in a comparable population without FFP [ 10 , 27 ]. There is need for a multi-disiplinary treatment of the underlying factors, which led to the FFP, in combination with treatment of the fractures [ 28 ].…”

“…If an operative treatment is chosen, the procedure should be as minimal invasive as possible [ 9 ]. FFP type I do not need surgical intervention [ 10 ]. Despite the recommendations for surgical treatment, which have been published by the authors in 2013 [ 7 ], it is not evident to date that patients with FFP type II, III and IV profit from operative therapy.…”