Low-impact pelvic fractures in the emergency department

Abstract

Objective: We examined the records of patients presenting to the emergency department (ED) with low-impact pelvic fractures. We describe frequency, demographics, management and patient outcomes in terms of ambulatory ability, living independence and mortality. Methods: Patients treated for a pelvic fracture over a 2-year period in Kingston, Ont., were identified. We performed a retrospective hospital record review to distinguish high- versus low-impact injury mechanisms, and to characterize the injury event, ED management and outcomes for patients with low-impact fractures. Results: Of 132 pelvic fractures identified, 77 were low-impact fractures. Patients were predominantly women (82%) with a mean age of 81 years; 96% had some pre-existing medical comorbidity. The pubic rami were most commonly involved (86%). The median length of stay in the ED was 9.4 hours. Twenty-five patients (32%) were admitted to hospital. Ten patients had surgical stabilization, mostly of the acetabulum. Five patients died in hospital, 4 from pneumonia and 1 from myocardial infarction. Eight additional patients died within 1 year of injury. At discharge, only 18% lived independently and 16% walked without aids versus 42% and 38%, respectively, before injury. Conclusion: Low-impact pelvic fractures affect predominantly elderly women with pre-existing comorbidities. A substantial amount of time and resources in the ED are used during the workup of these patients and while awaiting their disposition from the ED. These injuries are important because they affect independence and seem associated with an increased risk of death.

Survivorship and Severe Complications Are Worse for Octogenarians and Elderly Patients with Pelvis Fractures as Compared to Adults: Data from the National Trauma Data Bank

“…One potential limitation of the study is that we did not compare the comorbid conditions of the study sample to the entire NTDB. However, in a Canadian study, the authors found that more than 90% of octogenarians admitted to the emergency room with pelvis fractures had medical comorbidities [20]. Therefore, we can assume that our octogenarian patients also have similar comorbidities.…”

Clinical pathways for fragility fractures of the pelvic ring: personal experience and review of the literature

“…Clinical pathways characterized by multidisciplinarity have been recently re-worked to cope with problems specific to these patients and to secure their best possible outcome [ 5 ]. A constantly-rising number of fragility pelvic fractures has also been reported [ 6 ]. Their clinical picture, radiological morphology and intrinsic instability range widely from nearly stable to completely unstable conditions.…”

Fracturas osteoporóticas de ramas pélvicas: ¿Son una lesión benigna?

“…También muy es frecuente la afectación acetabular. Dodge y Brison [17] estudiaron 77 fracturas de baja energía con una edad media de 81 años encontrando un 22% de fracturas de cotilo. En nuestra revisión se observó que en el 36.7% de las fracturas el trazo comprometía el cotilo.…”

“…Otros estudios de características similares observan datos muy variables. Morris et al [2] registraron una mortalidad al año del 27%, Dodge & Brison [17] del 17% y Koval et al [9] del 9,5%. Estos son datos muy similares a la mortalidad anual observada en las fracturas de cadera, cuyas cifras son del 14 al 36% [26] .…”