Pelvic ring fractures in the elderly now and then – a pelvic registry study

Rollmann, Mika F.; Herath, Steven C.; Kirchhoff, F.; Braun, Benedikt J.; Holstein, Joerg H.; Pohlemann, Tim; Menger, Michael D.; Histing, Tina

doi:10.1016/j.archger.2017.03.007

Cited by 36 publications

(40 citation statements)

References 23 publications

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“…In the present study, 19% of all patients presented with an ISS ≥16. The median ISS was with 4 (interquartile range 4-8) in t1 and t2 lower than the median ISS in the later time periods, with an ISS of 9 in t3 (interquartile range 4-13) and 9 in t4 (interquartile range [4][5][6][7][8][9][10][11][12], which is inverse to the reported in-hospital mortality.…”

Section: Resultsmentioning

confidence: 93%

“…The number of patients included from t 1 was 474, from t 2 was 795, from t 3 was 1790 and from t 4 was 2606. The number of participating centers increased throughout the observation period without a relevant significant difference between the cohort of the centers that were involved throughout the complete study period and the supervening centers …”

Section: Methodsmentioning

confidence: 99%

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In‐hospital mortality of pelvic ring fractures in older adults now and then: A pelvic registry study

Rollmann

Herath

Braun

et al. 2018

Geriatrics Gerontology Int

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Aim With the predicted demographic change, the treatment of geriatric patients will become a major issue for health systems worldwide. The majority of pelvic ring fractures occur in older adults, and their treatment might be associated with a distinct mortality. Herein, we analyzed the data of 5665 patients with pelvic ring fractures aged ≥60 years included in the German Pelvic Trauma Registry from 1991 to 2013. Methods The data were collected prospectively, multicentrically in hospitals participating in the German Pelvic Trauma Registry. Demographic data were retrospectively analyzed, stratified for age, sex, type of injury, mode of therapy, injury severity score (ISS) and mortality. Results The overall mortality decreased over the 22‐year study period from 9.3% to 3.8% (P < 0.05), whereas the median ISS significantly increased. During the observation period, mortality was higher in patients with type B and, particularly, type C fractures when compared with patients with type A fractures. Mortality rates of patients aged >80 years did not significantly differ from those aged >60 or >70 years. Male patients showed a significantly higher mortality compared with female patients, as well as a significantly higher median ISS. The mortality rate of patients with surgically‐treated type C fractures decreased over the study period from 35.7% to 6.9% (P < 0.05). Conclusions Over the past two decades, the mortality of older patients after pelvic ring fractures has significantly decreased. The higher overall mortality rate of male patients might mainly be accounted for by the relatively higher fraction of type C fractures and a higher ISS. Geriatr Gerontol Int 2019; 19: 24–29.

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Section: Resultsmentioning

confidence: 93%

Section: Methodsmentioning

confidence: 99%

In‐hospital mortality of pelvic ring fractures in older adults now and then: A pelvic registry study

Rollmann

Herath

Braun

et al. 2018

Geriatrics Gerontology Int

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“…The prevalence of pelvis fractures caused by low-energy trauma, such as falls from standing height, has drastically increased. Most pelvis fractures are linked to osteoporosis and occur in individuals that are 60 years and older [78]. The number of low-energy, fall-related fractures outnumbers high-energy fractures by 9 to 1 [6] and is expected to substantially increase [79].…”

Section: Pelvis Fracturesmentioning

confidence: 99%

“…Thus, typical fall-induced fracture patterns in the elderly include bilateral fractures in the sacral ala and iliac wings and compression of the lateral pelvis into the superior pubic ramus resulting in pelvic ring collapse and larger fracture displacements [84]. Recently, it has been reported that with increasing activity levels of elderly patients, there has been a shift towards more severe injury patterns [78] (Fig. 2).…”

Section: Pelvis Fracturesmentioning

confidence: 99%

Biomechanics of Osteoporotic Fracture Fixation

Hollensteiner

Sandriesser

Bliven

et al. 2019

Curr Osteoporos Rep

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Purpose of Review Fractures of osteoporotic bone in elderly individuals need special attention. This manuscript reviews the current strategies to provide sufficient fracture fixation stability with a particular focus on fractures that frequently occur in elderly individuals with osteoporosis and require full load-bearing capacity, i.e., pelvis, hip, ankle, and peri-implant fractures. Recent Findings Elderly individuals benefit immensely from immediate mobilization after fracture and thus require stable fracture fixation that allows immediate post-operative weight-bearing. However, osteoporotic bone has decreased holding capacity for metallic implants and is thus associated with a considerable fracture fixation failure rate both short term and long term. Modern implant technologies with dedicated modifications provide sufficient mechanical stability to allow immediate weight-bearing for elderly individuals. Depending on fracture location and fracture severity, various options are available to reinforce or augment standard fracture fixation systems. Summary Correct application of the basic principles of fracture fixation and the use of modern implant technologies enables mechanically stable fracture fixation that allows early weight-bearing and results in timely fracture healing even in patients with osteoporosis.

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“…Ebenso beschrieben [13]. Im Hinblick auf die steigende Inzidenz von B-/C-Frakturen des Beckenringes bei geriatrischen Patienten müssen die behandelnden Kliniken ein Behandlungskonzept entwickeln, und dazu gehört die richtige Bildgebung, die die Verletzung im ganzen Ausmaß erfasst [24].…”

Section: Geschlecht Und Alterunclassified

Magnetic Resonance Imaging in Pelvic Fractures – Part 1: Which Criteria Lead Us to Supplementary MRI Diagnostics?

et al. 2019

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Introduction Isolated pelvic fractures are relatively rare with an incidence of 3 – 6% of all fractures, but their incidence in polytraumatized individuals increases to 25%. The S3 guideline Polytrauma gives a clear recommendation for diagnostics by means of pelvic radiography (X-ray) and computed tomography (CT). A recommendation for the diagnosis by means of magnetic resonance tomography (MRI) especially in patients with low energetic/missing trauma does not currently exist. It is unclear on the basis of which criteria the MRI can be indicated in pelvic fractures. The aim of our study was therefore to retrospectively record indications for the indication of MRI in pelvic fractures – with adequate as well as inadequate trauma. Material and Methods In a retrospective clinical study, a total of 140 patients (median 68 years, range 15 – 97, 75 female, and 66 male) with a pelvic fracture were included in the study over a period of three years. Overall, the trauma mechanism revealed 73 adequate and 67 inadequate fractures. 31/140 patients had undergone MRI of the pelvis in addition to a CT/X-ray scan. The two subgroups “with MRI” and “without MRI” were analyzed with regard to the parameters “sex”, “age”, “adequacy of the trauma”, “fracture localization”, “duration of admission to imaging”, “type of therapy” and “duration to surgery” compared. Results It was shown that the MRI diagnosis was performed especially in female, elderly patients (81 years, range 19 – 94 years). Patients with inappropriate trauma have received MRI more frequently (74%) than patients with adequate trauma (26%). With regard to fracture localization no differences could be shown. The MRI was performed on a median 4 days after the CT examination. Regarding the decision “conservative” vs. “operationally” our two groups without and with MRT tended to differ not. Patients with MRI were operated on median 2 days later than patients who did not receive MRI. Conclusions Pelvic fracture MRI should be performed primarily in elderly female patients without adequate trauma. In patients with adequate trauma, MRI is of low value, especially as MRI diagnostics are performed with delay, resulting in later surgery.

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Pelvic ring fractures in the elderly now and then – a pelvic registry study

Cited by 36 publications

References 23 publications

In‐hospital mortality of pelvic ring fractures in older adults now and then: A pelvic registry study

In‐hospital mortality of pelvic ring fractures in older adults now and then: A pelvic registry study

Biomechanics of Osteoporotic Fracture Fixation

Magnetic Resonance Imaging in Pelvic Fractures – Part 1: Which Criteria Lead Us to Supplementary MRI Diagnostics?

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