Pelvic ring injury in the elderly: Fragile patients with substantial mortality rates and long-term physical impairment

Abstract

Background Pelvic ring injuries in the elderly often occur after low-energy accidents. They may result in prolonged immobilization, complications and an intense rehabilitation process. The aim of this study was to assess mortality, physical functioning and quality of life (QoL) in elderly patients with pelvic ring injuries. Methods A cross-sectional study was performed including all elderly patients (� 65 years) admitted for a pelvic ring injury between 2007-2016. Mortality and survival were evaluated and patient reported outcome measures (PROMs) were used to assess physical functioning (SMFA) and QoL (EQ-5D). These were compared to age-matched normative data from the general Dutch population. Results A total of 153 patients, with a mean age of 79 years (SD 8) at the time of injury, were included in this study. The mortality rate was 20% at 30 days, 27% at 1 year and 41% at 3 years of follow-up. All six patients with a type C fracture died within 30 days. Analyses of the 153 patients showed that increasing age, fracture type C and Injury Severity Score (ISS) were all independent risk factors for mortality. Eventually, after excluding patients that died (N = 78) or were unable to contact (N = 2), 73 patients were eligible for follow-up, of which 53 patients (73%) responded. Mean Short Musculoskeletal Function Assessment (SMFA) scores were respectively 67.4 (function index), 65.2 (bother index), 66.5 (lower extremity), 60.4 (activities of daily living) and 68.2 (emotion). Mean EuroQuol-5D (EQ-5D) score was 0.72. Overall, physical functioning and quality of life were significantly decreased in comparison with normative data from the general population.

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)

“…In the studies listed in Table 4 , there always is an excess mortality in FFP patients when compared with the general population of the same age, be it in Scotland, the Netherlands, Austria, or Germany. As in the publications of Krappinger [ 8 ] and Banierink [ 20 ], we found a strong dependence of the one-year mortality on age: the rates of our patients below and above the age of 80 were 8.8% resp. 22.2%.…”

“…We did not find a remarkable difference in the one-year mortality between our study population without involvement of the posterior pelvic ring and other study populations, in which at least a part had involvement in the posterior pelvic ring. The one-year mortality rate of 16.7% in our patient cohort is situated at the lower end of data given in the published series in Table 4 , ranging from 11.2% [ 8 ] to 26.8% [ 20 ].…”

“…For comparison, van Dyck et al registered 20.2% of in-hospital complications, of which urinary tract infection and pneumonia also were the most frequent [ 18 ]. Banierink et al calculated a complication rate of 23% within 30 days after injury, in which delirium was included, whereas the last was not represented in other studies [ 20 ]. In-hospital complications occurred more often in patients with a longer hospital stay and with more comorbidities.…”

Epidemiology and mortality of pelvic and femur fractures—a nationwide register study of 417,840 fractures in Sweden across 16 years: diverging trends for potentially lethal fractures

“…Mortality within the 1st year after pelvic fracture has with few exceptions been investigated among inpatients only. A Dutch study of pelvic fractures among inpatients ≥ 65 years found a 1-year mortality of 27% (Banierink et al 2019), substantially higher than the 21% found in our study. A German study from 2017, including both in-and outpatients, found a 1-year mortality of 21% (Andrich et al 2017), like our results.…”

Pelvic insufficiency fractures following carbon-ion radiotherapy for uterine carcinomas

“…Pelvic insufficiency fractures (PIFs) are recognized as one of the late morbidities following RT for pelvic region [5]. Pelvic injury causes a significant decrease in the patients' quality of life (QOL) [6], Thus, we should consider the significance of PIFs as non-negligible late RT morbidities.…”