Pubic rami fractures in the elderly – a neglected injury?

Studer, Patrick; Suhm, Norbert; Zappe, Björn; Bless, Nicolas; Jakob, M.

doi:10.4414/smw.2013.13859

Cited by 41 publications

(67 citation statements)

References 37 publications

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“…This sex ratio in favor of women has also been reported in Switzerland (6/1) and France (4/1) [9,10]. The mean age of patients sustaining osteoporotic pelvic fracture is estimated around 80 years (ranging from 80 years to 84 years), similar to the mean age of 9,10]. Increased incidence of pelvic fracture with age is reported in all publications ( Fig.…”

Section: Introductionsupporting

confidence: 64%

“…Within 3 months of fracture, mortality rate ranged from 7.1 to 13% [16 && ,18]. At 1 year, mortality rate varied from 12.9 to 27% [9,[18][19][20]. In a series of 286 pubic rami fractures, mortality was increased compared with an agematched population, most obviously during the first year, but that remained significant after 5 years; interestingly, during the first years, hip fracture mortality was higher than for pelvic fractures, but at 5 years, there was no more significant difference between hip and pelvic fractures [21].…”

Section: Human Cost: Morbidity and Mortalitymentioning

confidence: 99%

“…Indeed, if generally acetabular fractures are more likely to be traumatic, a recent series of 573 acetabular fractures recorded 12.4% of them as being a result of low-energy impact, underlying that they represent a significant proportion of acetabular fractures [7]. As a characteristic of osteoporosis, pelvic fractures predominantly affect women and their incidence increases with age [1 && , 8,9]. In a German retrospective study [1 && ], the standardized incidence rate of pelvic fracture per 10 000 person-years was 28.7 (28.0-29.4) for women compared with 12.1 (11.5-12.8) for men (P < 0.001) (Fig.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pelvic fractures: epidemiology, consequences, and medical management

Breuil

Roux

Carle

2016

Current Opinion in Rheumatology

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Section: Introductionsupporting

confidence: 64%

Section: Human Cost: Morbidity and Mortalitymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pelvic fractures: epidemiology, consequences, and medical management

Breuil

Roux

Carle

2016

Current Opinion in Rheumatology

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“…"Gebrechlichkeit"; Abkürzung: FFP, siehe Abschnitt "Klassifikation" In klinischen Studien hat sich gezeigt, dass bei einer nativradiologisch nachgewiesenen Fraktur des vorderen Beckenrings in 54-97 % (!) der Fälle auch eine knöcherne Läsion im Bereich des hinteren Beckenrings vorliegt [9,11]. Bei klinischem Verdacht auf eine Fraktur in dieser Region sollte daher eine computertomografische Diagnostik des Beckens forciert werden (▶ Abb.…”

Section: Definitionunclassified

Die augmentierte iliosakrale Schraube bei Beckenfrakturen im Alter

Grüneweller¹,

Fuchs²,

Wähnert³

et al. 2017

OP-JOURNAL

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ZusammenfassungDie demografische Entwicklung hat in den letzten Jahren zu einer Zunahme an älteren multimorbiden Patienten mit Beckenringfraktur geführt. Dabei stellen Diagnose, Therapie sowie peri- und postoperatives Patientenmanagement eine große Herausforderung dar. Für eine optimale Patientenversorgung ist ein interdisziplinärer Behandlungsansatz notwendig. In der Altersgruppe der > 65-jähringen Patienten sind Beckenringverletzung häufig durch Niedrigenergietraumen verursacht und mit einer reduzierten Knochenqualität vergesellschaftet. Die therapeutischen Optionen reichen von konservativen bis hin zu verschiedenen operativen Maßnahmen. Allerdings wird auch die operative Therapie durch altersbedingte Komorbiditäten beeinflusst. Daher werden hierfür minimalinvasive und schonende OP-Methoden favorisiert. Die mit zunehmendem Alter reduzierte Knochenqualität erschwert jedoch die knöcherne Verankerung von unfallchirurgischen Implantaten erheblich. Im Folgenden stellen wir ein minimalinvasiv durchführbares Verfahren, die Zementaugmentation von iliosakralen Schrauben, vor. Dieses kann bei therapierefraktären Beschwerden und immobilisierenden Schmerzen zur Behandlung der hinteren Beckenringfraktur bei reduzierter Knochenqualität durchgeführt werden. Die Schraubenaugmentation trägt hier zu einer deutlichen Verbesserung der Implantatverankerung bei. Das Augmentationsverfahren kann ohne wesentliche Erweiterung des Zugangswegs und der chirurgischen Morbidität durchgeführt werden. Kanülierte und spitzenperforierte Schraubensysteme werden nach der gewohnten perkutanen Implantation bei reduziertem Eindrehmoment mittels Knochenzement im Bereich der Schraubenspitze augmentiert. Ziel dieser Therapie ist eine suffiziente Schmerzreduktion und die sofortige Mobilisation unter Vollbelastung, um Komplikationen und Folgeschäden durch Immobilisation für den geriatrischen Patienten zu vermeiden.

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“…They have been managed symptomatically for years, often without complete diagnostic investigations and limited follow up [5]. However, they can result in significant morbidity and high costs, including prolonged hospitalization, decrease in mobility, loss of autonomy, and increase in institutionalization [6].…”

Section: Introductionmentioning

confidence: 99%

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

Kanakaris

Greven

West

et al. 2017

International Orthopaedics (SICOT)

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Purpose The incidence of low energy pelvic fractures (FPFs) in the elderly is increasing. Comorbidities, decreased bonequality, problematic fracture fixation and poor compliance represent some of their specific difficulties. In the absence of uniform management, a standard operating procedure (SOP) was introduced to our unit, aiming to improve the quality of services provided to these patients. Methods A cohort study was contacted to test the impact of (1) using a specific clinical algorithm and (2) using different antiosteoporotic drugs. Multivariate regression analysis was used to determine prognostic factors. Study endpoints were the time-to-healing, length-of-stay, return to pre-injury mobility, union status, mortality and complications. Results A total of 132 elderly patients (≥65 years) admitted during the period 2012-2014 with FPFs were enrolled. Highenergy fractures, acetabular fractures, associated trauma affecting mobility, pathological pelvic lesions and operated FPFs were used as exclusion criteria. The majority of included patients were females (108/132; 81.8%), and the mean age was 85.8 years (range 67-108). Use of antiosteoporotics was associated with a shorter time of healing (p = 0.036). Patients treated according to the algorithm showed a significant protection against malunion (p < 0.001). Also, adherence to the algorithm allowed more patients to return to their pre-injury mobility status (p = 0.039). Conclusions The use of antiosteoporotic medication in elderly patients with fragility pelvic fractures was associated with faster healing, whilst the adherence to a structured clinical pathway led to less malunions and non-unions and return to pre-injury mobility state.

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Pubic rami fractures in the elderly – a neglected injury?

Cited by 41 publications

References 37 publications

Pelvic fractures: epidemiology, consequences, and medical management

Pelvic fractures: epidemiology, consequences, and medical management

Die augmentierte iliosakrale Schraube bei Beckenfrakturen im Alter

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

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