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Mortality and functional outcomes of fragility fractures of the pelvis by fracture type with conservative treatment: a retrospective, multicenter TRON study

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Abstract

Purpose

Fragility fractures of the pelvis (FFP) are becoming a commonly encountered disease in aging societies. We aimed to (1) clarify the overall survival rate of FFP, (2) compare survival rates by Rommens and Hofmann classification FFP type, (3) investigate the complications during hospitalization, and (4) investigate walking ability before and after injury depending on the type of fracture in patients with FFP treated conservatively.

Methods

This retrospective, multicenter study included 867 patients with FFP treated conservatively between 2014 and 2018 and excluded patients with insufficient follow-up for two years, lost data, and operative cases. This is a retrospective multicenter study. We established the database, which is named as TRON. We evaluated survival rate by fracture type using the log-rank test. We compared walking ability as defined by a new mobility score and the modified Majeed Pelvic Score among fracture types.

Results

We reviewed 552 cases (98 males and 454 females) with conservative treatment. The overall survival rates of patients with FFP treated conservatively were 0.90 at 1 year and 0.83 at 2 years. Although the survival rate was the lowest in FFP Type III, there was no significant difference in survival rates between fracture types (P = 0.143). The rates of complications during hospitalization were high for both Type III and Type IV fractures. Walking ability post-injury was worse in the patients with Type III fracture.

Conclusions

The survival rate of patients treated by conservative treatment was relatively good. Type III in the Rommens and Hofmann classification was related to lower life expectancy and loss of walking ability.

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Availability of data and material

The datasets during and/or analyzed during the current study available from the corresponding author on reasonable request.

References

  1. Report of a WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. World Health Organ Tech Rep Ser. 1994;843:1–129.

    Google Scholar 

  2. Bonjour J-P, Ammann P, Rizzoli R. Importance of preclinical studies in the development of drugs for treatment of osteoporosis: a review related to the 1998 WHO guidelines. Osteoporos Int. 1999;9(5):379–93.

    Article  CAS  Google Scholar 

  3. Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ. 2010;182(17):1864–73.

    Article  Google Scholar 

  4. Hertz K, Santy-Tomlinson J, editors. Fragility fracture nursing: holistic care and management of the orthogeriatric patient. Cham (CH): Springer; 2018.

    Google Scholar 

  5. Kannus P, Palvanen M, Niemi S, Parkkari J, Järvinen M. Epidemiology of osteoporotic pelvic fractures in elderly people in Finland: sharp increase in 1970–1997 and alarming projections for the new millennium. Osteoporos Int. 2000;11(5):443–8.

    Article  CAS  Google Scholar 

  6. Miki RA, Oetgen ME, Kirk J, Insogna KL, Lindskog DM. Orthopaedic management improves the rate of early osteoporosis treatment after hip fracture. A randomized clinical trial. J Bone Joint Surg Am. 2008;90(11):2346–53.

    Article  Google Scholar 

  7. Tile M. Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br. 1988;70(1):1–12.

    Article  CAS  Google Scholar 

  8. Burgess AR, Eastridge BJ, Young JW, Ellison TS, Ellison PS Jr, Poka A, et al. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma. 1990;30(7):848–56.

    Article  CAS  Google Scholar 

  9. Meinberg E, Agel J, Roberts C, Karam M, Kellam J. Fracture and dislocation classification compendium–2018. J Orthop Trauma. 2018;32(Suppl 1):S1-10.

    Article  Google Scholar 

  10. Tosounidis G, Wirbel R, Culemann U, Pohlemann T. Fehleinschätzung bei vorderer Beckenringfraktur im höheren Lebensalter. Misinterpretation of anterior pelvic ring fractures in the elderly (in German). Unfallchirurg. 2006;109(8):678–80.

    Article  CAS  Google Scholar 

  11. Stuby FM, Schäffler A, Haas T, König B, Stöckle U, Freude T. Insufficiency fractures of the pelvic ring (in German). Unfallchirurg. 2013;116(4):351–66. https://doi.org/10.1007/s00113-012-2349-y.

    Article  CAS  PubMed  Google Scholar 

  12. Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury. 2013;44(12):1733–44.

    Article  Google Scholar 

  13. Osterhoff G, Noser J, Held U, Werner CML, Pape H-C, Dietrich M. Early operative versus nonoperative treatment of fragility fractures of the pelvis: a propensity-matched multicenter study. J Orthop Trauma. 2019;33(11):e410–5.

    Article  Google Scholar 

  14. Noser J, Dietrich M, Tiziani S, Werner CML, Pape H-C, Osterhoff G. Mid-term follow-up after surgical treatment of fragility fractures of the pelvis. Injury. 2018;49(11):2032–5.

    Article  Google Scholar 

  15. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.

    Article  CAS  Google Scholar 

  16. Parker M, Palmer C. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br. 1993;75(5):797–8.

    Article  CAS  Google Scholar 

  17. Yoshida M, Tajima K, Saito Y, Sato K, Uenishi N, Iwata M. Mobility and mortality of 340 patients with fragility fracture of the pelvis. Eur J Trauma Emerg Surg. 2021;47(1):29–36.

    Article  Google Scholar 

  18. Majeed S. Grading the outcome of pelvic fractures. J Bone Joint Surg Br. 1989;71(2):304–6.

    Article  CAS  Google Scholar 

  19. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48(3):452–8.

    Article  CAS  Google Scholar 

  20. Taillandier J, Langue F, Alemanni M, Taillandier-Heriche E. Mortality and functional outcomes of pelvic insufficiency fractures in older patients. Joint Bone Spine. 2003;70(4):287–9.

    Article  Google Scholar 

  21. Leung WY, Ban CM, Lam JJ, Ip FK, Ko PS. Prognosis of acute pelvic fractures in elderly patients: retrospective study. Hong Kong Med J. 2001;7(2):139–45.

    CAS  PubMed  Google Scholar 

  22. Gotis-Graham I, McGuigan L, Diamond T, Portek I, Quinn R, Sturgess A, et al. Sacral insufficiency fractures in the elderly. J Bone Joint Surg Br. 1994;76(6):882–6.

    Article  CAS  Google Scholar 

  23. Agri F, Bourgeat M, Becce F, Moerenhout K, Pasquier M, Borens O, et al. Association of pelvic fracture patterns, pelvic binder use and arterial angio-embolization with transfusion requirements and mortality rates; a 7-year retrospective cohort study. BMC Surg. 2017;17(1):104.

    Article  Google Scholar 

  24. Manson T, O’Toole RV, Whitney A, Duggan B, Sciadini M, Nascone J. Young-Burgess classification of pelvic ring fractures: does it predict mortality, transfusion requirements, and non-orthopaedic injuries? J Orthop Trauma. 2010;24(10):603–9.

    Article  Google Scholar 

  25. Hart RA, Badra MI, Madala A, Yoo JU. Use of pelvic incidence as a guide to reduction of H-type spino-pelvic dissociation injuries. J Orthop Trauma. 2007;21(6):369–74.

    Article  Google Scholar 

  26. Lindahl J, Mäkinen TJ, Koskinen SK, Söderlund T. Factors associated with outcome of spinopelvic dissociation treated with lumbopelvic fixation. Injury. 2014;45(12):1914–20.

    Article  Google Scholar 

  27. Lehman RA Jr, Kang DG, Bellabarba C. A new classification for complex lumbosacral injuries. Spine J. 2012;12(7):612–28.

    Article  Google Scholar 

  28. Linstrom NJ, Heiserman JE, Kortman KE, Crawford NR, Baek S, Anderson RL, et al. Anatomical and biomechanical analyses of the unique and consistent locations of sacral insufficiency fractures. Spine. 2009;34(4):309–15.

    Article  Google Scholar 

  29. Rommens PM, Hopf JC, Herteleer M, Devlieger B, Hofmann A, Wagner D. 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). J Clin Med Res. 2020;9:2498.

    Google Scholar 

  30. van Dijk WA, Poeze M, van Helden SH, Brink PR, Verbruggen JP. Ten-year mortality among hospitalised patients with fractures of the pubic rami. Injury. 2010;41:411–4.

    Article  Google Scholar 

  31. Maier GS, Kolbow K, Lazovic D, Horas K, Roth KE, Seeger JB, et al. Risk factors for pelvic insufficiency fractures and outcome after conservative therapy. Arch Gerontol Geriatr. 2016;67:80–5.

    Article  Google Scholar 

  32. Brouwers L, Wouter Lansink KW, van Delft-Schreurs K. Differences in the Majeed Pelvic Score between injured and uninjured patients. J Orthop Trauma. 2019;33(5):244–9.

    Article  Google Scholar 

  33. Rommens PM, Boudissa M, Krämer S, Kisilak M, Hofmann A, Wagner D. Operative treatment of fragility fractures of the pelvis is connected with lower mortality. A single institution experience. PLoS ONE. 2021;16: e0253408.

    Article  CAS  Google Scholar 

  34. Wagner D, Kisilak M, Porcheron G, Krämer S, Mehling I, Hofmann A, et al. Trans-sacral bar osteosynthesis provides low mortality and high mobility in patients with fragility fractures of the pelvis. Sci Rep. 2021;11:14201.

    Article  CAS  Google Scholar 

  35. Saito Y, Tokutake K, Takegami Y, Yoshida M, Omichi T, Imagama S. Does surgical treatment for unstable fragility fracture of the pelvis promote early mobilization and improve survival rate and postoperative clinical function? [published online ahead of print, 2021 Jun 22]. Eur J Trauma Emerg Surg. 2021. https://doi.org/10.1007/s00068-021-01729-6.

  36. Rommens PM, Arand C, Hopf JC, Mehling I, Dietz SO, Wagner D. Progress of instability in fragility fractures of the pelvis: an observational study. Injury. 2019;50(11):1966–73.

    Article  CAS  Google Scholar 

  37. Krappinger D, Kaser V, Kammerlander C, Neuerburg C, Merkel A, Lindtner RA. Inter- and intraobserver reliability and critical analysis of the FFP classification of osteoporotic pelvic ring injuries. Injury. 2019;50(2):337–43.

    Article  Google Scholar 

  38. OECD (2021) Medical graduates (indicators). https://doi.org/10.1787/ac5bd5d3-en (Accessed on 16 September 2021)

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Acknowledgements

We thank Members of the Trauma research of Nagoya group (shown in alphabetical order of affiliation) as follows: Dr. Takeshi Oguchi (Anjo Kosei Hospital); Dr. Yoshiharu Oka (Chubu Rosai Hospital); Dr. Masahiro Hanabayashi (Ichinomiya Municipal Hospital), Dr. Hiroaki Yoshida (Kamiiida Daiichi General Hospital), Dr. Tokumi Kanemura (Kounan Kosei Hospital), Hidenori Inoue (Nagoya Daiichi Red Cross Hospital), Dr. Koji Maruyama (Nakatsugawa Municipal General Hospital), Dr. Kenichi Yamauchi (Toyohashi Municipal Hospital); Dr. Yasuhide Kanayama (Toyota Kosei Hospital); Dr. Tadahiro Sakai (TOYOTA memorial Hospital), Dr. Nobuhiro Okui (Yokkaichi Municipal Hospital) and Dr. Ryosuke Sugimoto, Dr. Takuya Sugimoto, Dr. Yujiro Kagami, Dr. Hiroshi Takahashi, Dr, Yujiro Katayama (Nagoya university) .

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Toshifumi Omichi, Yasuhiko Takegami, Yuki Saito & Shiro Imagama

  2. Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Katsuhiro Tokutake

  3. Department of Orthopedic Surgery, Nishichita General Hospital, Tokai, Japan

    Osamu Ito

  4. Department of Orthopedic Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan

    Toshihiro Ando

Authors
  1. Toshifumi Omichi
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  2. Yasuhiko Takegami
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  3. Katsuhiro Tokutake
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  4. Yuki Saito
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  5. Osamu Ito
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  6. Toshihiro Ando
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  7. Shiro Imagama
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Contributions

Conceptualization: YT and SI; Methodology: YT, YS; Formal analysis and investigation: TO; Writing—original draft preparation: TO; Writing—review and editing: KT; Resources: OI and TA; Supervision: SI.

Corresponding author

Correspondence to Yasuhiko Takegami.

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The approval number in our institute is 2020-0549.

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All patients provided written informed for their data to be used.

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Omichi, T., Takegami, Y., Tokutake, K. et al. Mortality and functional outcomes of fragility fractures of the pelvis by fracture type with conservative treatment: a retrospective, multicenter TRON study. Eur J Trauma Emerg Surg 48, 2897–2904 (2022). https://doi.org/10.1007/s00068-021-01839-1

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