Abstract
Objectives
To (1) to determine the incidence of elderly pelvic fractures over the last decade, (2) describe the epidemiology and outcome of patients with pubic rami fractures and compare these to those patients sustaining all other pelvic fractures, and (3) identify independent predictors of length of stay, return to domicile, and 1-year mortality for patients with pubic rami fractures.
Methods
We retrospectively identified 937 elderly patients (≥65 years) with pelvic fractures presenting to the study centre over a 15-year period. Patient demographics, mechanism of injury, and associated fractures were recorded for a defined 2-year period. Outcomes assessed were length of stay, return to original place of domicile, and 1-year mortality.
Results
The incidence increased from 7.9 per 100,000 to 13.1 per 100,000. The majority were fragility fractures of the pubic rami (84 %). Patients sustaining a pubic rami fracture were older, more likely to be female, less deprived and have sustained an isolated injury by a low-energy mechanism. Patients sustaining a pubic rami fracture were less likely to return to their original place of domicile. Pre-injury independence and mobility, socioeconomic status, associated fractures, energy of injury, and male gender were independent predictors of length of stay, return to original place of domicile, and 1-year mortality.
Conclusion
The incidence of elderly pelvic fractures is increasing, and fractures of the pubic ramus have different patient demographics compared to other pelvic fractures. Patient demographics could be used to predict: length of stay, return to domicile, and 1-year mortality after a pubic rami fracture.
Level of evidence
Retrospective prognostic study, Level IV.
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References
National Institute on Aging (2008) An Aging World. National Institute on Aging. U.S. National Institutes of Health. http://nia.nih.gov/
Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37:691–697
Melton LJ III, Sampson JM, Morrey BF, Ilstrup DM (1981) Epidemiologic features of pelvic fractures. Clin Orthop Relat Res 155:43–47
Kannus P, Palvanen M, Niemi S, Parkkari J, Jarvinen M (2000) Epidemiology of osteoporotic pelvic fractures in elderly people in Finland: sharp increase in 1970–1997 and alarming projections for the new millennium. Osteoporos Int 11:443–448
Court-Brown CM, Aitken SA, Forward D, O’Toole RV (2010) The epidemiology of fractures. In: Bucholz RW,Court-Brown CM, Heckman JD, Tornetta P (eds) Rockwood and green’s fractures in adults. 7th edn. Lippincott Williams and Wilkins, Philadelphia. pp 53–77. ISBN:1605476773
Koval KJ, Aharonoff GB, Schwartz MC, Alpert S, Cohen G, McShinawy A, Zuckerman JD (1997) Pubic rami fracture: a benign pelvic injury? J Orthop Trauma 11:7–9
Hill RM, Robinson CM, Keating JF (2001) Fractures of the pubic rami. Epidemiology and five-year survival. J Bone Joint Surg Br 83:1141–1144
Breuil V, Roux CH, Testa J, Albert C, Chassang M, Brocq O, Euller-Ziegler L (2008) Outcome of osteoporotic pelvic fractures: an underestimated severity. Survey of 60 cases. Joint Bone Spine 75:585–588
van Dijk WA, Poeze M, van Helden SH, Brink PR, Verbruggen JP (2010) Ten-year mortality among hospitalised patients with fractures of the pubic rami. Injury 41:411–414
Morris RO, Sonibare A, Green DJ, Masud T (2000) Closed pelvic fractures: characteristics and outcomes in older patients admitted to medical and geriatric wards. Postgrad Med J 76:646–650
Fox Ray N, Chan JK, Thamer M (1997) Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 12:24–35
Johnell O (1997) The socioeconomic burden of fractures: today and in the 21st century. Am J Med 103:20S–26S
Krappinger D, Struve P, Schmid R, Kroesslhuber J, Blauth M (2009) Fractures of the pubic rami: a retrospective review of 534 cases. Arch Orthop Trauma Surg 129:1685–1690
Court-Brown CM, Clement N (2009) Four score years and ten: an analysis of the epidemiology of fractures in the very elderly. Injury 40:1111–1114
Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audige L (2007) Fracture and dislocation classification compendium–2007: orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 21:S1–133
The Scottish Government (2009) Scottish Index of Multiple Deprivation 2009: General Report. Vol. 2010
The Scottish Government (2009) SIMD Postcode to Datazone Lookup Table. Vol. 2010
General Register Office for Scotland. http://www.gro-scotland.gov.uk/files2/stats/gros-mid-2008-population-estimates-scotland-population-estimates-by-sex-age-and-administrative-area/j1075008.html
General Register Office for Scotland. http://www.gro-scotland.gov.uk/press/news2007/rise-projected-for-scotlands-population.html
Office for National Statistics (2011) Mid-year population estimates. Office for National Statistics. http://www.statistics.gov.uk/cci/nugget.asp?id=949
Lawrence TM, White CT, Wenn R, Moran CG (2005) The current hospital costs of treating hip fractures. Injury 36:88–91
Steinitz D, Guy P, Passariello A (2004) All superior pubic rami fractures are not created equal. Can J Surg 47:422–425
Leung AH, Lam TP, Cheung WH, Chan T, Sze PC, Lau T, Leung KS (2011) An orthogeriatric collaborative intervention program for fragility fractures: a retrospective cohort study. J Trauma 71:1390–1394
Murray IR, Biant LC, Clement ND, Murray SC (2011) Should a hip fracture in a frail older person be a trigger for assessment of palliative care needs? BMJ Support Palliat Care 1:3–4
Beall DP, D’souza SL, Costello RF (2007) Percutaneous augmentation of the superior pubic ramus with polymethylmethacrylate: treatment of acute and chronic insufficiency fractures. Skeletal Radiol 36:979–983
Sermon A, Broos P, Vanderschot P (2008) Total hip replacement for acetabular fractures. Results in121 patients operated between 1983 and 2003. Injury 39:914–921
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Clement, N.D., Court-Brown, C.M. Elderly pelvic fractures: the incidence is increasing and patient demographics can be used to predict the outcome. Eur J Orthop Surg Traumatol 24, 1431–1437 (2014). https://doi.org/10.1007/s00590-014-1439-7
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DOI: https://doi.org/10.1007/s00590-014-1439-7