Abstract
PurposeThe incidence of low energy pelvic fractures (FPFs) in the elderly is increasing. Comorbidities, decreased bone-quality, 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.MethodsA 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.ResultsA total of 132 elderly patients (≥65 years) admitted during the period 2012–2014 with FPFs were enrolled. High-energy 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).ConclusionsThe 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.
Highlights
Pelvic fractures in the elderly are known to have distinct differences compared to those in young adults
During the above pre-specified period, out of 209 consecutive patients managed in our institution, 132 met the inclusion criteria (Fig. 3; flowchart of selection criteria)
The objective of this study was to determine the effect of using a specific management protocol and the use of antiosteoporotic medication on fracture healing in low energy pelvic fractures in the elderly population
Summary
Pelvic fractures in the elderly are known to have distinct differences compared to those in young adults. Fragility pelvic fractures are thought to be a relatively simple condition. They have been managed symptomatically for years, often without complete diagnostic investigations and limited follow up [5]. They can result in significant morbidity and high costs, including prolonged hospitalization, decrease in mobility, loss of autonomy, and increase in institutionalization [6]. Risk factors and characteristics of FPFs are similar to that of hip fractures: age ≥ 65 years, female predominance, tendency for falls, and presence of decreased bone density [7]
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