Abstract
Individuals who fall from heights of ≥6 m can suffer from complex pelvic and acetabular fractures. The extent to which an intentional fall correlates with prognosis and outcome after osteosynthesis is unclear. Therefore, we aimed to investigate the clinical outcomes of fallers with pelvic and acetabular fractures after osteosynthesis and compare the radiological and functional outcomes between intentional and accidental fallers. We retrospectively reviewed 49 fallers who fell from heights of ≥6 m, developed pelvic and acetabular fractures, survived after resuscitation, and completed surgical treatment between 2014 and 2017. Fallers were divided into intentional and accidental fallers. Sixteen patients were intentional fallers, whereas the rest of the patients were accidental fallers. Psychiatric counseling was provided to each of the intentional fallers during follow-up. All intentional fallers had preexisting mental disorders, and the most common diagnosis was adjustment disorder. The group of intentional fallers predominantly comprised females that had a higher injury and new injury severity scores and longer hospital stays. However, early loss of fixation (<3 months) and functional outcomes (Merle d'Aubigné and Majeed hip scores at 6- and 12-month follow-ups) did not significantly differ between intentional and accidental fallers. We found that intentional fallers with pelvic and acetabular fractures may have more severe combined injuries compared to accidental fallers. However, the radiological and functional outcomes of the intentional fallers after osteosynthesis were not inferior to those of the accidental fallers with the implementation of well-designed surgical protocols and individualized physical and mental rehabilitation programs.
Highlights
The optimal treatment of pelvic and acetabular fractures remains challenging for orthopedic surgeons, especially for multiplanar unstable pelvic and complex acetabular fractures
Regardless of the time point of functional evaluation, there was no significant difference between the two groups, there were more favorable functional outcomes for patients in the A group
The present study investigated the radiological and functional outcomes for intentional fallers after osteosynthesis of pelvic and acetabular fractures and compared their clinical outcomes with those of accidental fallers
Summary
The optimal treatment of pelvic and acetabular fractures remains challenging for orthopedic surgeons, especially for multiplanar unstable pelvic and complex acetabular fractures. Among the different mechanisms of unstable pelvic and acetabular fractures, the mechanism of falling from great heights always causes great instability of the pelvic ring or multiple levels of injury of the acetabulum, resulting in treatment difficulties and unpredictable prognoses [2,3,4]. Previous studies mostly focused on epidemiology, resuscitation outcomes, and quality of life assessment of patients with mental disorders who experienced pelvic fractures after attempting to commit suicide by jumping [6,7,8]. It is not known whether their functional performance after injury was only related to the injury or to other factors related to their mental disorders. The primary outcome evaluation of the current study is aimed at investigating the functional and radiological outcomes of patients with unstable pelvic and acetabular fractures caused by an intentional fall and comparing their clinical outcomes to those of accidental fallers who had similar injuries
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