Low-energy fractures of the pelvis in the elderly and mortality

Abstract

Abstract Objective While the prognostic impact of hip fractures in the elderly is widely accepted, the risk and excess mortality associated with pelvic fragility fractures is still underestimated and receives considerably less attention. Morbidity and mortality might thereby be related to fracture morphology and/or patient characteristics. The aim of this project is to investigate the prognostic value of specific fracture characteristics with respect to overall survival and to compare it with an established classification system. Methods Retrospective analysis of patients ≥60 years, treated conservatively for a CT-scan verified, low-energy pelvic ring fracture diagnosed between August 2006 and December 2018. Survival data was available from patients’ charts and cantonal or national registries. The prognostic value of fracture characteristic describing the anterior and posterior involvement of the pelvic ring was investigated. This analysis was repeated after patients were stratified into a high-risk vs a low-risk group according to patient characteristic (age, gender, comorbidities, mobility, living situation). This allowed to assess the impact of the different fracture morphologies on mortality in fit vs. frail senior patients separately Results Overall, 428 patients (83.4% female) with a mean age of 83.7 years were included. Two thirds of patients were still living in their home and mobile without walking aid at baseline. In-hospital mortality was 0.7%, overall, one-year mortality 16.9%. An independent and significant association of age, gender and comorbidities to overall survival was found. Further, the occurrence of a horizontal sacral fracture as well as a ventral comminution or dislocation was associated with an increased mortality. The effect of a horizontal sacral fracture was more accentuated in low-risk patients while the ventral fracture components showed a larger effect on survival in high-risk patients. No association of the FFP classification with survival was observed. Conclusion Specific fracture characteristics such as horizontal sacral fracture, comminuted and dislocated ventral fractures may indicate a higher mortality risk of patients with a pelvic fragility fracture. Hence, they should be taken into account in future treatment algorithms and decisions on patient management.