Abstract
BackgroundPelvic ring injuries in the elderly often occur after low-energy accidents. They may result in prolonged immobilization, complications and an intense rehabilitation process. The aim of this study was to assess mortality, physical functioning and quality of life (QoL) in elderly patients with pelvic ring injuries.MethodsA cross-sectional study was performed including all elderly patients (≥ 65 years) admitted for a pelvic ring injury between 2007-2016. Mortality and survival were evaluated and patient reported outcome measures (PROMs) were used to assess physical functioning (SMFA) and QoL (EQ-5D). These were compared to age-matched normative data from the general Dutch population.ResultsA total of 153 patients, with a mean age of 79 years (SD 8) at the time of injury, were included in this study. The mortality rate was 20% at 30 days, 27% at 1 year and 41% at 3 years of follow-up. All six patients with a type C fracture died within 30 days. Analyses of the 153 patients showed that increasing age, fracture type C and Injury Severity Score (ISS) were all independent risk factors for mortality. Eventually, after excluding patients that died (N = 78) or were unable to contact (N = 2), 73 patients were eligible for follow-up, of which 53 patients (73%) responded. Mean Short Musculoskeletal Function Assessment (SMFA) scores were respectively 67.4 (function index), 65.2 (bother index), 66.5 (lower extremity), 60.4 (activities of daily living) and 68.2 (emotion). Mean EuroQuol-5D (EQ-5D) score was 0.72. Overall, physical functioning and quality of life were significantly decreased in comparison with normative data from the general population.ConclusionElderly people who sustain a pelvic ring injury should be considered as a fragile population with substantial mortality rates. The patients who survived demonstrated a substantially lower level of physical functioning and quality of life in comparison with their age-matched peers from the general population.Level of evidenceIV, therapeutic study.
Highlights
The elderly population ( 65 years of age) has rapidly increased over the last few decades and it is predicted that this growth will continue in the future
Analyses of the 153 patients showed that increasing age, fracture type C and Injury Severity Score (ISS) were all independent risk factors for mortality
Physical functioning and quality of life were significantly decreased in comparison with normative data from the general population
Summary
The elderly population ( 65 years of age) has rapidly increased over the last few decades and it is predicted that this growth will continue in the future. One-third of all fractures and 73% of all pelvic injuries occur in the elderly [2]. The elderly population is vulnerable as a result of age-related reduced physical condition, pre-existing comorbidities, limited rehabilitation capacity and decreased coping mechanisms. The majority of pelvic ring injuries in this population is caused by low-energy mechanisms like a fall from standing position, often resulting in AO type A fractures [6,7,8], that are considered stable fractures with an intact posterior arch involving innominate bone avulsion, iliac wing, pubic rami, transverse sacral or coccyx fractures [9]. Pelvic ring injuries in the elderly often occur after low-energy accidents. They may result in prolonged immobilization, complications and an intense rehabilitation process. The aim of this study was to assess mortality, physical functioning and quality of life (QoL) in elderly patients with pelvic ring injuries
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