What is the long-term clinical outcome after fragility fractures of the pelvis? - A CT-based cross-sectional study

H Banierink,K Ten Duis,J Prijs,K.W Wendt,V.M.A Stirler,S.H Van Helden,R.J Nijveldt,M.F Boomsma,E Heineman,I.H.F Reininga,F.F.A Ijpma

doi:10.1016/j.injury.2021.09.056

Abstract

BackgroundRecently, Rommens and Hoffman introduced a CT-based classification system for fragility fractures of the pelvis (FFP). Although fracture characteristics have been described, the relationship with clinical outcome is lacking. The purpose of this study was to get insight into the type of treatment and subsequent clinical outcome after all types of FFP. MethodsA cross-sectional cohort study was performed including all elderly patients (≥ 65 years) with a CT-diagnosed FFP, between 2007-2019 in two level 1 trauma centers. Data regarding treatment, mortality and clinical outcome was gathered from the electronic patient files. Patients were asked to complete patient-reported outcome measures (PROMs) regarding physical functioning (SMFA) and quality of life (EQ-5D). Additionally, a standardized multidisciplinary treatment algorithm was constructed. ResultsA total of 187 patients were diagnosed with an FFP of whom 117 patients were available for follow-up analysis and 58 patients responded. FFP type I was most common (60%), followed by type II (27%), type III (8%) and type IV (5%). Almost all injuries were treated non-operatively (98%). Mobility at six weeks ranged from 50% (type III) to 80% type II). Mortality at 1 year was respectively 16% (type I and II), 47% (type III) and 13% (type IV). Physical functioning (SMFA function index) ranged from 62 (type III and IV) to 69 (type II) and was significantly decreased (P=<0.001) compared to the age-matched general population. Quality of life was also significantly decreased, ranging from 0.26 (type III) to 0.69 (type IV). ConclusionsFFP type I and II are most common. Treatment is mainly non-operative, resulting in good mobility after six weeks, especially for patients with FFP type I and II. Mortality rates at one year were substantial in all patients. Physical functioning and quality of life was about 20-30% decreased compared to the general population.

Highlights

Median follow-up of the 187 patients was four (IQR 2-7) years, of which 70 patients had deceased at a median of four years (IQR 2-6) after the injury
117 patients with a median of three years (IQR 2-6) after the injury were available for follow-up with patient-reported outcome measures (PROMs)
This study evaluated the clinical outcomes in a large cohort of elderly patients who sustained an fractures of the pelvis (FFP) in the last decade

Summary

Introduction

[m5G;October 24, 2021;17:46] Injury xxx (xxxx) xxx cently introduced a classification system for FFP based on CT imaging of the pelvis [3]. It distinguishes different subtypes with increasing degrees of instability ranging from simple type I injuries, defined as isolated anterior pelvic ring fractures, to more complex type IV injuries consisting of bilateral displaced posterior pelvic fractures. Rommens and Hoffman introduced a CT-based classification system for fragility fractures of the pelvis (FFP). Fracture characteristics have been described, the relationship with clinical outcome is lacking.

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