Which factors influence treatment decision in fragility fractures of the pelvis? - results of a prospective study

Ludwig Oberkircher,Juliana Hack,Daphne Eschbach,Julia Lenz,Benjamin Bücking,Carsten Schoeneberg,Steffen Ruchholtz,René Aigner,Christopher Bliemel

doi:10.1186/s12891-021-04573-2

Ludwig Oberkircher, Juliana Hack + Show 7 more

Open Access

https://doi.org/10.1186/s12891-021-04573-2

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Abstract

BackgroundThe aim of the present study was to describe specific characteristics of patients suffering from pelvic fragility fractures and evaluate factors that might influence treatment decisions which may optimize treatment pathways and patient mobility in the future.MethodsA prospective study with patients suffering from fractures of the pelvis and aged 60 years or above was performed between 2012 and 2016. Data acquisition took place at admission, every day during hospitalization and at discharge.ResultsOne hundred thirty-four patients (mean age of 79.93 (± 7.67) years), predominantly female (84%), were included. Eighty-six patients were treated non-operatively. Forty-eight patients underwent a surgical procedure. The main fracture types were B2 fractures (52.24%) and FFP IIb fractures (39.55%). At the time of discharge, pain level (NRS) could be significantly reduced (p < 0.001). Patients who underwent a surgical procedure had a significantly higher pain level on day three and four compared to the non-operative group (p = 0.032 and p = 0.023, respectively). Significant differences were found in the mobility level: patients treated operatively on day four or later were not able to stand or walk on day three as compared to non-operatively treated patients. Regarding B2 fractures, a significantly higher mobility level difference between time of admission and discharge was found in patients treated with a surgical procedure compared to patients treated non-operatively (p = 0.035).ConclusionsFracture type, mobility level and pain level influence the decision to proceed with surgical treatment. Especially patients suffering from B2 fractures benefitted in terms of mobility level at discharge when treated operatively.Level of evidenceII

Highlights

The incidence of fragility fractures of the pelvis in the elderly is greatly increasing due to rising life expectancy and an aging population [1,2,3,4,5]
The peak incidence of osteoporotic pelvic fractures seems to be in the ninth decade of life [7], and 75% of patients aged 60 or older with pelvic fractures were women in a recently published analysis by Rollmann et al [8] in accordance with the higher incidence of osteoporosis in women [9, 10]
Patient recruitment In our university hospital, we performed a prospective study with patients suffering from fractures of the pelvis between June 1, 2012, and December 31, 2016

Summary

Introduction

The aim of the present study was to describe specific characteristics of patients suffering from pelvic fragility fractures and evaluate factors that might influence treatment decisions which may optimize treatment pathways and patient mobility in the future. The incidence of fragility fractures of the pelvis in the elderly is greatly increasing due to rising life expectancy and an aging population [1,2,3,4,5]. To give consideration to the particularities of fragility fractures and sacral insufficiency fractures, Rommens and Hofmann developed a new classification system (FFP [fragility fractures of the pelvis] I-IV) [12, 13]. This system can aid in deciding whether an operation is warranted, but the classification has not been validated by any clinical studies to date. Standardized treatment protocols are still lacking despite the dramatically increasing incidence as well as the increased mortality, reduced mobility and significant loss of social independence in affected patients [6, 9, 14, 15]

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