Incidence Of Pelvic Fractures Research Articles

The incidence of pelvic fractures with traumatic lower limb amputation in modern warfare due to improvised explosive devices

A frequently-seen injury pattern in current military experience is traumatic lower limb amputation as a result of improvised explosive devices (IEDs). This injury can coexist with fractures involving the pelvic ring. This study aims to assess the frequency of concomitant pelvic fracture in IED-related lower limb amputation. A retrospective analysis of the trauma charts, medical notes, and digital imaging was undertaken for all patients arriving at the Emergency Department at the UK military field hospital in Camp Bastion, Afghanistan, with a traumatic lower limb amputation in the six months between September 2009 and April 2010, in order to determine the incidence of associated pelvic ring fractures. Of 77 consecutive patients with traumatic lower limb amputations, 17 (22%) had an associated pelvic fracture (eleven with displaced pelvic ring fractures, five undisplaced fractures and one acetabular fracture). Unilateral amputees (n = 31) had a 10% incidence of associated pelvic fracture, whilst 30 % of bilateral amputees (n = 46) had a concurrent pelvic fracture. However, in bilateral, trans-femoral amputations (n = 28) the incidence of pelvic fracture was 39%. The study demonstrates a high incidence of pelvic fractures in patients with traumatic lower limb amputations, supporting the routine pre-hospital application of pelvic binders in this patient group.

Epidemiology of hospitalized traumatic pelvic fractures and their combined injuries in Taiwan: 2000-2011 National Health Insurance data surveillance.

Background. From the viewpoint of prehospital emergency medicine, a greater proportion of pelvic fractures not of a life-threatening status but combined with other injuries need more comprehensive recognition. Methods. A 12-year nationwide health database of inpatients was reviewed. All cases diagnosed as pelvic fractures were enrolled. The associated injuries classified into 20 categories were further analyzed. Results. During 2000–2011, the hospitalized incidence of pelvic fractures in Taiwan ranged from 17.17 to 19.42 per 100,000, and an increasing trend with age was observed. The mean case-fatality rate was 1.6% for females and 2.1% for males; male patients with pelvic fractures had a significantly higher risk of death than female patients after adjusting for other covariates. 74.2% of these cases were combined with other injuries. The most common associated injuries in an identified body region were other orthopedic fractures of the lower limbs (21.50%), spine/trunk (20.97%), or upper limbs (18.18%), followed by significant head injuries (17.59%), intra-abdominal injuries (11.00%), and thoracic injuries (7.20%). Conclusion. The incidence of hospitalized pelvic fractures in Taiwan was low and the case-fatality rate was lower than those of other countries. Concurrently, coexistence of major combined injuries with pelvic fractures was easily treated at medical centers.

Pelvic Fractures at a New Level 1 Trauma Centre: Who Dies from Pelvic Trauma? The Inkosi Albert Luthuli Central Hospital Experience

To identify the incidence of pelvic trauma, causes of death and factors predicting death with pelvic fractures. All pelvic fractures were retrospectively identified from a registry spanning from March 2007 to August 2009. Data was captured on a proforma. Data for survivors, non-survivors and a subgroup with pelvic injury as the underlying cause of death were compared. Pelvic fracture incidence was 16% of major trauma cases. Patient with pelvic fractures had 31% mortality and 9% pelvic fracture-induced mortality. Motor vehicle collisions were the commonest external cause of pelvic fractures (59%); however, the highest mortality was from falls >6 m. The Injury Severity Score (ISS) was 29 in survivors, 36 in non-survivors, and 54 in the pelvic death subgroup. Type C fracture was a predictor of mortality (P = 0.135). 53% of the cases required transfusion in the first 24 hours. The pelvic death subgroup received a mean of 10.7 units of blood, versus 4 units for survivors and 3.7 units for non-survivors (P = 0.259). The overall incidence of pelvic fracture and associated mortality were higher than previously reported. Fracture severity and falls from heights are associated with additional injuries (higher ISS) and mortality. More severe fractures cause deaths directly attributable to the pelvic injury. The requirement for major blood transfusions for pelvic fracture hemorrhage was related to mortality. Female patients appeared to fare worse than males.

The role of gender and age in fracture distribution following the 2008 Wenchuan earthquake

This study explored demographic variations among victims injured in the 2008 Wenchuan earthquake. The study analyzed records of 2,148 patients who were hospitalized with earthquake-related injuries in 14 hospitals between May 12 and May 21 of 2008. We tested the effects of gender and age on the incidence of fractures and amputations. Although more women than men were hospitalized as earthquake victims, the results indicated that a higher incidence of pelvic fracture in women was the only statistically significant injury with regard to gender. Age had a more complex effect on the rate and pattern of fractures. Children younger than 15 years old were the most likely to sustain skull fractures and amputations. The elderly were the most likely to be associated with limb fractures. Adult men were the most likely to suffer spine fractures and adult women rib fractures. The paper concludes with an interpretation of the results in the context of China’s rural conditions and discusses implications for post-disaster emergency operations and planning.

Pelvic fractures after radiotherapy for cervical cancer

The incidence of pelvic fractures and associated risk factors was determined in women treated with curative-intent radiotherapy for cervical cancer. The records of 516 women treated with curative-intent radiotherapy for cervical cancer between 2001 and 2006 at the University of Texas M. D. Anderson Cancer Center were reviewed. Among these, 300 patients had at least 1 post-treatment computed tomography scan or magnetic resonance imaging study available for review, and they comprised our study population. All imaging studies were re-reviewed by a single radiologist to evaluate for fractures. Pelvic fractures were noted in 29 of 300 patients (9.7%). Fracture sites included sacrum (n = 24; 83%), sacrum and pubis (n = 3; 10%), iliac crest (n = 1; 3%), and sacrum and acetabulum (n = 1; 3%). Thirteen patients (45%) were symptomatic, with pain being the most common presenting symptom. The median time from the completion of radiotherapy to the detection of fractures on imaging studies was 14.1 months (range, 2.1-63.1 months), with 38% of patients diagnosed within 1 year and 83% diagnosed within 2 years of completing therapy. The median age of the patients at diagnosis was higher in the women who developed a fracture compared with the women who did not (56.5 years vs 46.7 years; P = .04). A higher number of women with a fracture were postmenopausal (62% vs 37%; P = .03). The median body mass index was lower in the women who had a fracture (26.0 kg/m2 vs 28.0 kg/m2; P = .03). Pelvic fractures were detected in a substantial proportion of women after radiotherapy for cervical cancer. Bone mineral density screening and pharmacologic intervention should be considered in these women.

Alcohol's Role on the Reliability of Clinical Examination to Rule Out Pelvic Fractures

The objective of this study was to determine if clinical examination accurately ruled out pelvic fractures in intoxicated patients sustaining blunt trauma A prospective comparison of intoxicated (blood alcohol level [BAL] greater than 0.08 g/dL) to nonintoxicated (BAL less than 0.08 g/dL) patients sustaining blunt trauma was performed between February 2004 and March 2007. Clinical factors were compared and subset analysis performed in which patients with factors known to compromise the clinical examination were excluded. Two hundred ninety-six intoxicated patients were compared with 1071 nonintoxicated patients. Intoxicated patients were younger and more often male. Intoxicated patients had a higher heart rate (97.1 beats/min +/- 17.9 vs 91.4 beats/min +/- 18.7, P < 0.0001) and lower systolic blood pressure (136.2 mmHg +/- 21.2 vs 141.9 mmHg +/- 26.6, P = 0.0005) than nonintoxicated patients. Intoxicated patients had a lower incidence of pelvic fracture (6.1 vs 10.6%). In subset analysis, the majority of the intoxicated patients did not have exclusion factors on examination and could be evaluated (66.6%). There were eight pelvic fractures diagnosed in this group and no missed injuries on clinical examination (sensitivity 100%). Clinical examination was not compromised by intoxication. Routine pelvic x-rays are not needed in the alert, intoxicated patient sustaining blunt trauma.

Risk of Pelvic Fractures in Older Women Following Pelvic Irradiation

Pelvic fractures, including hip fractures, are a major source of morbidity and mortality in older women. Although therapeutic pelvic irradiation could increase the risk of such fractures, this effect has not been studied. To determine if women who undergo pelvic irradiation for pelvic malignancies (anal, cervical, or rectal cancers) have a higher rate of pelvic fracture than women with pelvic malignancies who do not undergo irradiation. We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) cancer registry data linked to Medicare claims data. A total of 6428 women aged 65 years and older diagnosed with pelvic malignancies from 1986 through 1999 were included. We compared results for women who did (n = 2855) vs did not (n = 3573) undergo radiation therapy. To assess the influence of selection bias, we also evaluated the effect of irradiation on osteoporotic fractures in nonirradiated sites (arm and spine). We evaluated the effect of irradiation on the incidence of pelvic fractures over time, and adjusted for potential confounders using a proportional hazards model. Women who underwent radiation therapy were more likely to have a pelvic fracture than women who did not undergo radiation therapy (cumulative 5-year fracture rate, 14.0% vs 7.5% in women with anal cancer, 8.2% vs 5.9% in women with cervical cancer, and 11.2% vs 8.7% in women with rectal cancer); the difference was statistically significant and most fractures (90%) were hip fractures. We controlled for potential confounders including age, race, cancer stage, and geographic location. The impact of irradiation varied by cancer site: treatment for anal cancer was associated with a higher risk of pelvic fractures (hazard ratio, 3.16; 95% confidence interval, 1.48-6.73); than for cervical cancer (hazard ratio, 1.66; 95% confidence interval, 1.06-2.59); or rectal cancer (hazard ratio, 1.65; 95% confidence interval, 1.33-2.05). No statistically significant difference was found in the rate of arm or spine fractures between the irradiated and nonirradiated groups (hazard ratio, 1.15; 95% confidence interval, 0.89-1.48). Pelvic irradiation substantially increases the risk of pelvic fractures in older women. Given the high baseline risk of pelvic fracture, this finding is of particular concern.

Incidence, risk factors, and outcomes of fecal incontinence after acute brain injury: Findings from the traumatic brain injury model systems national database

Foxx-Orenstein A, Kolakowsky-Hayner S, Marwitz JH, Cifu DX, Dunbar A, Englander J, Francisco G. Incidence, risk factors, and outcomes of fecal incontinence after acute brain injury: findings from the Traumatic Brain Injury Model Systems national database. Arch Phys Med Rehabil 2003;84:231-7. Objective: To investigate the incidence, risk factors, and outcome in patients with fecal incontinence after acute brain injury. Design: A retrospective study of the incidence of and risk factors contributing to fecal incontinence, and outcomes at admission to and discharge from inpatient rehabilitation and at 1-year follow-up. Setting: Medical centers in the federally sponsored Traumatic Brain Injury Model Systems (TBIMS). Participants: A total of 1013 consecutively enrolled rehabilitation inpatients from 17 TBIMS centers who were admitted to acute care within 24 hours of traumatic brain injury and seen at 1-year postinjury between 1990 and 2000. Interventions: Not applicable. Main Outcome Measures: Incidence of fecal incontinence, length of coma, length of posttraumatic amnesia (PTA), admission Glasgow Coma Scale (GCS) score, length of stay (LOS), FIM[trade ] instrument scores, disposition at discharge and follow-up, and incidences of pelvic fracture, frontal contusion, and urinary tract infection (UTI). Results: The incidence of fecal incontinence was 68% at admission to inpatient rehabilitation, 12.4% at rehabilitation discharge, and 5.2% at 1-year follow-up. Analysis of variance and chi-square analyses revealed statistically significant associations between the incidence of fecal incontinence at rehabilitation admission and admission GCS score, length of coma and PTA, LOS, and incidence of UTI and frontal contusion. Fecal incontinence at rehabilitation discharge was significantly associated with several variables, including age, discharge disposition, admission GCS score, length of coma, PTA, LOS, FIM scores, and incidence of pelvic fracture and frontal contusion. Significant associations were also found between fecal incontinence at 1-year follow-up and age, discharge and current 1-year disposition, admission GCS score, length of coma, LOS, FIM scores, and incidence of UTI (P[lt ].05). Although logistic regression analyses were significant (P[lt ].001), and predicted continence with 100% accuracy, demographics, injury characteristics, medical complications, and functional outcomes did not predict incontinence at discharge and at 1-year follow-up. Conclusions: Fecal incontinence is a significant problem after brain injury. Certain factors may increase its likelihood. Further studies evaluating mechanisms of fecal incontinence and treatment or control interventions would be useful. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Outcome operativ versorgter Beckenringverletzungen im Vergleich verschiedener Nachuntersuchungsbeurteilungen

In high-energy trauma there is a high incidence of pelvic fractures. Evaluating the long-term outcome of pelvic ring fractures it is difficult to separate the effects of the pelvic trauma from other injuries. To improve the treatment and prognosis of unstable pelvic ring fractures it is necessary to compare the results of the different conservative and surgical therapies. So far there have been no publications using different outcome evaluation protocols to improve the quality of the treatment. The aim of this study was to compare three scoring systems for the rating of long-term outcome after pelvic ring fractures. 36 patients who had received surgical stabilization of 19 Tile B- and 17 Tile C-type fractures were followed up for an average of 26 months. All of these patients had at least one additional injury, mainly craniocerebral trauma or injuries of the upper and lower extremity. The follow-up included a detailed clinical and radiological examination as well as an evaluation of the patients satisfaction as to the operative treatment. The information given by the patient on pain and ability to work as well as the social status was an important prognostic factor in the different protocols. However, these data often lacked objectivity. As our follows ups showed poor results compared to the Mennel test, we need to complete the different protocols by this test as an important prognostic factor.

Incidence of pelvic fractures in Finland in 1988.

In 1988, 1212 patients with an acute pelvic fracture were registered in Finnish hospitals for primary treatment. The overall incidence in women was 29/10(5) and in men 20/10(5). The female to male ratio was 2.9 in patients who were over 49 years of age, while in younger age groups the ratio was 0.5. Half of the cases were pubic fractures. In half of the cases the mechanism of injury was a fall and in one quarter a traffic accident. Slightly more than half of the cases were stable and half of the cases were of moderate severity. The average length of hospital stay varied from 17 days in men to 21 days in women.

Epidemiologic Features of Pelvic Fractures

The epidemiology of pelvic fractures was investigated in Rochester, Minnesota, residents during the decade 1968 to 1977. The overall incidence was 37 per 100,000 person-years, substantially higher than previous population-based studies would indicate. The incidence increased markedly with age in both sexes, and was greater for women than men at all ages over 35, reaching a maximum incidence of 446.3 per 100,000 person-years in women 85 or older. Half of all pelvic fractures were attributed to moderate trauma, usually a fall from standing height, 95% of which were minor (Type I or II). Moderate trauma was responsible for the increase in pelvic fracture incidence with age in the high-risk population of postmenopausal women. A large proportion of both men and women with moderate trauma fractures had some evidence of preexisting osteoporosis.

Genitourinary complications of pelvic fractures.

This age of speed and great industrialization in which we are living has resulted in a considerable increase in the incidence of pelvic fractures. The frequency of associated urologic complications has risen in proportion. The effect of the automobile and the airplane on the frequency of these injuries, as well as their complications, is readily appreciated by references to the literature. Thirty-five years ago, only 4% of the cases of ruptured bladder were due to vehicular accidents. 1 Twenty years ago, Noland and Conwell 2 found that 35% of the cases of pelvic fracture were due to this cause, while only five years ago, Butt and Moore 3 reported that 73% of their cases were related to such accidents. It has long been known that the cause of death, in those patients who had pelvic fractures complicated by injury to the urinary tract and who survived the initial injury, was