Risk Of Pelvic Fracture Research Articles

Short-course preoperative radiotherapy increases pelvic fracture risk in rectal cancer

Short-course preoperative radiotherapy increases pelvic fracture risk in rectal cancer

Long-term pelvic fracture and overall mortality risk after pelvic cancer and pelvic radiation.

The association of pelvic radiation with pelvic fracture risk has not been examined in prospective cohort settings with comprehensive fracture risk assessment, cancer-free comparison populations, and long-term follow-up. Our objective is to better characterize pelvic fracture and overall mortality risks in postmenopausal women participating in the Women's Health Initiative. A total of 135 743 Women's Health Initiative participants aged 50 to 79 years enrolled from 40 US clinical centers from 1993 to 1998 who had entry Fracture Risk Assessment Tool scores were eligible. Outcomes included pelvic cancer diagnosis, pelvic fracture occurrence, and mortality. Cox proportional hazards regression models were used to examine associations of pelvic cancer and pelvic radiation with pelvic fracture and mortality risk. After 17.7 years (median) follow-up, 4451 pelvic cancers, 10 139 pelvic fractures, and 33 040 deaths occurred. In multivariable analyses, women with incident pelvic cancer, compared with women who remained pelvic cancer free, had higher pelvic fracture risk (hazard ratio [HR] = 1.26, 95% confidence interval [CI] = 1.11 to 1.43) and higher overall mortality risk (HR = 2.91, 95% CI = 2.77 to 3.05). Women with pelvic cancer treated with pelvic radiation, compared with women with pelvic cancer not treated with pelvic radiation, had higher pelvic fracture risk (HR = 1.98, 95% CI = 1.41 to 2.78) and higher overall mortality after pelvic cancer (HR = 1.32, 95% CI = 1.15 to 1.52). Postmenopausal women with pelvic cancer, especially those receiving pelvic radiation, are at higher pelvic fracture risk and higher overall mortality risk. As therapeutic advances have reduced cancer mortality, attention to and interventions for pelvic fracture prevention may be important in pelvic cancer survivors.

The Association of Pelvic Bone Mineral Density and With Proximal Femoral and Spine Bone Mineral Density in Post-menopausal Women

Pelvic fragility fractures result in significant morbidity and their incidence has increased over the past 30 years. One of the main risk factors in skeletal fragility is bone mineral density (BMD). Most of the current literature has focused on understanding spine and hip BMD. We aimed to measure the BMD of pelvis in a cohort of post-menopausal women and compare it to BMD at other skeletal sites. A questionnaire regarding risk factors for osteoporosis was completed by each participant. DXA scan of the pelvis was performed using research software. Three areas of the pelvis corresponding to common fractures were defined on pelvic DXA: R1 = symphysis public, R2 = inferior public rami, R3 = superior public rami. Pelvic BMD was calculated as the average BMD of R1-3. BMD at each location was reported as mean and standard deviation (SD). ANOVA was used to compare BMD between R1-R3 and pelvis, femoral neck, total hip, and spine. Pearson correlation was used to correlate pelvic BMD to BMD of proximal femur and spine. BMD was compared in four participant groups: 1- osteoporosis in spine and hip, 2- osteoporosis in spine only, 3-osteoporosis in hip only, and 4- no osteoporosis in spine and hip. The effect of diabetes and obesity on BMD at various skeletal sites was analyzed. Among the one hundred postmenopausal women enrolled in the study, age was: 64 ± 8, 31% were obese (BMI ≥ 30), and 8% had a diagnosis of type 2 diabetes. Pelvic area R3 had significantly higher BMD than R1 or R2 (p < 0.001). Pelvic BMD (0.50 ± 0.16) was significantly lower than total hip (0.70 ± 0.20) and spine BMD (0.97 ± 0.19) (p < 0.001). Pelvic BMD correlated with BMD at other skeletal locations, with the highest correlation with total hip (total hip: R2: 0.70, femoral neck R2: 0.50, spine R2: 0.65). Pelvic BMD was significantly lower in patients with osteoporosis of both hip and spine compared to the group without osteoporosis at both locations (p = 0.02). Obesity and type 2 diabetes were both associated with significantly higher BMD at pelvis, spine, and total hip. Pelvic BMD is lower than at other skeletal sites and is highly correlated with total hip area bone density. Obesity and type 2 diabetes are associated with higher pelvic BMD. To establish guidelines for the treatment pelvic BMD, studies defining the association of pelvic BMD with pelvic fracture risk are needed.

Risk of Pelvic Fracture With Radiation Therapy in Older Patients

Older patients undergoing radiation therapy (RT) for pelvic malignancies are at increased risk for pelvic fracture, which is associated with significant morbidity and mortality. RT techniques such as brachytherapy or intensity modulated RT (IMRT) allow for more conformal dose distributions, but it is not known whether the risk for pelvic fracture varies by RT modality. This observational cohort study involved 28,354 patients ≥65 years old, treated with RT for pelvic malignancies. We evaluated the relative risk of pelvic fracture by type of RT when accounting for baseline factors. To test for nonspecific effects, we also evaluated risk of nonpelvic fractures in the same population. The 5-year incidence of pelvic fractures was 12.7% (95% confidence interval [CI], 11.6%-13.8%), 11.8% (10.8%-12.8%), and 3.7% (3.4%-4.0%) for patients with gastrointestinal, gynecologic, and prostate cancer, respectively. On multivariable analysis, being treated with IMRT (hazard ratio, 0.85; 95% CI, 0.73-0.99) or brachytherapy therapy alone (hazard ratio, 0.43; 95% CI, 0.34-0.54) was associated with a reduced hazard for pelvic fractures compared with 3D conformal radiation therapy in female patients. In contrast, there was no association with RT modality and the hazard for nonpelvic fractures among females. There was no significant association between pelvic fractures and IMRT or brachytherapy for male patients. White race, advanced age, and higher comorbidity were associated with an increased hazard for pelvic fracture. IMRT and brachytherapy were associated with a reduced risk of pelvic fractures in older women undergoing RT for pelvic malignancies. Pelvic insufficiency fracture risk should be considered when treating with pelvic RT.

Risk of Pelvic Fracture by Type of Radiation Therapy in Older Patients

Risk of Pelvic Fracture by Type of Radiation Therapy in Older Patients

Increased risk of pelvic fracture after radiotherapy in rectal cancer survivors: A propensity matched study.

To determine whether radiotherapy (RT) can increase pelvic fracture risk in rectal cancer survivors. Rectal cancer patients who underwent curative surgery between 1996 and 2011 in Taiwan were retrospectively studied using the National Health Insurance Research Database (NHIRD) of Taiwan. ICD‐9 Codes 808, 805.4‐805.7, 806.4‐806.7, and 820 (including pelvic, sacrum, lumbar, and femoral neck fracture) were defined as pelvic fracture. Propensity scores for RT, age, and sex were used to perform one‐to‐one matches between the RT and non‐RT group. Risks of pelvic and arm fractures were compared by multivariable Cox regression. Of the 32 689 patients, 7807 (23.9%) received RT, and 1616 suffered from a pelvic fracture (incidence rate: 1.17/100 person‐years). The median time to pelvic fracture was 2.47 years. After matching, 6952 patients each in the RT and non‐RT groups were analyzed. RT was associated with an increased risk of pelvic fractures in the multivariable Cox model (hazard ratio (HR): 1.246, 95% confidence interval (CI): 1.037‐1.495, P = 0.019) but not with arm fractures (HR: 1.013, 95% CI: 0.814‐1.259, P = 0.911). Subgroup analyses revealed that RT was associated with a higher pelvic fracture rate in women (HR: 1.431, 95% CI: 1.117‐1.834) but not in men, and the interaction between sex and RT was significant (P = 0.03). The HR of pelvic fracture increased 2‐4 years after RT (HR: 1.707, 95% CI: 1.150‐2.534, P = 0.008). An increased risk of pelvic fracture is noted in rectal cancer survivors, especially women, who receive RT.

Influence of energy absorbers on Malgaigne fracture mechanism in lumbar-pelvic system under vertical impact load

Malgaigne fractures are the most common and widespread pelvic injuries resulting from the shear forces the action mechanism of which has not been explained in the literature yet. Military accidents with improvised explosive devices (IED) perfectly reflect this type of pelvic fracture. The finite element (FE) model of lumbar-pelvic complex (LPC) was developed based on computed tomography (CT) scans with the seat including steel frame, padding and soft tissue. The correlation coefficients of both low (100 N) and high (500 N) loads were greater than that currently obtained in the literature due to the presence of muscle force, pubic symphysis and joint cartilage. The dynamic analysis was performed to determine the influence of varying kinds of foam materials i.e. polyurethane, aluminium honeycomb structured and polyurethane auxetic foam on the stress/strain distribution in LPC under vertical impact load with the velocity of 7 m/s. Performed analysis showed the first fracture occurred in the L5 vertebrae resulting in the sacroiliac ligaments disruption and stress concentration in the pelvic ring causing further fractures of the wing of ilium, pubis and ischium bones. This results clearly explain the inconclusive findings about the second fracture that occurs in the pelvic area under a vertical impact load. The applied seat padding foam significantly reduced the stresses transmitted to the anatomical structures, thereby avoiding the risk of pelvic fracture. The analysis has proven that the auxetic polyurethane foam can be used as a good energy absorber.

Biomechanical analysis of iliac crest loading following cortico-cancellous bone harvesting

BackgroundIliac crest bone harvesting is a frequently performed surgical procedure widely used to treat bone defects. The objective of this study is to assess the biomechanical quantities related to risk for pelvic fracture after harvesting an autologous bone graft at the anterior iliac crest.MethodsFinite element models with a simulated harvest site (sized 15 × 20 mm, 15 × 35 mm, 30 × 20 mm and 30 × 35 mm) in the iliac wing are created. The relevant loading case is when the ipsilateral leg is lifted off the ground. Musculoskeletal analysis is utilized to compute the muscle and joint forces involved in this motion. These forces are used as boundary conditions for the finite element analyses. Bone tissue stress is analyzed.ResultsCritical stress peaks are located between the anterior superior iliac spine (ASIS) and the anterior edge of the harvest site. Irrespective of the graft size, the iliac wing does not show any significant stress peaks with the harvest site being 20 to 25 mm posterior to the ASIS. The harvest area itself inhibits the distribution of the forces applied on the ASIS to extend to the posterior iliac wing. This leads to a lack of stress posterior to the harvest site. A balanced stress distribution with no stress peaks appears when the bone graft is taken below the iliac crest.ConclusionA harvest site located at least 20 to 25 mm posterior to the ASIS should be preferred to minimize the risk of iliac fatigue fracture.

Increased Risk of Pelvic Fracture after Radiation Therapy in Rectal Cancer Survivors: A Propensity Matched Study

High-dose pelvic radiation is associated with increased pelvic fracture risk in cervical cancer and prostate cancer patients. However, it is not clear whether rectal radiotherapy would increase pelvic fracture risk in rectal cancer survivors. Rectal cancer patients who underwent curative surgery between 1996 to 2011 in Taiwan were retrospectively studied. Age, sex, comorbidities, Charlson comorbidity score, osteoporosis status, previous fracture status, radiotherapy, chemotherapy, and target therapy data were collected from National Health Insurance Research Database (NHIRD) of Taiwan. ICD-9 Codes 808, 805.4-805.7, 806.4-806.7, and 820 (including pelvic, sacrum, lumbar vertebral fracture, and femoral neck fracture) were defined as pelvic fracture in this study. Propensity scores for radiotherapy for each patient were used to perform one-to-one match between radiotherapy group and non-radiotherapy group. Incidences of pelvic fracture and arm fracture (as a control) were compared by multivariate Cox regression. Demographic sub-group analyses were also studied. Of the 32689 patients studied, 7807 patients (23.9%) received radiotherapy, and 1616 patients suffered from pelvic fracture (incidence: 4.9%). After propensity score matching, 6952 patients in the radiotherapy group and 6952 patients in the non-radiotherapy group were analyzed. Radiotherapy was associated with increased risk of pelvic fracture in multi-variate Cox model (hazard ratio(HR): 1.216, 95% CI: 1.017-1.454, p =0.032), but was not associated with increased risk of arm fracture (HR: 1.014, 95% CI: 0.819-1.254, p=0.901). Previous fracture, older age, and female sex also showed increased risk of pelvic fracture and arm fracture. Subgroup analyses revealed radiotherapy was associated with higher risk of pelvic fracture in four types of patients: age over 60 years old (HR: 1.235, 95% CI: 1.021-1.495), females (HR: 1.39, 95% CI:1.091-1.771), those without previous fractures (HR: 1.257, 95% CI:1.02-1.55), and those who received chemotherapy (HR: 1.382, 95% CI: 1.049-1.681). Increased risk of pelvic fracture is noted in rectal cancer survivors who had received radiotherapy, especially in those who are elderly, female, without previous fracture experiences, and with chemotherapy.Abstract 2382; TableMultivariate Cox regression after propensity score matchPelvic fractureArm fractureHR (95% CI)P valueHR (95% CI)P valueRadiotherapy1.216 (1.017-1.454)0.0321.014 (0.819-1.254)0.901Osteoporosis1.264 (1.002-1.595)0.0481.009 (0.740-1.376)0.955Previous fracture2.190 (1.777-2.712)<0.0011.969 (1.499-2.586)<0.001Age (>=60 y vs. <60 y)1.085 (1.075-1.096)<0.0011.024 (1.014-1.034)<0.001Sex (Male vs. Female)0.498 (0.414-0.600)<0.0010.393 (0.315-0.491)<0.001 Open table in a new tab

Characteristics and outcomes of acute pediatric blunt torso trauma based on injury intent

IntroductionBlunt trauma is a leading cause of pediatric morbidity. We compared injuries, interventions and outcomes of acute pediatric blunt torso trauma based on intent. MethodsWe analyzed de-identified data from a prospective, multi-center emergency department (ED)-based observational cohort of children under age eighteen. Injuries were classified based on intent (unintentional/inflicted). We compared demographic, physical and laboratory findings, ED disposition, hospitalization, need for surgery, 30-day mortality, and cause of death between groups using Chi-squared or Fisher's test for categorical variables, and Mann-Whitney test for non-normal continuous factors comparing median values and interquartile ranges (IQR). ResultsThere were 12,044 children who sustained blunt torso trauma: Inflicted=720 (6%); Unintentional=9563 (79.4%); Indeterminate=148 (1.2%); Missing=1613 (13.4%). Patients with unintentional torso injuries significantly differed from those with inflicted injuries in median age in years (IQR) [10 (5, 15) vs. 14 (8, 16); p-value<0.001], race, presence of pelvic fractures, hospitalization and need for non-abdominal surgery. Mortality rates did not differ based on intent. Further adjustment using binary, logistic regression revealed that the risk of pelvic fractures in the inflicted group was 96% less than the unintentional group (OR: 0.04; 95%CI: 0.01–0.26; p-value=0.001). ConclusionsChildren who sustain acute blunt torso trauma due to unintentional causes have a significantly higher risk of pelvic fractures and are more likely to be hospitalized compared to those with inflicted injuries.

Association of 3 Different Antihypertensive Medications With Hip and Pelvic Fracture Risk in Older Adults

On the basis of observational studies, the use of thiazide diuretics for the treatment of hypertension is associated with reduced fracture risk compared with nonuse. Data from randomized clinical trials are lacking. To examine whether the use of thiazide diuretics for the treatment of hypertension is associated with reduced fracture risk compared with nonuse. Using Veterans Affairs and Medicare claims data, this study examined hip and pelvic fracture hospitalizations in Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial participants randomized to first-step therapy with a thiazide-type diuretic (chlorthalidone), a calcium channel blocker (amlodipine besylate), or an angiotensin-converting enzyme inhibitor (lisinopril). Recruitment was from February 1994 to January 1998; in-trial follow-up ended in March 2002. The mean follow-up was 4.9 years. Posttrial follow-up was conducted through the end of 2006, using passive surveillance via national databases. For this secondary analysis, which used an intention-to-treat approach, data were analyzed from February 1, 1994, through December 31, 2006. Hip and pelvic fracture hospitalizations. A total of 22 180 participants (mean [SD] age, 70.4 [6.7] years; 43.0% female; and 49.9% white non-Hispanic, 31.2% African American, and 19.1% other ethnic groups) were followed for up to 8 years (mean [SD], 4.9 [1.5] years) during masked therapy. After trial completion, 16 622 participants for whom claims data were available were followed for up to 5 additional years (mean [SD] total follow-up, 7.8 [3.1] years). During the trial, 338 fractures occurred. Participants randomized to receive chlorthalidone vs amlodipine or lisinopril had a lower risk of fracture on adjusted analyses (hazards ratio [HR], 0.79; 95% CI, 0.63-0.98; P = .04). Risk of fracture was significantly lower in participants randomized to receive chlorthalidone vs lisinopril (HR, 0.75; 95% CI, 0.58-0.98; P = .04) but not significantly different compared with those randomized to receive amlodipine (HR, 0.82; 95% CI, 0.63-1.08; P = .17). During the entire trial and posttrial period of follow-up, the cumulative incidence of fractures was nonsignificantly lower in participants randomized to receive chlorthalidone vs lisinopril or amlodipine (HR, 0.87; 95% CI, 0.74-1.03; P = .10) and vs each medication separately. In sensitivity analyses, when 1 year after randomization was used as the baseline (to allow for the effects of medications on bone to take effect), similar results were obtained for in-trial and in-trial plus posttrial follow-up. These findings from a large randomized clinical trial provide evidence of a beneficial effect of thiazide-type diuretic therapy in reducing hip and pelvic fracture risk compared with treatment with other antihypertensive medications. clinicaltrials.gov Identifier: NCT00000542.

Abstract 100: Hip and Pelvic Fracture Risk in Adults Treated with Three Different Classes of Antihypertensive Medications: The ALLHAT Study

Observational studies suggest that thiazide-type diuretics reduce fracture risk compared to other antihypertensive medications. The effects of calcium channel blockers (CCB) and angiotensin converting-enzyme inhibitors (ACEi) on fracture risk have not been well studied. We examined the relationship of antihypertensive drug therapy and hip and pelvic fracture hospitalizations in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial ( ALLHAT ). It included &gt;33,000 participants randomized to the thiazide-type diuretic chlorthalidone (C), ACEi lisinopril (L), or CCB amlodipine (A) as first line hypertension (HTN) therapy. Mean follow up was 4.9 years during the randomized phase (in-trial), and 5 additional years after the conclusion of the trial (post-trial) using linkage to national data bases. Risks of hip and pelvic fractures for L and A relative to C were derived from Cox models. There were 341 hip and pelvic fractures in-trial. Participants assigned C had the lowest risk and those assigned L the highest ( Figure 1a). The adjusted risk for L compared to C was 1.33 (95% CI 1.02-1.73; p=.04). Participants assigned A had intermediate risk compared to C (HR 1.22, 95% CI 0.93-1.59). During the combined in-trial and post-trial periods ( Figure 1b ), there were 646 fractures; the results were similar to the in-trial results, although differences were not statistically significant. Participants randomized to C continued to have the lowest risk of fractures after in-trial period, suggesting a legacy effect from prior C use. These findings have public health importance given the high prevalence of HTN in older adults and the widespread use of A and L in older adults.

Which pediatric blunt trauma patients do not require pelvic imaging?

This study aimed to develop a tool in identifying traumatized children at low risk of pelvic fracture and to determine the sensitivity of this low-risk model for pelvic fractures. We hypothesized that the proportion of children without predictors with pelvic fracture is less than 1%. This is a retrospective trauma registry analysis of previously healthy children 1 year to 17 years old presenting to the pediatric emergency department with blunt trauma. Postulated predictors of pelvic fracture on radiograph or computed tomography included pain/abnormal examination result of the pelvis/hip, femur deformity, hematuria, abdominal pain/tenderness, Glasgow Coma Scale (GCS) score of 13 or lower, and hemodynamic instability. We used multivariable logistic regression to identify independent predictors of fracture. Of 1,121 eligible patients (mean [SD] age, 8.5 [4.6] years), 87 (7.8%) had pelvic fracture. Independent predictors included pain/abnormal examination result of the pelvis/hip (odds ratio [OR], 16.7; 95% confidence interval [CI], 9.6-29.1), hematuria (OR, 6.6; 95% CI, 3.0-14.6), femoral deformity (OR, 5.9; 95% CI, 3.1-11.3), GCS score of 13 or lower (OR, 2.4; 95% CI, 1.3-4.3), and hemodynamic instability (OR, 3.4; 95% CI, 1.7-6.9). One of 590 children (0.2%; 95% CI, 0-0.5%) without predictors had pelvic fractures versus 86 (16.2%) of 531 in those with one or more predictors (OR, 119; 95% CI, 16.6-833). One of 87 children with pelvic fractures had no predictors (1.1%; 95% CI, 0-3%). When assuming a 100% radiography rate, this tool saves 53% pelvic radiographs. Children with multiple blunt trauma without pain/abnormal examination result of the pelvis/hip, femur deformity, hematuria, abdominal pain/tenderness, GCS score of 13 or lower, or hemodynamic instability constitute a low-risk population for pelvic fracture, with less than 0.5% risk rate. This population does not require routine pelvic imaging. Therapeutic study, level IV.

Hip protectors for preventing hip fractures in older people.

Older people living in nursing care facilities or older adults living at home are at high risk of falling and a hip fracture may occur after a fall. Hip protectors have been advocated as a means to reduce the risk of hip fracture. Hip protectors are plastic shields (hard) or foam pads (soft), usually fitted in pockets in specially designed underwear.This is an update of a Cochrane review first published in 1999, and updated several times, most recently in 2010. To determine if the provision of external hip protectors (sometimes referred to as hip pads or hip protector pads) reduces the risk of fracturing the hip in older people. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (December 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12), MEDLINE (1950 to week 3 November 2012), MEDLINE In-Process (18 December 2012), EMBASE (1988 to 2012 Week 50), CINAHL (1982 to December 2012), BioMed Central (January 2010), trial registers and reference lists of relevant articles. All randomised or quasi-randomised controlled trials comparing an intervention group provided with hip protectors with a control group not provided with hip protectors. Two review authors independently assessed risk of bias and extracted data. We sought additional information from trialists. Data were pooled using fixed-effect or random-effects models as appropriate. This review includes 19 studies, nine of which were cluster randomised. These included approximately 17,000 people (mean age range 78 to 86 years). Most studies were overall at low risk of bias for fracture outcomes. Trials tested hard or soft hip protectors enclosed in special underwear in 18 studies.Pooling of data from 14 studies (11,808 participants) conducted in nursing or residential care settings found moderate quality evidence for a small reduction in hip fracture risk (risk ratio (RR) 0.82, 95% confidence interval (CI) 0.67 to 1.00); the absolute effect is 11 fewer people (95% CI, from 20 fewer to 0) per 1000 having a hip fracture when provided with hip protectors.There is moderate quality evidence when pooling data from five trials in the community (5614 participants) that shows little or no effect in hip fracture risk (RR 1.15, 95% CI 0.84 to 1.58); the absolute effect is two more people (95% CI 2 fewer to 6 more) per 1000 people having a hip fracture when provided with hip protectors.There is probably little to no effect on falls (rate ratio 1.02, 95% CI 0.9 to 1.16) or fractures other than of the hip or pelvis (rate ratio 0.87, 95% CI 0.71 to 1.07). However, the risk ratio for pelvic fractures is RR 1.27 (95% CI 0.78 to 2.08); this is an absolute effect of one more person (95% CI 1 fewer to 5 more) per 1000 having a pelvic fracture when provided with hip protectors.The incidence of adverse events while wearing hip protectors, including skin irritation, ranged from 0% to 5%. Adherence, particularly in the long term, was poor. Hip protectors probably reduce the risk of hip fractures if made available to older people in nursing care or residential care settings, without increasing the frequency of falls. However, hip protectors may slightly increase the small risk of pelvic fractures. Poor acceptance and adherence by older people offered hip protectors is a barrier to their use. Better understanding is needed of the personal and design factors that may influence acceptance and adherence.

Pelvic Fracture Rates in Community-Living People With and Without Disability and in Residents of Nursing Homes

There are limited data on the epidemiology of pelvic fractures. The purpose of this study was to calculate incidence rates of pelvic fractures leading to hospital admission and to compare incidence rates between residents of nursing homes and community-dwelling persons with and without care need. Data were retrieved from a database of the largest health insurance company in Bavaria, Germany. Between 2004 and 2009, 10,170 pelvic fractures were observed in 751,101 women and 491,098 men. Age- and gender-specific incidence rates were calculated. Incidence rates were further stratified by setting (nursing home versus community) and functional status (no care need versus care need for those in the community). In addition, the average cumulative risk for a pelvic fracture at different ages was calculated. The incidence rate increased from 0.54 and 0.38 per 1000 person-years in women and men aged 65 to 69 years to 9.35 and 4.45 per 1000 person-years in women and men aged 90 years and older, respectively. Persons living in a nursing home or living at home with care need had considerably higher incidence rates than community-dwelling older persons without care need. The average cumulative risk at the age of 65 years for an incident pelvic fracture until the age of 90 years was 6.9% in women and 2.8% in men. The incidence of pelvic fractures leading to hospital admission is higher in women than in men and rises dramatically with increasing age. Persons with care need have a particularly high risk for pelvic fracture.

The Acetabular Component in Primary Total Hip Arthroplasty

The cemented all-polyethylene acetabular component has almost completely been replaced by the cementless porous-coated acetabular component. A variety of different designs, incorporating several types of porous coatings, have proven to be reliable and durable. The ability to reposition a cementless cup to optimize component orientation allows the joint replacement surgeon to minimize impingement and maximize component stability. This is essential to prevent dislocation and damage to bearing surface of the acetabular component. Insertion of a hemispherical cementless cup with 1 mm of under-reaming typically allows for secure interference fit, good apposition of the implant to the underlying bone, an insignificant risk of pelvic fracture, and a rare risk of ingrowth failure.

Low-Risk Criteria for Pelvic Radiography in Pediatric Blunt Trauma Patients

The American College of Surgeons recommends that any patient with blunt trauma undergoes radiographic evaluation, including a radiograph of the pelvis. Studies have questioned the use of such routine pelvic radiographs (PXR) in pediatrics. Selective elimination of PXR would save time, money and unshielded radiation exposure to the gonads. To determine if a defined set of historical and clinical factors could predict low risk for pelvic fracture and incorporate these factors into a clinical decision guideline. A retrospective chart review of all blunt trauma patients 25 years or younger in whom a PXR was obtained from January 2002 to June 2006 presenting to an urban level 1 trauma center. A total of 579 patients underwent 580 trauma evaluations. Variables including sex, mechanism of injury, Glascow Coma Score, Pediatric Trauma Score, fall height, lower extremity injury, blood on rectal examination, blood at meatus, and clinical need for computed tomography (CT) were compared with outcomes of pelvic fracture and pelvic fracture requiring surgical intervention. There were 22 pelvic fractures identified, resulting in a fracture rate of 4%. The negative predictive value for pelvic fracture was 98.3% (95% confidence interval [95% CI], 96.9%-99.2%) if no lower extremity injury was present, 99% (95% CI, 98.2%-99.6%) if physical examination of the pelvis was normal, and 99.5% (95% CI, 98.6%-99.9%) if there was no need for abdominopelvic CT. The negative predictive value was 100% (95% CI, 98.8%-100%) if any one of these 3 factors is present. Using the clinical findings of (1) lack of lower extremity injury, (2) lack of an abnormal physical examination of the pelvis, and (3) no need for abdominopelvic CT, pelvic fracture can be reliably excluded. Pelvic radiography can be eliminated in the evaluation of these patients, potentially decreasing time expenditure, radiation exposure, and cost.

Prehospital predictors of risk for pelvic fractures in pediatric trauma patients

Pelvic fractures are uncommon in children, but can occur as a result of high-energy impact injuries to the lower torso in association with blunt trauma. Pelvic fractures can be associated with significant morbidity while the work-up and treatment for these injuries is costly. The aim was to identify risk factors that help determine which pediatric trauma patients are at highest risk of sustaining a pelvic fracture to aid in the development of criteria for the targeted use of pelvic radiographic imaging. A retrospective analysis was conducted using the only pediatric trauma registry in the state of Maryland, located at The Johns Hopkins Children's Center. All blunt trauma patients who were younger than 15 years of age from 1990 to 2005 were included in the analysis (n = 13,360) with a final diagnosis of pelvic fracture as the primary outcome of interest. Comparisons were made using Pearson's chi-square for categorical and the Mann-Whitney rank sum test for non-normally distributed variables. Pelvic fractures following blunt trauma in children are associated with age, race, place and mechanism of injury. Compared to children 4 years and younger, pelvic fractures were more likely to occur in children aged 5-9 years (OR = 3; P = 0.000), as well as 10-14 years (OR = 5; P = 0.000). Compared to blunt trauma injuries from falls, children who were struck by vehicles or who were occupants in motor vehicle crashes (MVC) were six times (P = 0.000) and twice (P = 0.02) as likely to sustain a pelvic fracture, respectively. Four factors were demonstrated by this study to be significantly associated with pediatric pelvic fractures: being Caucasian, age between 5 and 14 years, being struck as a pedestrian or a motor vehicle crash occupant. Identification of these factors may aid clinicians in selecting patients who are at highest risk for pelvic fracture and may benefit most from pelvic radiography.

Pelvic Fracture Risk Assessment on Admission

Patients with pelvic fractures (PF) have high incidences of associated injuries and mortality. To identify patients with PF at the highest risk for mortality on admission to a Level I trauma center, investigators analyzed 566 PF in 12,128 patients (1996 to 2005). PF were categorized on arrival as high risk (HR) or low risk (LR) by initial blood pressure, examination, radiographs, and CT. HR PF included open fractures, open-book injuries, PF 4 or greater abbreviated injury score, and hypotension (89 mmHg or less systolic blood pressure); all other cases were categorized as LR PF. Patients with PF had 6 per cent (35 of 566) mortality compared with 3 per cent (300 of 11,529) without PF. Mortality was 24 per cent (25 of 103) in HR PF, including 11 per cent (one of nine) of open fractures, 25 per cent (12 of 49) of open-book injuries, 23 per cent (14 of 62) of 4 or greater abbreviated injury score, and 33 per cent (20 of 60) of hypotensive patients compared with 3 per cent (13 of 454) of LR PF. Compared with LR PF, patients with HR PF were younger (43.5 vs 53.8 years) with higher injury severity scores (28.7 vs 11.9) and longer hospital stays (10.6 vs 7.4 days). PF mortality remains high despite treatment in a Level I trauma center. Trauma mechanism, initial blood pressure, pelvic radiography, and CT can be used to predict a patient's mortality risk.

Risk factors for pelvic fractures in lateral impact motor vehicle crashes

Lateral impact motor vehicle crashes account for over 10% of all crashes and are more likely to result in pelvic fractures than frontal crashes. We performed a case control study of lateral impact motor vehicle crashes using the 1995–2004 National Accident Sampling System Crashworthiness Data System to determine occupant and vehicle risk factors for pelvic fractures. Cases ( N = 728) were occupants involved in a near-side lateral impact crash who experienced a pelvic fracture and controls were occupants ( N = 5710) who did not experience a pelvic fracture. Occupant risk factors evaluated were age, body mass index (BMI), gender including pregnancy status, and seat belt use. Vehicle risk factors evaluated were vehicle body type, weight of striking and struck vehicles, and magnitude of intrusion of side or door panel. Using multivariate logistic regression analysis, we found that age 65 years or older, female gender, underweight body mass index, and increasing magnitude of intrusion of the door or side panel of the vehicle were associated with an increased risk of a pelvic fracture. Injury prevention strategies should focus on decreasing the magnitude of side or door panel intrusion to decrease the risk of pelvic fracture in the event of a lateral impact crash.