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

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

Injury. 2022 Feb;53(2):506-513. doi: 10.1016/j.injury.2021.09.056. Epub 2021 Oct 1.

Authors

H Banierink¹, K Ten Duis², J Prijs³, K W Wendt⁴, V M A Stirler⁵, S H van Helden⁶, R J Nijveldt⁷, M F Boomsma⁸, E Heineman⁹, I H F Reininga¹⁰, F F A IJpma¹¹

Affiliations

¹ University of Groningen, University Medical Center Groningen, Department of Trauma Surgery, Groningen, the Netherlands. Electronic address: h.banierink@umcg.nl.
² University of Groningen, University Medical Center Groningen, Department of Trauma Surgery, Groningen, the Netherlands. Electronic address: k.ten.duis@umcg.nl.
³ University of Groningen, University Medical Center Groningen, Department of Trauma Surgery, Groningen, the Netherlands. Electronic address: j.prijs@umcg.nl.
⁴ University of Groningen, University Medical Center Groningen, Department of Trauma Surgery, Groningen, the Netherlands. Electronic address: k.w.wendt@umcg.nl.
⁵ Radboud University, Radboud University Medical Center, Department of Surgery, Nijmegen, the Netherlands. Electronic address: vincent.stirler@radboudumc.nl.
⁶ Isala Hospital Zwolle, Department of Surgery, Zwolle, the Netherlands. Electronic address: s.h.van.helden@isala.nl.
⁷ Isala Hospital Zwolle, Department of Surgery, Zwolle, the Netherlands. Electronic address: r.j.nijveldt@isala.nl.
⁸ Isala Hospital Zwolle, Department of Radiology, Zwolle, the Netherlands. Electronic address: m.f.boomsma@isala.nl.
⁹ University of Groningen, University Medical Center Groningen, Department of Surgery, Groningen, the Netherlands. Electronic address: e.heineman@umcg.nl.
¹⁰ University of Groningen, University Medical Center Groningen, Department of Trauma Surgery, Groningen, the Netherlands; Emergency Care Network Northern Netherlands (AZNN), Northern Netherlands Trauma Registry, Groningen, the Netherlands. Electronic address: i.h.f.reininga@umcg.nl.
¹¹ University of Groningen, University Medical Center Groningen, Department of Trauma Surgery, Groningen, the Netherlands. Electronic address: f.f.a.ijpma@umcg.nl.

PMID: 34656318
DOI: 10.1016/j.injury.2021.09.056

Abstract

Background: Recently, 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.

Methods: A 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.

Results: A 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).

Conclusions: FFP 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.

Keywords: Fragility fracture; Mortality; Pelvic ring; Physical functioning; Quality of life.

MeSH terms

Aged
Cross-Sectional Studies
Fractures, Bone*
Humans
Osteoporotic Fractures* / diagnostic imaging
Osteoporotic Fractures* / therapy
Pelvic Bones* / diagnostic imaging
Pelvis / diagnostic imaging
Quality of Life
Retrospective Studies
Tomography, X-Ray Computed