Does surgical treatment for unstable fragility fracture of the pelvis promote early mobilization and improve survival rate and postoperative clinical function?
Fragility fracture
Pelvis
Rommens classification
Trauma
Journal
European journal of trauma and emergency surgery : official publication of the European Trauma Society
ISSN: 1863-9941
Titre abrégé: Eur J Trauma Emerg Surg
Pays: Germany
ID NLM: 101313350
Informations de publication
Date de publication:
Oct 2022
Oct 2022
Historique:
received:
18
04
2021
accepted:
11
06
2021
pubmed:
23
6
2021
medline:
12
10
2022
entrez:
22
6
2021
Statut:
ppublish
Résumé
This retrospective multicenter study aimed to compare rates of early mobilization and survival and functional outcome of surgical treatment (S) with that of conservative treatment (C) according to each unstable fragility fracture of the pelvis (FFP) classification type with displacement of the posterior component ≥ 5 mm. We analyzed 64 patients with unstable type III and IV FFP who could move and transfer themselves before injury and had ≥ 5 mm displacement of the posterior component. We compared survival rate, early mobilization, walking ability at final follow-up, and complications at admission for each type of surgical and conservative treatment. Most of the unstable FFP were type IIIa and IVb in the study population. Type III comprised 40 cases (group S:13/group C:27) and type IV comprised 24 cases (group S:7/group C:17). There were no significant differences in 3 month and 1 year survival rates, although group C (III) had the tendency of higher mortality rate (p = 0.08). Mobilization (transferring to a wheelchair) was enabled significantly earlier in group S (III) than in group C (III) (p = 0.02), but in type IV, most patients enabled early mobilization even without surgical intervention. There were no significant differences in hospital complications and walking ability at final follow-up. In this study, the superiority of surgical treatment for unstable FFP was not proven. However, the results suggest that type IVb may be a relatively stable type compared to type III and that type IVb should be considered separately from bilaterally complete unstable sacral fractures due to high-energy trauma.
Identifiants
pubmed: 34156485
doi: 10.1007/s00068-021-01729-6
pii: 10.1007/s00068-021-01729-6
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
3747-3756Informations de copyright
© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Andrich S, Haastert B, Neuhaus E, et al. Epidemiology of pelvic fractures in Germany: considerably high incidence rates among older people. PLoS ONE. 2015. https://doi.org/10.1371/journal.pone.0139078 .
doi: 10.1371/journal.pone.0139078
pubmed: 26418971
pmcid: 4587805
Soles GL, Ferguson TA. Fragility fractures of the pelvis. Curr Rev Musculoskelet Med. 2012;5(3):222–8. https://doi.org/10.1007/s12178-012-9128-9 .
doi: 10.1007/s12178-012-9128-9
pubmed: 22589010
pmcid: 3535080
Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury. 2013;44:1733–44. https://doi.org/10.1016/j.injury.2013.06.023 .
doi: 10.1016/j.injury.2013.06.023
pubmed: 23871193
Rommens PM, Wagner D, Hofmann A. Surgical management of osteoporotic pelvic fractures: a new challenge. Eur J Trauma Emerg Surg. 2012;38(5):499–509. https://doi.org/10.1007/s00068-012-0224-8 .
doi: 10.1007/s00068-012-0224-8
pubmed: 23162670
pmcid: 3495273
Höch A, Özkurtul O, Pieroh P, Josten C, Böhme J. Outcome and 2 year survival rate in elderly patients with lateral compression fractures of the pelvis. Geriatr Orthop Surg Rehabil. 2017;8:3–9. https://doi.org/10.1177/2151458516681142 .
doi: 10.1177/2151458516681142
pubmed: 28255503
Balogh Z, King KL, Mackay P, et al. The epidemiology of pelvic ring fractures: a population-based study. J Trauma. 2007;63:1066–73. https://doi.org/10.1097/TA.0b013e3181589fa4 .
doi: 10.1097/TA.0b013e3181589fa4
pubmed: 17993952
Grewal IS, Mir HR. Assessment of instability in type B pelvic ring fractures. J Clin Orthop Trauma. 2020;11(6):1009–15. https://doi.org/10.1016/j.jcot.2020.10.004 .
doi: 10.1016/j.jcot.2020.10.004
pubmed: 33192003
pmcid: 7656487
Osterhoff G, Noser J, Held U, Werner CML, Pape HC, Dietrich M. Early operative versus nonoperative treatment of fragility fractures of the pelvis: a propensity-matched multicenter study. J Orthop Trauma. 2019;33(11):410–5. https://doi.org/10.5167/uzh-172550 .
doi: 10.5167/uzh-172550
Bruce B, Reilly M, Sims S. OTA highlight paper predicting future displacement of nonoperatively managed lateral compression sacral fractures: can it be done? J Orthop Trauma. 2011;25(9):523–7. https://doi.org/10.1097/BOT.0b013e3181f8be33 .
doi: 10.1097/BOT.0b013e3181f8be33
pubmed: 21857419
Weaver MJ, Bruinsma W, Toney E, Dafford E, Vrahas MS. What are the patterns of injury and displacement seen in lateral compression pelvic fractures? Clin Orthop Relat Res. 2012;470(8):2104–10. https://doi.org/10.1007/s11999-012-2364-x .
doi: 10.1007/s11999-012-2364-x
pubmed: 22585347
pmcid: 3392389
Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg. 1993;75:797–8. https://doi.org/10.1302/0301-620X.75B5.8376443 .
doi: 10.1302/0301-620X.75B5.8376443
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83. https://doi.org/10.1016/0021-9681(87)90171-8 .
doi: 10.1016/0021-9681(87)90171-8
pubmed: 3558716
Starr AJ, Walter JC, Harris RW, Reinert CM, Jones AL. Percutaneous screw fixation of fractures of the iliac wing and fracture-dislocations of the sacro-iliac joint (OTA types 61-B2.2 and 61-B2.3, or Young Burgess “lateral compression type II” pelvic fractures). J Ortho Trauma. 2002;16(2):116–23. https://doi.org/10.1097/00005131-200202000-00008 .
doi: 10.1097/00005131-200202000-00008
Steer R, Balendra G, Matthews J, Wullschleger M, Reidy J. The use of anterior subcutaneous internal fixation (INFIX) for treatment of pelvic ring injuries in major trauma patients, complications and outcomes. SICOT J. 2019;5:22. https://doi.org/10.1051/sicotj/2019019 .
doi: 10.1051/sicotj/2019019
pubmed: 31250805
pmcid: 6598424
Rommens PM, Ossendorf C, Pairon P, Dietz SO, Wagner D, Hoffman A. Clinical pathways for fragility fractures of pelvic ring: personal experience and review of literature. J Ortho Sci. 2015;20(1):1–11. https://doi.org/10.1007/s00776-014-0653-9 .
doi: 10.1007/s00776-014-0653-9
Miyai I, Sonoda S, Nagai S, et al. Results of new policies for inpatient rehabilitation coverage in Japan. Neurorehabil Neural Repair. 2011;25:540–7. https://doi.org/10.1177/1545968311402696 .
doi: 10.1177/1545968311402696
pubmed: 21451116
Hill RM, Robinson CM, Keating JF. Fractures of the pubic rami epidemiology and five-year survival. J Bone Joint Surg Br. 2001;83(8):1141–4. https://doi.org/10.1302/0301-620X.83B8.0831141 .
doi: 10.1302/0301-620X.83B8.0831141
pubmed: 11764428
Rapp K, Cameron ID, Kurrle S, et al. Excess mortality after pelvic fractures in institutionalized older people. Osteoporos Int. 2010;21(11):1835–9. https://doi.org/10.1007/s00198-009-1154-0 .
doi: 10.1007/s00198-009-1154-0
pubmed: 20057998
Yoshida M, Tajima K, Saito Y, Sato K, Uenishi N, Iwata M. Mobility and mortality of 340 patients with fragility fracture of the pelvis. Eur J Trauma Emerg Surg. 2021;47(1):29–36. https://doi.org/10.1007/s00068-020-01481-3 .
doi: 10.1007/s00068-020-01481-3
pubmed: 32860102
Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg Br. 1989;71(2):304–6. https://doi.org/10.1302/0301-620X.71B2.2925751 .
doi: 10.1302/0301-620X.71B2.2925751
pubmed: 2925751
Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48(3):452–8. https://doi.org/10.1038/bmt.2012.244 .
doi: 10.1038/bmt.2012.244
pubmed: 23208313
Taillandier J, Langue F, Alemanni M, Taillandier-Heriche E. Mortality and functional outcomes of pelvic insufficiency fractures in older patients. Joint Bone Spine. 2003;70:287–9. https://doi.org/10.1016/S1297-319X(03)00015-0 .
doi: 10.1016/S1297-319X(03)00015-0
pubmed: 12951312
Koval KJ, Aharonoff GB, Schwartz MC, et al. Pubic rami fracture: a benign pelvic injury? J Orthop Trauma. 1997;11:7–9. https://doi.org/10.1097/00005131-199701000-00003 .
doi: 10.1097/00005131-199701000-00003
pubmed: 8990025
Krappinger D, Struve P, Schmid R, Kroesslhuber J, Blauth M. Fractures of the pubic rami: a retrospective review of 534 cases. Arch Orthop Trauma Surg. 2009;129:1685–90. https://doi.org/10.1007/s00402-009-0942-5 .
doi: 10.1007/s00402-009-0942-5
pubmed: 19629504
Hagino H, Nakamura T, Fujiwara S, Oeki M, Okano T, Teshima R. Sequential change in quality of life for patients with incident clinical fractures: a prospective study. Osteoporos Int. 2009;20:695–702. https://doi.org/10.1007/s00198-008-0761-5 .
doi: 10.1007/s00198-008-0761-5
pubmed: 18836672
Bliuc D, Nguyen ND, Milch VE, et al. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009;301:513–21. https://doi.org/10.1001/jama.2009.50 .
doi: 10.1001/jama.2009.50
pubmed: 19190316
Johnell O, Kanis JA, Odén A, et al. Mortality after osteoporotic fractures. Osteoporos Int. 2004;15:38–42. https://doi.org/10.1007/s00198-003-1490-4 .
doi: 10.1007/s00198-003-1490-4
pubmed: 14593451
Ueda Y, Inui T, Kurata Y, Tsuji H, Saito J, Shitan Y. Prolonged pain in patients with fragility fractures of the pelvis may be due to fracture progression. Eur J Trauma Emerg Surg. 2019;47(2):507–13. https://doi.org/10.1007/s00068-019-01150-0 .
doi: 10.1007/s00068-019-01150-0
pubmed: 31111165
Linstrom NJ, Heiserman JE, Kortman KE, et al. Anatomical and biomechanical analyses of the unique and consistent locations of sacral insufficiency fractures. Spine. 2009;34:309–15. https://doi.org/10.1097/brs.0b013e318191ea01 .
doi: 10.1097/brs.0b013e318191ea01
pubmed: 19214089
pmcid: 2709278
Committee of Japanese Guidelines for the Prevention and Treatment of Osteoporosis. The Japanese guidelines for the prevention and treatment of osteoporosis. 2015th ed. Tokyo: Life Science Publishing; 2015.
Sullivan MP, Baldwin KD, Donegan DJ, Mehta S, Ahn J. Geriatric fractures about the hip: divergent patterns in the proximal femur, acetabulum, and pelvis. Orthopedics. 2014;37:151–7. https://doi.org/10.3928/01477447-20140225-50 .
doi: 10.3928/01477447-20140225-50
pubmed: 24762143
Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA. 2009;302:1573–9. https://doi.org/10.1001/jama.2009.1462 .
doi: 10.1001/jama.2009.1462
pubmed: 19826027
pmcid: 4410861
Petersen MB, Jørgensen HL, Hansen K, Duus BR. Factors affecting postoperative mortality of patients with displaced femoral neck fracture. Injury. 2006;37:705–11. https://doi.org/10.1016/j.injury.2006.02.046 .
doi: 10.1016/j.injury.2006.02.046
pubmed: 16765352
Goldacre MJ, Roberts SE, Yeates D. Mortality after admission to hospital with fractured neck of femur: database study. BMJ. 2002;325:868–9. https://doi.org/10.1136/bmj.325.7369.868 .
doi: 10.1136/bmj.325.7369.868
pubmed: 12386038
pmcid: 129634
Leibson CL, Tosteson AN, Gabriel SE, Ransom JE, Melton LJ. Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc. 2002;50:1644–50. https://doi.org/10.1046/j.1532-5415.2002.50455.x .
doi: 10.1046/j.1532-5415.2002.50455.x
pubmed: 12366617
Morris RO, Sonibare A, Green DJ, Masud T. Closed pelvic fractures: characteristics and outcomes in older patients admitted to medical and geriatric wards. Postgrad Med J. 2000;76(900):646–50. https://doi.org/10.1136/pmj.76.900.646 .
doi: 10.1136/pmj.76.900.646
pubmed: 11009580
pmcid: 1741752
Marrinan S, Pearce MS, Jiang XY, Waters S, Shanshal Y. Admission for osteoporotic pelvic fractures and predictors of length of hospital stay, mortality and loss of independence. Age Ageing. 2015;44(2):258–61. https://doi.org/10.1093/ageing/afu123 .
doi: 10.1093/ageing/afu123
pubmed: 25365963
Clement ND, Court-Brown CM. Elderly pelvic fractures: the incidence is increasing and patient demographics can be used to predict the outcome. Eur J Orthop Surg Traumatol. 2014;24(8):1431–7. https://doi.org/10.1007/s00590-014-1439-7 .
doi: 10.1007/s00590-014-1439-7
pubmed: 24664452
Studer P, Suhm N, Zappe B, Bless N, Jakob M. Pubic rami fractures in the elderly—a neglected injury? Swiss Med Wkly. 2013;143: w13859. https://doi.org/10.4414/smw.2013.13859 .
doi: 10.4414/smw.2013.13859
pubmed: 24089312
Rommens PM. Paradigm shift in geriatric fracture treatment. Eur J Trauma Emerg Surg. 2019;45:181–9. https://doi.org/10.1007/s00068-019-01080-x .
doi: 10.1007/s00068-019-01080-x
pubmed: 30725152