Pelvic fragility fractures in older people admitted to hospital: the clinical burden

Abstract

Introduction

Pelvic fragility fractures are common in older people. To deliver better care in hospital, a better understanding of their characteristics and outcomes post-hospitalisation will allow clinicians to better design hospital services to manage their needs.

Methods

Using routinely collected electronic hospital records over 3 months, data were collected and analysed on consecutive patients admitted with pelvic fragility fractures (as defined by a pelvic fracture sustaining following a fall from standing height or less) to acute medical wards for older people.

Results

Twenty-four patients were admitted over this period. Their mean age was 87 years (SD 9.4), the majority were female (83%), a significant proportion had cognitive impairment with an abbreviated mental test score of ≤ 7 (67%), and the median number of comorbid conditions was three. These patients were at high risk of future fractures (50% with a known diagnosis of osteoporosis; significant FRAX scores; 75% had a fall) but only 50% had a bone health assessment. The median duration in hospital was 13 days. 33% of patients were discharged home directly while the rest were discharged to either a care home or another hospital for further rehabilitation. 54% had a hospital-related complication including kidney injury, delirium, and hospital-acquired infections—there were two inpatient mortalities. At 3 months post-fracture, 54% were readmitted and 33% died.

Conclusion

Pelvic fragility fractures are associated with worse inpatient and post-discharge clinical outcomes. This is an older multi-morbid cohort needing significant post-fracture rehabilitation care. Their care in hospital needs to address their management complexities.