Age and “general health”—beside fracture classification—affect the therapeutic decision for geriatric pelvic ring fractures: a German pelvic injury register study
- 109 Downloads
Pelvic ring fractures in the elderly gain increasing importance. Nonetheless, data on factors influencing treatment decision in relation to fracture classification, age, and the resulting treatment are still rare.
Prospectively collected data of the German Pelvic Injury Registry from patients aged over 65 years with a pelvic ring fracture were evaluated retrospectively. Acetabular fractures, as well as type A1 and A3 fractures, were excluded. The variables age, injury pattern, type of treatment, the reason for conservative treatment, and Orthopaedic Trauma Association (OTA)/Tile classification were analyzed. Furthermore, the fracture distribution was examined after dividing patients into six age groups.
A total of 1814 patients with a mean age of 80.7 ± 7.6 years, predominantly female (79.0%), were available for evaluation. The majority of patients suffered from isolated pelvic ring fractures (70.1%) and 8.2% were severely injured (ISS > 16). The most common fracture types were type A2 (35.4%), type B2 (38.0%), and type C1 (7.3%). Especially pelvic ring fractures of type A2 (96.9%) and type B2 (83.0%) were treated conservatively (overall 76.9%). Fracture instability according to the OTA/Tile classification increased the probability for an operative treatment (generalized odds ratio [OR] 6.90 [5.62; 8.52]). In contrary, increasing age independent of the fracture pattern decreased this probability (OR 0.47 [0.41–0.53]). With increasing fracture instability, general health conditions were up to 50% of the reasons for conservative treatment.
The results of the present study underline the importance of the factors age and general health besides fracture classification for therapeutic decision-making in the treatment of pelvic ring fractures in the elderly.
KeywordsPelvic fracture Fragility fracture Pelvis Treatment Epidemiology
Conceived and designed the study: AH, PP, CJ, and FMS
Data acquisition: AH, FG, SM, FH, HK, HGP, SCH, HS, and FMS
Analyzed the data: AH, PP, TH, CJ, and FMS
Wrote and draft the paper: AH, PP, FG, HS, and FMS
Approved the final version of the manuscript: AH, PP, FG, TH, SM, FH, HK, HGP, SCH, HS, CJ, and FMS
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 9.Rommens PM, Gercek E, Hansen M et al (2003) Mortality, morbidity and functional outcome after open book and lateral compression lesions of the pelvic ring. A retrospective analysis of 100 type B pelvic ring lesions according to Tile's classification. Unfallchirurg 106(7):542–549CrossRefGoogle Scholar
- 12.Loggers SAI, Joosse P, Jan Ponsen K (2018) Outcome of pubic rami fractures with or without concomitant involvement of the posterior ring in elderly patients. Eur J Trauma Emerg Surg. https://doi.org/10.1007/s00068-018-0971-2
- 21.Böhme J, Höch A, Boldt A et al (2012) Influence of routine CT examination on fracture classification and therapy for pelvic ring fractures in patients aged over 65 years old. Z Orthop Unfall 150(5):477–483Google Scholar