Skip to main content

Advertisement

SpringerLink
Log in

Age and “general health”—beside fracture classification—affect the therapeutic decision for geriatric pelvic ring fractures: a German pelvic injury register study

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Keller JM, Sciadini MF, Sinclair E et al (2012) Geriatric trauma: demographics, injuries, and mortality. J Orthop Trauma 26(9):e161–e165

    Article  Google Scholar 

  2. Andrich S, Haastert B, Neuhaus E et al (2015) Epidemiology of pelvic fractures in Germany: considerably high incidence rates among older people. PLoS One 10(9):e0139078

    Article  Google Scholar 

  3. Andrich S, Haastert B, Neuhaus E et al (2017) Excess mortality after pelvic fractures among older people. J Bone Miner Res 32(9):1789–1801

    Article  Google Scholar 

  4. Nanninga GL, de LK, Panneman MJM et al (2014) Increasing rates of pelvic fractures among older adults: the Netherlands, 1986-2011. Age Ageing 43(5):648–653

    Article  Google Scholar 

  5. Verbeek DO, Ponsen KJ, Fiocco M et al (2018) Pelvic fractures in the Netherlands: epidemiology, characteristics and risk factors for in-hospital mortality in the older and younger population. Eur J Orthop Surg Traumatol 28(2):197–205

    Article  Google Scholar 

  6. Ojodu I, Pohlemann T, Hopp S et al (2015) Predictors of mortality for complex fractures of the pelvic ring in the elderly: a twelve-year review from a German level I trauma center. Injury 46(10):1996–1998

    Article  Google Scholar 

  7. Garbuz DS, Masri BA, Esdaile J et al (2002) Classification systems in orthopaedics. J Am Acad Orthop Surg 10(4):290–297

    Article  Google Scholar 

  8. Rollmann MF, Herath SC, Holstein JH et al (2017) Surgical treatment of pelvic ring fractures in the elderly now and then: a pelvic registry study. Aging Clin Exp Res 29(4):639–646

    Article  Google Scholar 

  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):542–549

    Article  CAS  Google Scholar 

  10. Pohlemann T, Stengel D, Tosounidis G et al (2011) Survival trends and predictors of mortality in severe pelvic trauma: estimates from the German pelvic trauma registry initiative. Injury 42(10):997–1002

    Article  Google Scholar 

  11. Wang H, Phillips JL, Robinson RD et al (2015) Predictors of mortality among initially stable adult pelvic trauma patients in the US: data analysis from the National Trauma Data Bank. Injury 46(11):2113–2117

    Article  Google 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

  13. Keil DS, Gross S, Seymour RB et al (2018) Mortality after high-energy pelvic fractures in patients of age 65 years or older. J Orthop Trauma 32(3):124–128

    Article  Google Scholar 

  14. Marsh JL, Slongo TF, Agel J et al (2007) Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 21(10 Suppl):S1–S133

    Article  CAS  Google Scholar 

  15. Hauschild O, Strohm PC, Culemann U et al (2008) Mortality in patients with pelvic fractures: results from the German pelvic injury register. J Trauma 64(2):449–455

    Article  Google Scholar 

  16. Edwardes MD, Baltzan M (2000) The generalization of the odds ratio, risk ratio and risk difference to r x k tables. Stat Med 19(14):1901–1914

    Article  CAS  Google Scholar 

  17. Clement ND, Court-Brown CM (2014) Elderly pelvic fractures: the incidence is increasing and patient demographics can be used to predict the outcome. Eur J Orthop Surg Traumatol 24(8):1431–1437

    Article  Google Scholar 

  18. Höch A, Özkurtul O, Pieroh P et al (2017) Outcome and 2-year survival rate in elderly patients with lateral compression fractures of the pelvis. Geriatr Orthop Surg Rehabil 8(1):3–9

    Article  Google Scholar 

  19. Maier GS, Kolbow K, Lazovic D et al (2016) Risk factors for pelvic insufficiency fractures and outcome after conservative therapy. Arch Gerontol Geriatr 67:80–85

    Article  Google Scholar 

  20. Henry SM, Pollak AN, Jones AL et al (2002) Pelvic fracture in geriatric patients: a distinct clinical entity. J Trauma 53(1):15–20

    Article  Google Scholar 

  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):477–483

    PubMed  Google Scholar 

  22. Rommens PM, Hofmann A (2013) Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury 44(12):1733–1744

    Article  Google Scholar 

  23. Kanakaris NK, Greven T, West RM et al (2017) Implementation of a standardized protocol to manage elderly patients with low energy pelvic fractures: can service improvement be expected? Int Orthop 41(9):1813–1824

    Article  Google Scholar 

  24. Schmal H, Froberg L, S Larsen M et al (2018) Evaluation of strategies for the treatment of type B and C pelvic fractures. Bone Joint J 100-B(7):973–983

    Article  CAS  Google Scholar 

  25. Eckardt H, Egger A, Hasler RM et al (2017) Good functional outcome in patients suffering fragility fractures of the pelvis treated with percutaneous screw stabilisation: assessment of complications and factors influencing failure. Injury 48(12):2717–2723

    Article  Google Scholar 

  26. Haws BE, Wuertzer S, Lenchik L et al (2015) Misclassification of pelvic ring injuries in the National Trauma Data Bank. J Orthop Trauma 29(10):460–462

    Article  Google Scholar 

Download references

Author information

Author notes

  1. Holger Keil

    Present address: Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany

  2. Andreas Höch and Philipp Pieroh contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany

    Andreas Höch, Philipp Pieroh & Christoph Josten

  2. Department of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06097, Halle (Saale), Germany

    Philipp Pieroh & Tim Hohmann

  3. Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany

    Florian Gras

  4. Centre for Musculoskeletal Surgery, Charité - University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Sven Märdian

  5. Department of Trauma Surgery, Otto-von-Guericke-University, Leipziger Strasse 44, 39120, Magdeburg, Germany

    Francis Holmenschlager

  6. Department for Trauma, Hand Surgery and Orthopedics, Hospital of Karlsruhe, Moltkestrasse 90, 76133, Karlsruhe, Germany

    Holger Keil

  7. Trauma Research Group, Department of Orthopedics and Trauma Surgery, Reconstructive and Septic Surgery, and Sports Traumatology, German Armed Forces Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany

    Hans-Georg Palm

  8. Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Building 57, Kirrbergerstr. 1, 66421, Homburg, Germany

    Steven C. Herath

  9. Department of Orthopaedics and Traumatology, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, 5000, Odense, Denmark

    Hagen Schmal

  10. Department of Trauma Surgery, BG Trauma Centre Murnau, Professor Küntscher Str. 8, 82418, Murnau, Germany

    Fabian M. Stuby

Authors
  1. Andreas Höch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philipp Pieroh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Florian Gras
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tim Hohmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sven Märdian
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Francis Holmenschlager
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Holger Keil
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hans-Georg Palm
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Steven C. Herath
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Christoph Josten
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hagen Schmal
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Fabian M. Stuby
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Pelvic Injury Register of the German Trauma Society

Contributions

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

Corresponding author

Correspondence to Andreas Höch.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Höch, A., Pieroh, P., Gras, F. et al. Age and “general health”—beside fracture classification—affect the therapeutic decision for geriatric pelvic ring fractures: a German pelvic injury register study. International Orthopaedics (SICOT) 43, 2629–2636 (2019). https://doi.org/10.1007/s00264-019-04326-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-019-04326-w

Keywords

Search

Navigation