Elsevier

Joint Bone Spine

Volume 70, Issue 4, August 2003, Pages 287-289
Joint Bone Spine

Original article
Mortality and functional outcomes of pelvic insufficiency fractures in older patients

https://doi.org/10.1016/S1297-319X(03)00015-0Get rights and content

Abstract

Objective. – To evaluate 1-year mortality and functional outcomes after pelvic insufficiency fractures in older patients.

Patients and methods. – Retrospective review of medical records of patients 65 years of age or older admitted to our geriatrics department for pelvic fracture related to bone insufficiency over a 10-year period (1990-1999). For each patient, we recorded the circumstances of the fracture, time to diagnosis and imaging studies needed for diagnosis, functional status, place of residence before and after the fracture, general health status, treatment, short-term outcome, complications if any, length of hospital stay, and 1-year outcome.

Results. – Sixty patients (54 women and 6 men) with a mean age of 83 ± 7.1 years had 49 pubic rami fractures, 16 sacral fractures, and three acetabular fractures. The sacral fractures were usually found only by radionuclide bone scanning, so that time to diagnosis was longer. A history of fracture or risk factor for fracture was found in 45% of the patients. One patient died during the hospital stay. No thromboembolic events were recorded. Twenty-four patients experienced other intercurrent events (urinary retention, lower respiratory tract infection, or urinary tract infection). Mean hospital length of stay was 45 ± 28 d overall and was longer in the subset of patients who were not fully self-sufficient before the fracture. At discharge, 50% of patients had not recovered their former level of self-sufficiency and 25% had to be institutionalized. The 1-year mortality rate was 14.3%. Pelvic insufficiency fractures are common in older patients. Although they are rarely life threatening, they deserve special attention as a source of functional disability.

Introduction

Insufficiency fractures of the pelvis occur in older patients, either spontaneously or after a trivial trauma such as a fall from the standing position. Osteoporosis is present in most cases. Fractures of the proximal femur, also a consequence of osteoporosis, are known to be associated with loss of self-sufficiency in 25-75% of formerly self-sufficient patients [1], [2] and with a 1-year mortality rate of 18-28% [3], [4]. Pelvic fractures, in contrast, are usually considered benign.

Section snippets

Patients and methods

We retrospectively studied the medical records of patients older than 65 years of age who were admitted to our geriatrics department between 1 January 1990, and 31 December 1999, and whose discharge diagnosis was insufficiency fracture of the pelvis. We evaluated the functional impact of these fractures. From each medical record, we abstracted the following information: circumstances of occurrence of the fracture, time to diagnosis and imaging studies needed to establish the diagnosis,

Results

Sixty cases were identified, 54 women and 6 men, with a mean age of 83 ± 7.1 years (range, 65-99 years). Among these patients, 36.7% of patients were 86-90 years of age. Fifty-two patients reported a minor fall on the day of admission or within the last few days. In the eight remaining patients, the fractures were considered spontaneous. Most fractures involved the pubic rami (49 patients, including 23 with fractures through the superior and the inferior pubic rami on the same side). A fracture

Discussion

The clinical manifestations and diagnostic challenges of pelvic insufficiency fractures, particularly those involving the sacrum, have been described in several case-series [5], [6], [7], [8]. However, few studies have provided information on outcomes in these patients, which were the focus of our study. The marked female predominance (90%) in our study population is consistent with earlier studies of fractures of the pelvis [9], publis rami [10], or sacrum [6]. However, our patients were older

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