Original articleMortality and functional outcomes of pelvic insufficiency fractures in older patients
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.
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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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