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. 2019 May 28;14(5):e0216809.
doi: 10.1371/journal.pone.0216809. eCollection 2019.

Pelvic ring injury in the elderly: Fragile patients with substantial mortality rates and long-term physical impairment

Hester Banierink  1 , Kaj Ten Duis  1 , Rob de Vries  1 , Klaus Wendt  1   2 , Erik Heineman  3 , Inge Reininga  1   2 , Frank IJpma  1
Affiliations

Pelvic ring injury in the elderly: Fragile patients with substantial mortality rates and long-term physical impairment

Hester Banierink et al. PLoS One. .

Abstract

Background: Pelvic ring injuries in the elderly often occur after low-energy accidents. They may result in prolonged immobilization, complications and an intense rehabilitation process. The aim of this study was to assess mortality, physical functioning and quality of life (QoL) in elderly patients with pelvic ring injuries.

Methods: A cross-sectional study was performed including all elderly patients (≥ 65 years) admitted for a pelvic ring injury between 2007-2016. Mortality and survival were evaluated and patient reported outcome measures (PROMs) were used to assess physical functioning (SMFA) and QoL (EQ-5D). These were compared to age-matched normative data from the general Dutch population.

Results: A total of 153 patients, with a mean age of 79 years (SD 8) at the time of injury, were included in this study. The mortality rate was 20% at 30 days, 27% at 1 year and 41% at 3 years of follow-up. All six patients with a type C fracture died within 30 days. Analyses of the 153 patients showed that increasing age, fracture type C and Injury Severity Score (ISS) were all independent risk factors for mortality. Eventually, after excluding patients that died (N = 78) or were unable to contact (N = 2), 73 patients were eligible for follow-up, of which 53 patients (73%) responded. Mean Short Musculoskeletal Function Assessment (SMFA) scores were respectively 67.4 (function index), 65.2 (bother index), 66.5 (lower extremity), 60.4 (activities of daily living) and 68.2 (emotion). Mean EuroQuol-5D (EQ-5D) score was 0.72. Overall, physical functioning and quality of life were significantly decreased in comparison with normative data from the general population.

Conclusion: Elderly people who sustain a pelvic ring injury should be considered as a fragile population with substantial mortality rates. The patients who survived demonstrated a substantially lower level of physical functioning and quality of life in comparison with their age-matched peers from the general population.

Level of evidence: IV, therapeutic study.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Types of pelvic ring injuries [9].
Fig 2
Fig 2. Kaplan-Meier survival curve indicating survival in years according to age at the time of injury.
See this image and copyright information in PMC

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