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. 2022 Jun 30;22(1):543.
doi: 10.1186/s12877-022-03222-0.

Focusing on individual morphological fracture characteristics of pelvic ring fractures in elderly patients can support clinical decision making

Michaela Ramser  1 , Dieter Cadosch  2 , Werner Vach  3   4 , Nathalie Strub  3 , Franziska Saxer #  2   5 , Henrik Eckardt #  2
Affiliations

Focusing on individual morphological fracture characteristics of pelvic ring fractures in elderly patients can support clinical decision making

Michaela Ramser et al. BMC Geriatr. .

Abstract

Introduction: Pelvic ring fractures in the elderly are often caused by minor trauma. Treatment of these patients is currently based on fracture classification, clinical course, and ability to mobilize. Our aim was to identify morphological fracture characteristics with potential prognostic relevance and evaluate their association with clinical decision making and outcome, as well as their interobserver reliability.

Methods: Five fracture characteristics were investigated as potential variables: 1. Extent of the dorsal pelvic ring fracture (absent, unilateral, bilateral); 2. Extent of the ventral pelvic ring fracture (absent, unilateral, bilateral); 3. Presence of a horizontal sacral fracture; 4. Ventral dislocation; 5. Ventral comminution. These characteristics were assessed retrospectively in a series of 548 patients. The association of their presence with the decision to perform surgery, failure of conservative treatment and the length of hospital stay (LOS) was determined. Further, the inter-observer reliability for the specific characteristics was calculated and the relation with survival assessed.

Results: Four of the five evaluated characteristics showed an association with clinical decision making and patient management. In particular the extent of the dorsal fractures (absent vs. unilateral vs. bilateral) (OR = 7.0; p < 00.1) and the presence of ventral comminution/dislocation (OR = 2.4; p = 0.004) were independent factors for the decision to perform surgery. Both the extent of the dorsal fracture (OR = 1.8; p < 0.001) and the presence of ventral dislocation (OR = 1.7; p = 0.003) were independently associated with a prolonged overall LOS. The inter-observer agreement for the fracture characteristics ranged from moderate to substantial. A relevant association with increased mortality was shown for horizontal sacral and comminuted ventral fractures with hazard ratios (HR) of 1.7 (95% CI: 1.1, 2.5; p = 0.008) and HR = 1.5 (95% CI: 1.0, 2.2; p = 0.048).

Conclusion: In the elderly, the extent of the dorsal fractures and the presence of ventral comminution/dislocation were associated to the decision to undergo surgery, failure of conservative treatment and length of stay. Survival was related to horizontal sacral fractures and ventrally comminuted fractures. These characteristics thus represent a simplified but highly informative approach for the evaluation of pelvic ring fractures in the elderly. This approach can support clinical decision making, promote patient-centred treatment algorithms and thus improve the outcome of individualized care.

Keywords: Conservative treatment; Elderly; FFP; Failure of conservative treatment mortality; Fracture characteristics; Fragility fractures of the pelvis; Frailty; Individualised care; Outcome; Patient-centred treatment; Pelvic fracture; Surgery.

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Conflict of interest statement

No competing interests.

Figures

Fig. 1
Fig. 1
Decision making for the treatment of pelvic fractures in the elderly
Fig. 2
Fig. 2
Relation of individual fracture characteristic and clinical decision-making
Fig. 3
Fig. 3
Relation of individual fracture characteristics and length of stay in surgically and conservative treated patients
Fig. 4
Fig. 4
Fracture characteristic and survival
See this image and copyright information in PMC

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