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Ali KA, He L, Li W, Zhang W, Huang H. Sleep quality and psychological health in patients with pelvic and acetabulum fractures: a cross-sectional study. BMC Geriatr 2024; 24:314. [PMID: 38575871 PMCID: PMC10993547 DOI: 10.1186/s12877-024-04929-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/29/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES It is known that difficulty sleeping after a fracture can have negative effects on both mental and physical health and may prolong the recovery process. The objective of this study is to explore how sleep quality and psychological health are linked in patients with pelvic and acetabulum fractures. METHODS A study was conducted on 265 patients between 2018 and 2022 who had suffered pelvic and acetabulum fractures. The study examined various factors, including age, gender, cause of injury, post-operative complications, and injury severity. The study employed ordinal logistic regression to examine the relationship between various pelvic fractures and seven subscales of the Majeed Pelvic Score (MPS), as well as the Sleep Disorder Questionnaire (SDQ) and Beck Depression Inventory (BDI). The study focused on the postoperative outcome one year after surgery, and each patient was assessed at the one-year mark after surgical intervention. Additionally, the study evaluated the functional outcome, sleep quality, and psychological disorders of the patients. RESULTS From 2018 to 2022, a total of 216 patients suffered from pelvic and acetabulum fractures. Among them, 6.6% experienced borderline clinical depression, and 45.2% reported mild mood disturbances. Anxiety was found to be mild to moderate in 46% of Tile C and posterior acetabulum wall fracture patients. About 24.8% of patients reported insomnia, while 23.1% reported sleep movement disorders. However, no significant correlation was found between fracture types and sleep disorders. The mean Majeed pelvic score (MPS) was 89.68. CONCLUSIONS Patients with pelvic and acetabular fractures typically experience functional improvement, but may also be at increased risk for insomnia and sleep movement disorders, particularly for certain types of fractures. Psychological well-being varies between fracture groups, with signs of borderline clinical depression observed in some cases. However, anxiety levels do not appear to be significantly correlated with pelvic and acetabular fractures.
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Affiliation(s)
- Khan Akhtar Ali
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Qiaokou District, Wuhan, Hubei, 430030, China
| | - LingXiao He
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Qiaokou District, Wuhan, Hubei, 430030, China
| | - Wenkai Li
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Qiaokou District, Wuhan, Hubei, 430030, China
| | - Weikai Zhang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Qiaokou District, Wuhan, Hubei, 430030, China
| | - Hui Huang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Qiaokou District, Wuhan, Hubei, 430030, China.
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McKibben NS, O’Hara NN, Slobogean GP, Gaski GE, Nascone JW, Sciadini MF, Natoli RM, McKinley T, Virkus WW, Sorkin AT, Howe A, O’Toole RV, Levy JF. Work Productivity Loss After Minimally Displaced Complete Lateral Compression Pelvis Fractures. J Orthop Trauma 2024; 38:42-48. [PMID: 37653607 PMCID: PMC10841261 DOI: 10.1097/bot.0000000000002681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE To quantify work impairment and economic losses due to lost employment, lost work time (absenteeism), and lost productivity while working (presenteeism) after a lateral compression pelvic ring fracture. Secondarily, productivity loss of patients treated with surgical fixation versus nonoperative management was compared. METHODS DESIGN Secondary analysis of a prospective, multicenter trial. SETTING Two level I academic trauma centers. PATIENT SELECTION CRITERIA Adult patients with a lateral compression pelvic fracture (OTA/AO 61-B1/B2) with a complete posterior pelvic ring fracture and less than 10 mm of initial displacement. Excluded were patients who were not working or non-ambulatory before their pelvis fracture or who had a concomitant spinal cord injury. OUTCOME MEASURES AND COMPARISONS Work impairment, including hours lost to unemployment, absenteeism, and presenteeism, measured by Work Productivity and Activity Impairment assessments in the year after injury. Results after non-operative and operative treatment were compared. RESULTS Of the 64 included patients, forty-seven percent (30/64) were treated with surgical fixation, and 53% (30/64) with nonoperative management. 63% returned to work within 1 year of injury. Workers lost an average of 67% of a 2080-hour average work year, corresponding with $56,276 in lost economic productivity. Of the 1395 total hours lost, 87% was due to unemployment, 3% to absenteeism, and 10% to presenteeism. Surgical fixation was associated with 27% fewer lost hours (1155 vs. 1583, P = 0.005) and prevented $17,266 in average lost economic productivity per patient compared with nonoperative management. CONCLUSIONS Lateral compression pelvic fractures are associated with a substantial economic impact on patients and society. Surgical fixation reduces work impairment and the corresponding economic burden. LEVEL OF EVIDENCE Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Natasha S. McKibben
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Nathan N. O’Hara
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Gerard P. Slobogean
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Greg E. Gaski
- Department of Orthopaedic Surgery, Inova Fairfax Medical Campus, Falls Church, VA
| | - Jason W. Nascone
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Marcus F. Sciadini
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Roman M. Natoli
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Todd McKinley
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Walter W. Virkus
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Anthony T. Sorkin
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Andrea Howe
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Robert V. O’Toole
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Joseph F. Levy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Sobantu NA, Tshabalala MD, Chetty V. Exploring the collaborative care of patients with pelvic fractures in Tshwane, South Africa. S Afr Fam Pract (2004) 2023; 65:e1-e9. [PMID: 37265140 DOI: 10.4102/safp.v65i1.5705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Pelvic fractures are complex injuries that lead to long-term disabilities and poor health-related quality of life (HRQoL). Even though pelvic fractures are known to be challenging to manage, there is limited information on guidelines and protocols to ensure that patients receive comprehensive and collaborative healthcare. METHODS A qualitative descriptive phenomenological approach was utilised to explore current practices and innovations of healthcare professionals (HPs) in Tshwane academic hospitals in the collaborative management and rehabilitation of patients with pelvic fractures, using semi-structured interviews. Thematic analysis was used to analyse data. RESULTS Six overarching themes were identified from the interviews with HPs: The biopsychosocial lens of the patient, limitations in approaches to care, contextual impediments to care, the team challenge; the biopsychosocial aspects of care and forging forward to improve care. CONCLUSION A multidisciplinary approach is encouraged for the comprehensive management of pelvic fractures. However, a poor understanding of roles and poor referral structures challenge this approach. Further barriers to caring include staff shortages and limited resources. Healthcare professionals recommended interprofessional education and collaborative practice, student training and using standardised outcome measurement tools to improve care for patients with pelvic fractures.Contribution: This study lays a foundation to initiate conversations about the development of an interprofessional model of care for patients with pelvic fractures. Findings might inform health policies on the management of pelvic fractures. Healthcare professionals might apply strategies that enhance the quality of healthcare provided. Patients with pelvic fractures might receive quality interprofessional healthcare that promotes quality of life, post pelvic fractures.
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Affiliation(s)
- Ntombenkosi A Sobantu
- Department of Physiotherapy, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa; and, Department of Physiotherapy, Faculty of Health Sciences, University of KwaZulu-Natal, Durban.
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Hu S, Guo J, Zhu B, Dong Y, Li F. Epidemiology and burden of pelvic fractures: Results from the Global Burden of Disease Study 2019. Injury 2023; 54:589-597. [PMID: 36528424 DOI: 10.1016/j.injury.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Pelvic fracture is a severe injury resulting in high mortality and disability rate, and brought heavy health burden. However, existing research conclusions only restricted to the national level while global estimation of pelvic fracture was lack. We aimed to estimate the global incidence, prevalence, and years lived with disability (YLDs) of pelvic fracture by region, age, gender, cause and sociodemographic index (SDI). MATERIALS AND METHODS Publicly available data was gained based on the Global Burden of Disease Study (GBD) 2019. We calculated the estimated annual percent change (EAPC) to analyze the temporal trends of pelvic fractures from 1990 to 2019. Incidence, prevalence and YLDs were analyzed by region, age, gender, cause and SDI. Spearman's rank order correlation was used to determine the correlation between SDI and incidence, prevalence and YLDs. RESULTS Globally, there were about 6 million incident cases, 18.8 million prevalent cases and 3.2 million YLDs cases of pelvic fractures for both sexes in 2019. The incidence number increased over 40% compared to 1990. However, the age standardized rate of incidence (ASIR) (EAPC = -0.22; 95% CI, -0.38 to -0.05), prevalence (ASPR) (EAPC = -0.42; 95% CI, -0.51 to -0.32) and YLDs (ASYR) (EAPC = -0.41; 95% CI, -0.50 to -0.32) all presented downward trends. Males had higher ASIR, ASPR and ASYR than females in each year from 1990 to 2019. The incidence, prevalence and YLDs rates were higher in males in early adulthood but exceeded in females at older age. A positive correlation was observed between ASIR and SDI (rho = 0.3732, p < 0.01). Regions with higher SDI tended to have higher ASIR, ASPR and ASYR than lower SDI regions. Falls and road injuries were the major causes of pelvic fracture at all ages and during the whole period. CONCLUSION The global health burden of pelvic fracture still remained high during the past thirty years. More policies and strategies are needed to face the challenge brought by population growth and aging.
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Affiliation(s)
- Shian Hu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, China
| | - Jianfeng Guo
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, China
| | - Binxiang Zhu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, China
| | - Yimin Dong
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, China.
| | - Feng Li
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, China.
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Brahme IS, Hu CH, Cole PA. Infection from an Iliosacral Screw 16 Years Postoperatively in Demolition Derby Umpire Crushed Between 2 Cars: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00021. [PMID: 36719947 DOI: 10.2106/jbjs.cc.22.00606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/20/2022] [Indexed: 02/01/2023]
Abstract
CASE A 47-year-old man crushed between 2 cars during a demolition derby, a nonracing North American motorsport, underwent open reduction and internal fixation, iliosacral screw fixation, arterial embolization, and multiple urologic procedures after massive pelvic ring injury, remarkably recovering nearly full function. Sixteen years after injury, he developed an abscess emanating from an iliosacral screw requiring irrigation, debridement, and hardware removal. CONCLUSION Deep surgical infections from iliosacral screws may present late, even more than 15 years after the original surgery. Obesity, preoperative embolization, diabetes, and urethral injuries are relevant risk factors. Similar patients should have a low threshold for infection workup when presenting with symptoms, even years after surgery.
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Affiliation(s)
- Indraneel S Brahme
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota.,Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota
| | - Caroline H Hu
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota.,Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota
| | - Peter A Cole
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota.,Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota.,HealthPartners Orthopaedics & Sports Medicine, Bloomington, Minnesota
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Muacevic A, Adler JR, Hormazabal J. Revisiting Non-operative Treatment of Lateral Compression Pelvic Fractures, Analysis of Rehabilitation, and Radiologic Outcomes in a Historical Cohort Using Today's Association of Osteosynthesis (AO) Stability Criteria. Cureus 2022; 14:e32101. [PMID: 36601154 PMCID: PMC9803861 DOI: 10.7759/cureus.32101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Type I lateral compression pelvic fractures (LC-I) have historically been treated conservatively. Inferior outcomes in a distinctive subset of these injuries have been reported, therefore their management has shifted towards surgery. Revisiting the historical series of LC-I allows us to determine whether non-operative management of these unstable patterns results in poorer outcomes. The objective was to evaluate the differences in the rehabilitation progress, fracture consolidation, and displacement in non-operatively treated LC-I fractures that would be considered unstable using today's Association of Osteosynthesis (AO) criteria. METHODS We conducted a retrospective review of conservatively treated LC-I injuries in a single-level I trauma center between June 2010 and June 2014. Patients were distributed in stable (group A) and unstable (group B) groups according to the 2018 AO classification. Time to walk independently (TWI), time to return to work (TRW), fracture consolidation, and displacement were analyzed. RESULTS 34 patients, mean age of 45.5 ±14.5 years, were included. Mean TWI in groups A and B were 71.2 ±31.9 and 105.9 ±50.9 days (p=0.027). Mean TRW was 106 ±51.3 and 157 ±84 days in groups A and B, respectively (p=0.038). A difference in mean TWI and TRW of 34.7 and 51.3 days between groups was observed. No significant differences in fracture consolidation or displacement were observed. CONCLUSION Unstable fractures presented significantly longer TWI and TRW. The revised AO classification contributes to the identification of fracture patterns that correlate with prolonged rehabilitation in which additional treatment strategies might be considered.
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Luijken K, van de Wall BJM, Hooft L, Leenen LPH, Houwert RM, Groenwold RHH. How to assess applicability and methodological quality of comparative studies of operative interventions in orthopedic trauma surgery. Eur J Trauma Emerg Surg 2022; 48:4943-4953. [PMID: 35809102 DOI: 10.1007/s00068-022-02031-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/05/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE It is challenging to generate and subsequently implement high-quality evidence in surgical practice. A first step would be to grade the strengths and weaknesses of surgical evidence and appraise risk of bias and applicability. Here, we described items that are common to different risk-of-bias tools. We explained how these could be used to assess comparative operative intervention studies in orthopedic trauma surgery, and how these relate to applicability of results. METHODS We extracted information from the Cochrane risk-of-bias-2 (RoB-2) tool, Risk Of Bias In Non-randomised Studies-of Interventions tool (ROBINS-I), and Methodological Index for Non-Randomized Studies (MINORS) criteria and derived a concisely formulated set of items with signaling questions tailored to operative interventions in orthopedic trauma surgery. RESULTS The established set contained nine items: population, intervention, comparator, outcome, confounding, missing data and selection bias, intervention status, outcome assessment, and pre-specification of analysis. Each item can be assessed using signaling questions and was explained using good practice examples of operative intervention studies in orthopedic trauma surgery. CONCLUSION The set of items will be useful to form a first judgment on studies, for example when including them in a systematic review. Existing risk of bias tools can be used for further evaluation of methodological quality. Additionally, the proposed set of items and signaling questions might be a helpful starting point for peer reviewers and clinical readers.
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Affiliation(s)
- Kim Luijken
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Bryan J M van de Wall
- Department of Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Lotty Hooft
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.,Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Luke P H Leenen
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R Marijn Houwert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
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8
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Sobantu NA, Tshabalala MD, Chetty V. Rehabilitation approaches and strategies in the management of adult patients following pelvic fractures: a scoping review protocol (Preprint). JMIR Res Protoc 2022; 12:e38884. [PMID: 37133918 DOI: 10.2196/38884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Pelvic fractures can lead to disability and a poor health-related quality of life, thereby contributing to the burden of disease in South Africa. Rehabilitation plays an important role in improving the functional outcomes in patients with pelvic fractures. However, there is limited published research that presents optimal interventions and guidelines to improve outcomes in affected individuals. OBJECTIVE The purpose of this study is to examine and map the range of and gaps in rehabilitation approaches and strategies used by health care professionals globally in the management of adult patients with pelvic fractures. METHODS The synthesis of evidence will follow the framework outlined by Arksey and O'Malley and supported by the Joanna Briggs Institute. The identification of research questions; the identification of relevant studies; the selection of eligible studies; charting data; collating, summarizing, and reporting of the results; and consultation with relevant stakeholders will be undertaken. Peer-reviewed articles written in English; from quantitative, qualitative, and mixed methods studies; and searched through Google Scholar, MEDLINE, PubMed, and Cochrane Library will be considered. Studies eligible for selection will be full-text articles written in English about adult patients with pelvic fractures. Studies on children with pelvic fractures and on interventions following pathological pelvic fractures as well as opinion papers and commentaries will be excluded from the study. Rayyan software will be used for title and abstract screening to determine inclusion in the study and to improve collaboration between the reviewers. The Mixed Methods Appraisal Tool (version 2018) will be used to appraise the quality of the studies. RESULTS This protocol will guide a scoping review to examine and map the range of and gaps in rehabilitation approaches and strategies used by health care professionals globally in the management of adult patients with pelvic fractures, irrespective of level of care. Impairments, activity limitations, and participation restrictions in patients with pelvic fractures will be highlighted, which will give an indication of the rehabilitation needs of the affected individuals. Results of this review might provide evidence for health care professionals, policy makers, and scholars to aid rehabilitative care and further integration of patients into health care systems and community. CONCLUSIONS The rehabilitation needs of patients with pelvic fractures will be drawn from this review and will be presented in a flow diagram. Rehabilitation approaches and strategies in the management of patients with pelvic fractures will be identified to guide health care professionals in the promotion of quality health care for these patients. TRIAL REGISTRATION OSF Registries osf.io/k6eg8; https://osf.io/k6eg8. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/38884.
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Affiliation(s)
- Ntombenkosi Appears Sobantu
- Department of Physiotherapy, University of KwaZulu-Natal, Westville Campus, Durban, South Africa
- Department of Physiotherapy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | - Verusia Chetty
- Department of Physiotherapy, University of KwaZulu-Natal, Westville Campus, Durban, South Africa
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Banierink H, Ten Duis K, Meesters AML, Trouwborst NM, Heineman E, Wendt KW, Ploegmakers JJW, Reininga IHF, IJpma FFA. The effects of pelvic ring injuries on quality of life, physical, and mental health: results of a 2-year prospective cohort study. Eur J Trauma Emerg Surg 2022; 48:2849-2857. [PMID: 35254459 PMCID: PMC9360067 DOI: 10.1007/s00068-022-01893-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/22/2022] [Indexed: 11/30/2022]
Abstract
Purpose Pelvic ring injuries are known to affect the patients’ daily life in terms of physical functioning and quality of life (QoL). Still, prospective studies on the patient’s perception over the first 2 years of rehabilitation are lacking. Therefore, patients cannot be properly informed about whether or when they will return to their pre-existing level of physical functioning and QoL. Methods A prospective longitudinal cohort study was performed over a 4-year period including all consecutive patients above 18 years who sustained a pelvic ring injury in a level 1 trauma center. Validated patient-reported outcome measures (PROMs) were used to assess physical functioning (SMFA) and QoL (EQ-5D) at baseline (recalled pre-injury score), 6 weeks, 3 months, 6 months, 1 year and 2 years after the injury. It was assessed whether patients had fully recovered by comparing follow-up scores to baseline PROMs. Binary logistic regression analysis was used to identify independent predictors for patients who did not fully recover. Most experienced difficulties at 3 months and 1 year were identified by analyzing the highest reported scores on individual items of the SMFA. Results A total of 297 patients with a pelvic ring injury were identified of which 189 were eligible for follow-up and 154 (82%) responded. Median SMFA function score at 3 months, 1 and 2 years was 70, 78 and 88, respectively, compared to 96 out of 100 before the injury. Median SMFA bother score was 67, 79 and 88, respectively. Median EQ-5D score at 3 months, 1 and 2 years was 0.61, 0.81 and 0.85, respectively, compared to 1 (maximum achievable) before the injury. After 1 and 2 years of follow-up, 61% and 75% of the patients fully “recovered” in physical functioning and 52% and 71% fully recovered in terms of QoL. Female gender and high-energy trauma were independent predictors for not fully recovering after 1 year. After 3 months of follow-up, 54% of patients reported severe difficulties with recreational activities, whereas after 1 year, most experienced difficulties (31% of patients) concerned heavy house or yard work. Moreover, after 3 months and 1 year, 44% and 27% of patients reported feeling physically disabled. Conclusion Pelvic ring injuries have a large impact on the patients’ daily life in the first 2 years of rehabilitation. Directly after the injury, physical functioning and QoL decrease strongly but then gradually improve over a 2-year period with about 75% of patients fully recovering. Female gender and high-energy trauma are shown to be independent predictors for not fully recovering. After 3 months, patients experience difficulties with both the physical and mental effects of the injury which continue to be present after 1 year. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-022-01893-3.
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Affiliation(s)
- Hester Banierink
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Kaj Ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anne M L Meesters
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nymke M Trouwborst
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik Heineman
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Klaus W Wendt
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joris J W Ploegmakers
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Inge H F Reininga
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Emergency Care Network Northern Netherlands (AZNN), Northern Netherlands Trauma Registry, Groningen, The Netherlands
| | - Frank F A IJpma
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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10
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Seemann RJ, Hempel E, Rußow G, Tsitsilonis S, Stöckle U, Märdian S. Clinical and Patient-Related Outcome After Stabilization of Dorsal Pelvic Ring Fractures: A Retrospective Study Comparing Transiliac Fixator (TIFI) and Spinopelvic Fixation (SPF). Front Surg 2021; 8:745051. [PMID: 34912842 PMCID: PMC8666530 DOI: 10.3389/fsurg.2021.745051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose: Aim of this retrospective cohort study was the comparison of the transiliac fixator (TIFI) and spinopelvic fixation (SPF) for fixation of dorsal pelvic ring fractures in terms of clinical outcome, complications, and quality of life. Methods: Thirty-eight patients (23 men, 15 women; mean age 47 ± 19 years) with dorsal pelvic ring fractures (type-C-injuries after AO/OTA) that have been stabilized by either TIFI (group TIFI, n = 22) or SPF (group SPF, n = 16) between May 2015 and December 2018 were retrospectively reviewed. Outcome measurements included demographic data, perioperative parameters, and complications and were obtained from the medical information system. Quality of life was assessed using the German version of the short form 36 (SF-36) and short muskuloskeletal function assessment (SMFA-D). Clinical results were assessed using Merle d'Aubigné-Score, Iowa Pelvic Score, and Majeed Pelvic Score. Results: Both groups show relatively good post-operative results, which has previously been reported. Quality of life was comparable in both groups. Group TIFI was slightly superior regarding complication rates, cutting/suture time, and fluoroscopy time. Group SPF seemed to be superior regarding pain and pelvic scores. Conclusion: None of the methods could demonstrate significant superiority over the other. Management of pelvic injuries remains a highly individual challenge adapted to the individual patients' condition. Nevertheless, if fractures allow for stabilization with TIFI, the use of this method should be taken into consideration as a less invasive and more tissue-conserving approach.
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Affiliation(s)
- Ricarda Johanna Seemann
- Center for Muskuloskeletal Surgery, Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Erik Hempel
- Center for Muskuloskeletal Surgery, Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gabriele Rußow
- Center for Muskuloskeletal Surgery, Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin, Germany
| | - Serafeim Tsitsilonis
- Center for Muskuloskeletal Surgery, Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin, Germany
| | - Ulrich Stöckle
- Center for Muskuloskeletal Surgery, Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sven Märdian
- Center for Muskuloskeletal Surgery, Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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11
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Are Sarcopenia and Myosteatosis in Elderly Patients with Pelvic Ring Injury Related to Mortality, Physical Functioning and Quality of Life? J Clin Med 2021; 10:jcm10214874. [PMID: 34768394 PMCID: PMC8584633 DOI: 10.3390/jcm10214874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/16/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to evaluate the prevalence of sarcopenia and/or myosteatosis in elderly patients with pelvic ring injuries and their influence on mortality, patient-perceived physical functioning and quality of life (QoL). A multicenter retrospective cohort study was conducted including elderly patients aged ≥ 65 treated for a pelvic ring injury. Cross-sectional computed tomography (CT) muscle measurements were obtained to determine the presence of sarcopenia and/or myosteatosis. Kaplan–Meier analysis was used for survival analysis, and Cox proportional hazards regression analysis was used to determine risk factors for mortality. Patient-reported outcome measures for physical functioning (SMFA) and QoL (EQ-5D) were used. Multivariable linear regression analyses were used to determine the effect of sarcopenia and myosteatosis on patient-perceived physical functioning and QoL. Data to determine sarcopenia and myosteatosis were available for 199 patients, with a mean follow-up of 2.4 ± 2.2 years: 66 patients (33%) were diagnosed with sarcopenia and 65 (32%) with myosteatosis, while 30 of them (15%) had both. Mortality rates in patients at 1 and 3 years without sarcopenia and myosteatosis were 13% and 21%, compared to 11% and 36% in patients with sarcopenia, 17% and 31% in patients with myosteatosis and 27% and 43% in patients with both. Higher age at the time of injury and a higher Charlson Comorbidity Index (CCI) were independent risk factors for mortality. Patient-reported mental and emotional problems were significantly increased in patients with sarcopenia.
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Bayrak A, Duramaz A. Erectile Dysfunction after Conservative Treatment of Sacral Fractures in Males without Injury to the Urinary System. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 161:154-159. [PMID: 34544164 DOI: 10.1055/a-1611-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND This study aimed to determine the incidence of erectile dysfunction (ED) reported by patients, and to define the prognostic relationship between ED and conservatively treated sacral fracture without urethral injury. METHODS Patients aged between 20 - 50 years who were sexually active and had no known sexual dysfunction prior to the trauma were included in the study. Seventy-seven patients (47 married, 30 single) treated conservatively for sacral fracture between April 2012 and February 2017 were retrospectively screened. Patients were compared in terms of age, marital status, body mass index (BMI), trauma mechanism, additional system injury, functional outcomes, and complications. Functional outcomes were assessed using the International Index of Erectile Function (IIEF-5) and the Majeed pelvic fracture functional assessment scale (MPS). RESULTS No statistically significant difference was observed between fracture types with respect to age, BMI, follow-up, marital status, trauma mechanism, and accompanying injury. The incidence of ED was 27.3% for those that received conservative treatment after sacrum fracture. The mean score of IIEF-5 was 18.6 ± 6.6 and MPS was 77.2 ± 13.2. There was no significant relationship between the injury type of the patients and the IIEF-5 and MPS scores (p = 0.593 and p = 0.907, respectively). The lowest IIEF-5 score was found in Denis type 2 fractures (p = 0.020). CONCLUSION The frequency of ED was higher in Denis type 2 sacrum fractures. Sexual function should be questioned in the follow-up, especially in those fracture types.
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Affiliation(s)
- Alkan Bayrak
- Orthopedics and Traumatology, Bakirkoy Dr Sadi Konuk Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Altug Duramaz
- Orthopedics and Traumatology, Bakirkoy Dr Sadi Konuk Egitim ve Arastirma Hastanesi, Istanbul, Turkey
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13
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Fann WC, Hung CC, Chaboyer W, Lee BO. Effectiveness of a Nurse-Delivered Intervention on Illness Perceptions and Quality of Life in Patients With Injury. J Nurs Res 2021; 29:e163. [PMID: 34091568 DOI: 10.1097/jnr.0000000000000439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Research has shown that nursing interventions are able to affect short-term outcomes in patients with injury. However, evidence based on a comprehensive nurse-led intervention may be beneficial for trauma care. PURPOSE This study was designed to assess the effect of a nursing intervention on the illness perceptions and quality of life of patients with injury. METHODS A two-group experimental design and a follow-up period of 12 months were used. Ninety-four patients were randomly assigned to either the experimental group or the control group. A nurse-led cognitive behavioral therapy intervention was used to improve outcomes. RESULTS The illness perception variables of "personal control" and "treatment control" were found to be significantly improved in the experimental group at 3 months after discharge, whereas "emotional perception" was significantly improved at 6 months after discharge. The intervention was also shown to improve "social quality of life" at 6 and 12 months after injury. CONCLUSIONS This study adds new knowledge related to nursing interventions for patients with injury in terms of the intervention achieving longer-term effects than the interventions examined in previous studies. The results highlight the importance of providing interprofessional collaborative care. However, the intervention protocol should be tested further in future studies.
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Affiliation(s)
- Wen-Chih Fann
- MSc, MD, Attending Physician, Department of Emergency Medicine, Chia-Yi Chang Gung Memorial Hospital, Taiwan
| | - Chang-Chiao Hung
- PhD, RN, Associate Professor, Department of Nursing, Chang Gung University of Science and Technology, and Associate Research Fellow, Department of Nursing, Chia-Yi Chang Gung Memorial Hospital, Taiwan
| | - Wendy Chaboyer
- PhD, RN, Professor, School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Bih-O Lee
- PhD, RN, Professor, College of Nursing, Kaohsiung Medical University, Taiwan, and Adjunct Professor, Faculty of Nursing, Universitas Airlangga, Indonesia
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de Krom MAP, Kalmet PHS, Jagtenberg EM, Jansen JJR, Versteegh VE, Verbruggen JPAM, Seelen HAM, Poeze M. Medium-Term Patient-Reported Quality of Life and Activities of Daily Living in Surgically Treated Trauma Patients With Pelvic, Acetabular or Combined Pelvic and Acetabular Fractures in a Retrospective Single-Center Study. J Orthop Trauma 2021; 35:192-197. [PMID: 32956206 DOI: 10.1097/bot.0000000000001965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To gain more insights in the medium-term patient-reported quality of life (QoL), activities of daily living (ADL), and number of complications in trauma patients with an acetabular fracture (AF), a pelvic fracture (PF), and those with a surgically combined pelvic and AF (PAF). DESIGN Retrospective single-center study. SETTING Level I academic trauma center. PATIENTS/PARTICIPANTS 51 trauma patients with PF, AF, or PAF who were surgically treated between 2014 and 2017. INTERVENTION Open reduction and internal fixation. MAIN OUTCOME MEASUREMENTS Primary outcome measures are patient-reported outcome questionnaire, which includes 2 items, the QoL, as measured with the Short Form-12, and the ADL, as measured with the Lower Extremity Functional Scale. The secondary outcome parameter was the occurrence of complications during a follow-up of at least 2 years. RESULTS The mean physical component score (PCS) of the QoL (P = 0.03) and the ADL (P = 0.03) were significantly higher in patients with AF compared with patients with PF. The incidence of the overall postoperative complications did not significantly differ between the PF, AF, and PAF groups (P = 0.28). CONCLUSIONS This study found that the PCS of the QoL and the ADL in surgically treated trauma patients with PF were significantly lower compared with patients with AF. No significant differences were found in overall complication rate between the PF, AF, and PAF groups. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Maartje A P de Krom
- Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Pishtiwan H S Kalmet
- Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Eline M Jagtenberg
- Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joey J R Jansen
- Department of Amputation, Adelante Rehabilitation Center, Traumatology and Orthopaedics, Hoensbroek, the Netherlands
| | - Viktor E Versteegh
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jan P A M Verbruggen
- Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Henk A M Seelen
- Adelante Center of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands; and
| | - Martijn Poeze
- Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
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15
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Kask G, Repo JP, Tukiainen EJ, Blomqvist C, Barner-Rasmussen I. Soft Tissue Sarcoma of Lower Extremity: Functional Outcome and Quality of Life. Ann Surg Oncol 2021; 28:6892-6905. [PMID: 33740199 PMCID: PMC8460521 DOI: 10.1245/s10434-021-09774-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/24/2021] [Indexed: 02/06/2023]
Abstract
Background Few studies have focused on patient-related factors in analyzing long-term functional outcome and health-related quality of life (HRQoL) in patients with postoperative lower extremity soft tissue sarcoma (STS). Objective The purpose of this study was to investigate factors associated with postoperative functional outcome and HRQoL in patients with lower extremity STS. Methods This cross-sectional study was performed in a tertiary referral center using the Toronto Extremity Salvage Score (TESS), Quality-of-Life Questionnaire (QLQ)-C30 and 15 Dimension (15D) measures. Functional outcome and HRQoL data were collected prospectively. All patients were treated by a multidisciplinary team according to a written treatment protocol. Results A total of 141 patients who had undergone limb-salvage surgery were included. Depending on the outcome measure used, 19–51% of patients were completely asymptomatic and 13–14% of patients had an unimpaired HRQoL. The mean score for TESS, 15D mobility score, and QLQ-C30 Physical Functioning scale were 86, 0.83, and 75, respectively, while the mean score for 15D was 0.88, and 73 for QLQ-C30 QoL. Lower functional outcome was statistically significantly associated with higher age, higher body mass index (BMI), and the need for reconstructive surgery and radiotherapy, while lower HRQoL was statistically significantly associated with higher age, higher BMI, and reconstructive surgery. Conclusion Functional outcome and HRQoL were generally high in this cross-sectional study of patients with STS in the lower extremity. Both tumor- and treatment-related factors had an impact but patient-related factors such as age and BMI were the major determinants of both functional outcome and HRQoL. Supplementary Information The online version of this article (10.1245/s10434-021-09774-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gilber Kask
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, HUS, Helsinki, Finland. .,Tampere University Hospital, Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere, Finland. .,Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Jussi P Repo
- Tampere University Hospital, Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere, Finland
| | - Erkki J Tukiainen
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, HUS, Helsinki, Finland
| | - Carl Blomqvist
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, HUS, Helsinki, Finland.,Department of Oncology, Örebro University Hospital, Örebro, Sweden
| | - Ian Barner-Rasmussen
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, HUS, Helsinki, Finland
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Verma V, Sen RK, Tripathy SK, Aggarwal S, Sharma S. Factors affecting quality of life after pelvic fracture. J Clin Orthop Trauma 2020; 11:1016-1024. [PMID: 33192004 PMCID: PMC7656473 DOI: 10.1016/j.jcot.2020.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/16/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Functional outcome and health-related quality of life (HRQOL) after pelvis fracture is suboptimal; majority of the patients do not return to their preinjury activities. Many researchers reported that late morbidity in pelvis fracture is associated with severity of the fracture, associated trauma, pelvic fracture-related complications and methods of treatment. MATERIAL AND METHODS One hundred and twelve patients with pelvis fracture who were treated either conservatively (n = 88) or surgically (n = 24) with a minimum of two years follow up were evaluated clinically and radiologically. The clinical outcome was evaluated using Majeed score and self-reported Short Musculoskeletal Function Assessment (SMFA). Their HRQOL was evaluated using the 36-item Short Form Survey (SF-36) and WHOQOL-BREF questionnaires. The fracture-displacement in the anterior or posterior pelvis ring was measured from the anteroposterior radiograph or inlet/outlet view. RESULTS The average Majeed score was 76.65 ± 14.73 (range, 36 to 96). There were 81 patients with good to excellent outcomes and 31 patients with poor to fair outcomes. The average SF-36 Physical Component Summary (PCS) score was 47.71 ± 7.88 (range, 27.3 to 61.5) and SF-36 Mental Component Summary (MCS) was 49.20 ± 9.37 (range, 23.1 to 56.8). The functional level of the general population in the physical and mental domain was achieved in 48.23% and 65.3% of pelvic-fractured patients respectively. General population norms were achieved in 56.3%, 63.4%, 65.2% and 84.8% of patients in WHOQOL-BREF domain one, two, three and four respectively. The patients had significantly worse functional outcome and HRQOL if residual displacement was > 1 cm. Age, sex, associated injuries and injury mechanism were not affecting the HRQOL in patients with acceptable residual displacement of ≤ 1 cm. CONCLUSION Pelvic fracture with the residual displacement of ≤ 1 cm in the sacroiliac joint/symphysis pubis result in better functional outcome and HRQOL. Injury mechanism and associated injury have no impact on the HRQOL if the residual displacement is within the acceptable limit.
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Affiliation(s)
- Vishal Verma
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Sujit Kumar Tripathy
- Dept. of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, India
- Corresponding author. Dept of Orthopaedics AIIMS, Bhubanewar, Sijua Patrapada, Bhubaneswar, 751019, India.
| | - Sameer Aggarwal
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Suresh Sharma
- Dept. of Biostatistics, Punjab University, Chandigarh, India
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17
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Beder FK, Hamdy MS, El-Desouky II, Abdelkader KF, Abdelazeem AH. Symphyseal plate with trans-symphyseal cross-screws for fixation of tile-type B1 pelvic ring injuries: radiological and functional evaluation. INTERNATIONAL ORTHOPAEDICS 2020; 44:2745-2751. [PMID: 33057743 DOI: 10.1007/s00264-020-04851-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/09/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Failure to neutralize the different physiological forces acting on the inferior as well as the superior regions of the pubic symphysis, the long healing time, is blamed for the repeated failures of conventional superior symphyseal plating. MATERIAL AND METHODS A three years prospective case series study between January 2017 and December 2019 was done, to evaluate the radiological and the functional outcomes, using Matta/Tornetta and Majeed criteria respectively, of the combination of trans-symphyseal cross-screws configuration and superior symphyseal plate in Tile-type B1 pelvic injuries. RESULTS Thirty patients, 18 with anteroposterior compression type II and 12 with type III, with a mean follow-up of 20 months ±5 were included. Radiologically, 26 (86.6%) cases showed an excellent, one (3.3%) good and three (10%) fair outcome. Clinically, excellent outcome in 26 (86.6%) cases, good in two (6.6%) cases, and fair in two (6.6%). Intra-operative drill bit breakage occurred in three (10%) cases and was the only reported technical complication. Significant re-displacement was reported in three (10%) cases. CONCLUSION The open trans-symphyseal cross-screws for fixation of the superior symphyseal plate is a simple, efficient, and safe technique with the biomechanical advantages of an extra-fixation point to the inferior symphysis together with a long and a strong bony anchorage.
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Affiliation(s)
- Fady Kamal Beder
- Pelvic Trauma and Arthroplasty Unit, Department of Orthopaedics and Traumatology, Kasr-Alainy Hospital, Cairo University, Cairo, Egypt
| | - Mohamed Salama Hamdy
- Pelvic Trauma and Arthroplasty Unit, Department of Orthopaedics and Traumatology, Kasr-Alainy Hospital, Cairo University, Cairo, Egypt
| | - Ihab Ibraheem El-Desouky
- Pelvic Trauma and Arthroplasty Unit, Department of Orthopaedics and Traumatology, Kasr-Alainy Hospital, Cairo University, Cairo, Egypt
| | - Khaled Fawzy Abdelkader
- Pelvic Trauma and Arthroplasty Unit, Department of Orthopaedics and Traumatology, Kasr-Alainy Hospital, Cairo University, Cairo, Egypt
| | - Ahmed Hazem Abdelazeem
- Pelvic Trauma and Arthroplasty Unit, Department of Orthopaedics and Traumatology, Kasr-Alainy Hospital, Cairo University, Cairo, Egypt.
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18
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Mostafa AMHAM, Kyriacou H, Chimutengwende-Gordon M, Khan WS. An overview of the key principles and guidelines in the management of pelvic fractures. J Perioper Pract 2020; 31:341-348. [PMID: 32894996 PMCID: PMC8406373 DOI: 10.1177/1750458920947358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pelvic fractures are complex injuries with a range of different presentations depending on the mechanism of trauma. Due to the morbidity and mortality of pelvic fractures, patients require thorough investigation and timely management with multidisciplinary input. Various surgical and non-surgical techniques can be used to treat pelvic fractures, as well as any associated visceral injuries. Following repair, it is important to remain vigilant for postoperative complications such as infection, sexual and urinary dysfunction, chronic pain and adverse psychological health. This article summarises the relevant UK guidance and literature and presents them in a format that follows the patient’s journey. In doing so, it highlights the key perioperative factors that need to be considered in cases of pelvic fracture.
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Affiliation(s)
| | - Harry Kyriacou
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Wasim S Khan
- Department of Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge, UK
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19
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Banierink H, ten Duis K, Wendt K, Heineman E, IJpma F, Reininga I. Patient-reported physical functioning and quality of life after pelvic ring injury: A systematic review of the literature. PLoS One 2020; 15:e0233226. [PMID: 32678840 PMCID: PMC7367481 DOI: 10.1371/journal.pone.0233226] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/30/2020] [Indexed: 01/13/2023] Open
Abstract
Background Pelvic ring injuries are one of the most serious traumatic injuries with large consequences for the patients’ daily life. During recent years, the importance of the patients’ perception of their functioning and quality of life following injury has increasingly received attention. This systematic review reports on self-reported physical functioning and quality of life after all types of pelvic ring injuries. Methods The online databases MEDLINE-PubMed and Ovid-EMBASE were searched for studies published between 2008 and 2019 to identify published evidence of patient-reported physical functioning and quality of life after which they were assessed for their methodological quality. Results Of the 2577 articles, 46 were reviewed in full-text, including 3049 patients. Most studies were heterogeneous, with small cohorts of patients, a variety of injury types, treatment methods and use of different, often non-validated, outcome measures. The overall methodological quality was moderate to poor. Nine different PROMs were used, of which the Majeed Pelvic Score (MPS), SF-36 and EQ-5D were the most widely used. Mean scores respectively ranged from 75–95 (MPS), 53–69 (SF-36, physical functioning) and 0.63–0.80 (EQ-5D). Conclusions Physical functioning and quality of life following pelvic ring injuries seem fair and tend to improve during follow-up. However, differences in patient numbers, injury definition, treatment strategy, follow-up duration and type of PROMs used between studies hampers to elucidate the actual effects of pelvic ring injuries on a patient’s life. Implications of key findings Physicians and researchers should use valid and reliable patient-reported outcome instruments on large cohorts of patients with properly defined injuries to truly evaluate physical functioning and quality of life after pelvic ring injuries. Systematic review registration number PROSPERO International prospective register of systematic reviews; registration number CRD42019129176.
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Affiliation(s)
- Hester Banierink
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Kaj ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Klaus Wendt
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Emergency Care Network Northern Netherlands (AZNN), Northern Netherlands Trauma Registry, Groningen, The Netherlands
| | - Erik Heineman
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Frank IJpma
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Inge Reininga
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Emergency Care Network Northern Netherlands (AZNN), Northern Netherlands Trauma Registry, Groningen, The Netherlands
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20
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Sakran JV, Ezzeddine H, Schwab CW, Bonne S, Brasel KJ, Burd RS, Cuschieri J, Ficke J, Gaines BA, Giacino JT, Gibran NS, Haider A, Hall EC, Herrera-Escobar JP, Joseph B, Kao L, Kurowski BG, Livingston D, Mandell SP, Nehra D, Sarani B, Seamon M, Yonclas P, Zarzaur B, Stewart R, Bulger E, Nathens AB. Proceedings from the Consensus Conference on Trauma Patient-Reported Outcome Measures. J Am Coll Surg 2020; 230:819-835. [PMID: 32201197 DOI: 10.1016/j.jamcollsurg.2020.01.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/07/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Joseph V Sakran
- Division of Acute Care Surgery, Departments of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Hiba Ezzeddine
- Division of Acute Care Surgery, Departments of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - C William Schwab
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perlman School of Medicine, University of Pennsylvania, Philadelphia
| | - Stephanie Bonne
- Division of Trauma, Department of Surgery, New Jersey Medical School Rutgers, Newark, NJ
| | - Karen J Brasel
- Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health Sciences University, Portland, OR
| | - Randall S Burd
- Division of Trauma and Burn Surgery, Department of Surgery, Children's National Medical Center, Washington, DC
| | - Joseph Cuschieri
- Divisions of Trauma, Burn, and Critical Care, Division of Trauma, Burn
| | - James Ficke
- Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Barbara A Gaines
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh; University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Joseph T Giacino
- Division of Rehabilitation Neuropsychology, Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Charlestown
| | - Nicole S Gibran
- Division of Restorative Burn Surgery, Division of Trauma, Burn
| | - Adil Haider
- Medical College in Pakistan, The Aga Khan University, Karachi, Pakistan
| | - Erin C Hall
- MedStar Washington Hospital Center, Washington, DC; Department of Surgery, Washington, DC
| | - Juan P Herrera-Escobar
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Bellal Joseph
- Division of Trauma, Acute Care, Burn and Emergency Surgery, Department of Surgery, the University of Arizona College of Medicine, Tucson, AZ
| | - Lillian Kao
- Division of Acute Care Surgery, Department of Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston
| | - Brad G Kurowski
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center; Department of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - David Livingston
- Division of Trauma, Department of Surgery, New Jersey Medical School Rutgers, Newark, NJ
| | - Samuel P Mandell
- Divisions of Trauma, Burn, and Critical Care, Division of Trauma, Burn
| | - Deepika Nehra
- Divisions of Trauma, Burn, and Critical Care, Division of Trauma, Burn
| | - Babak Sarani
- Division of Trauma and Acute Care Surgery (Sarani), Georgetown University School of Medicine, Washington, DC
| | - Mark Seamon
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perlman School of Medicine, University of Pennsylvania, Philadelphia
| | - Peter Yonclas
- Division of Trauma, Department of Surgery, New Jersey Medical School Rutgers, Newark, NJ
| | - Ben Zarzaur
- Division of Acute Care and Regional General Surgery, Department of Surgery, University of Wisconsin School of Medicine, Madison, WI
| | - Ronald Stewart
- Department of Surgery, University of Texas Health San Antonio, San Antonio, TX; Committee on Trauma, Chicago, IL
| | - Eileen Bulger
- Critical Care, Department of Surgery, Harborview Medical Center, University of Washington, Seattle, WA; Committee on Trauma, Chicago, IL
| | - Avery B Nathens
- American College of Surgeons; Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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