What are predictors for patients' quality of life after pelvic ring fractures?

Increased Neighborhood Deprivation Is Associated with Prolonged Hospital Stays After Surgical Fixation of Traumatic Pelvic Ring Injuries

BACKGROUND

The purpose of this study was to understand the role of social determinants of health assessed by the Area Deprivation Index (ADI) on hospital length of stay and discharge destination following surgical fixation of pelvic ring fractures.

METHODS

A retrospective chart analysis was performed for all patients who presented to our level-I trauma center with pelvic ring injuries that were treated with surgical fixation. Social determinants of health were determined via use of the ADI, a comprehensive metric of socioeconomic status, education, income, employment, and housing quality. ADI values range from 0 to 100 and are normalized to a U.S. mean of 50, with higher scores representing greater social deprivation. We stratified our cohort into 4 ADI quartiles. Statistical analysis was performed on the bottom (25th percentile and below, least deprived) and top (75th percentile and above, most deprived) ADI quartiles. Significance was set at p < 0.05.

RESULTS

There were 134 patients who met the inclusion criteria. Patients in the most deprived group were significantly more likely to have a history of smoking, to self-identify as Black, and to have a lower mean household income (p = 0.001). The most deprived ADI quartile had a significantly longer mean length of stay (and standard deviation) (19.2 ± 19 days) compared with the least deprived ADI quartile (14.7 ± 11 days) (p = 0.04). The least deprived quartile had a significantly higher percentage of patients who were discharged to a resource-intensive skilled nursing facility or inpatient rehabilitation facility compared with those in the most deprived quartile (p = 0.04). Race, insurance, and income were not significant predictors of discharge destination or hospital length of stay.

CONCLUSIONS

Patients facing greater social determinants of health had longer hospital stays and were less likely to be discharged to resource-intensive facilities when compared with patients of lesser social deprivation. This may be due to socioeconomic barriers that limit access to such facilities.

LEVEL OF EVIDENCE

Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

[Quality of Life and Return to Work Following Rehabilitation - Results of the icfPROreha Study]

BACKGROUND

Not only the severity of an injury, but also bio-psycho-social factors affect health-related quality of life and participation in social life after severe musculoskeletal injuries.

METHODS

Multicentre prospective longitudinal study with follow-up up to 78 weeks after discharge from inpatient trauma rehabilitation. Data were collected using a comprehensive assessment tool. Quality of life was assessed using the EQ-5D-5L, return to work by patients' self-reports and routine data of health insurances. Analyses of the association between quality of life and return to work, change over time in quality of life compared to the general German population and multivariate analyses to predict quality of life were conducted.

RESULT

Of 612 study participants (444 men (72.5%); M=48.5 years; SD 12.0), 502 (82.0%) returned to work 78 weeks after discharge from inpatient rehabilitation. Quality of life improved during rehabilitation treatment from 50.18 to 64.50 (mean of visual analogue scale of EQ-5D-5L) and slightly to 69.38 78 weeks after discharge from inpatient trauma rehabilitation. EQ-5D index was below the values of the general population. In total, 18 factors were selected to predict quality of life 78 weeks after discharge from inpatient trauma rehabilitation. Among others, pain at rest and suspected anxiety disorder at admission had a very strong effect on quality of life. Contextual factors such as therapies after acute care and self-efficacy also had an effect on quality of life 78 weeks after discharge from inpatient rehabilitation.

CONCLUSION

Bio-psycho-social factors affect long-term quality of life of patients with musculoskeletal injuries. Already at the time of discharge from acute treatment and even more at the beginning of inpatient rehabilitation, decisions can be made in order to achieve the best possible quality of life for those affected.

Computed tomography micromotion analysis in the follow-up of patients with surgically treated pelvic fractures: a prospective clinical study

PURPOSE

High-energy pelvic fractures are complex injuries often requiring surgical treatment. Different radiological methods exist to evaluate the reduction and healing process postoperatively but with certain limitations. The aim of this study was to evaluate Computed Tomography Micromotion Analysis (CTMA) in a clinical setting for follow-up of surgically treated pelvic fracture patients.

METHODS

10 patients surgically treated for a pelvic fracture were included and prospectively followed with Computed Tomography (CT) at 0, 6, 12 and 52 weeks postoperatively. CTMA was used to measure postoperative translation and rotation of the pelvic fracture during the 52 weeks follow-up. Clinical outcomes were collected through the questionnaires EQ-5D index score and Majeed score.

RESULTS

10 patients were included with mean age (± SD, min-max) 52 (16, 31-80) years and 70% (n = 7) were males. The median (IQR, min-max) global translation from 0 to 52 weeks was 6.0 (4.6, 1.4-12.6) millimeters and median global rotation was 2.6 (2.4, 0.7-4.7) degrees. The general trend was a larger translation between 0 and 6 weeks postoperatively compared to 6-12 and 12-52 weeks. For the clinical outcomes, the general trend was that all patients started from high scores which decreased in the first postoperative follow-up and recovered to different extent during the study period.

CONCLUSION

CTMA was successfully used in the follow-up of surgically treated pelvic fracture patients. Movement in the pelvic fractures after surgical fixation was largest between 0 and 6 weeks.

Long-term patient reported sexual and urological dysfunction in males after operatively treated pelvic ring injuries Do generic outcome measures identify genitourinary health problems?

BACKGROUND

A consecutive series of 177 male patients, with high energy pelvic ring injuries, were treated operatively in our institution. The purpose of this study was to evaluate long-term sexual and urological dysfunction in these patients using validated disease specific patient reported outcome measures (PROMs), and identify if sexual and urological dysfunction is detectable from generic outcome scores used in the assessment of pelvic ring injury at a minimum of 10 years follow-up (range 10-22).

METHODS

Surviving patients were contacted to complete validated PROMs to examine genitourinary and global functional outcome. Fifty-two male participants, had a mean age of 44-years-old (range,16-69) and ISS of 17 at time of injury. Mean duration follow-up of 15 years. The primary outcome measures were the Sexual Health Inventory for Men (SHIM) and the Modular Questionnaire for Male Lower Urinary Tract Symptoms (MLUTS). Secondary outcomes were the EQ-5D and Short Form 36. Responses were tested for correlation between generic and disease-specific PROMs and analyzed for association with genitourinary injury and age as risk factors of poor outcome.

RESULTS

Genitourinary injuries occurred in 7 patients (13%), and ten patients (19%) had documented neurological dysfunction following injury. Satisfactory general functional outcome was reported with EQ-5D-3L VAS score of 71. However, 80% report some level of sexual dysfunction with 37% reporting it as severe. MLUTS mean symptom score was 9 (range, 0 - 26) and bothersomeness score was 21 (range, 0-90). There was poor correlation between urological and sexual dysfunction scores and between the disease specific and generic scores.

CONCLUSION

In operatively treated pelvic ring injuries, validated disease specific PROMs, (SHIM and MLUTs) identified a significant impact to both sexual and urological patient health, with 37% reporting severe sexual dysfunction. Longstanding sexual and/or urological dysfunction can be a source of significant psychological impact that this study has shown is not identifiable using generic PROMs; EQ-5D-3L and SF-36. To gain a holistic understanding of the functional outcome of patients following a pelvic injury, urological and sexual dysfunction must not be overlooked.

The effects of pelvic ring injuries on quality of life, physical, and mental health: results of a 2-year prospective cohort study

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.

Are Sarcopenia and Myosteatosis in Elderly Patients with Pelvic Ring Injury Related to Mortality, Physical Functioning and Quality of Life?

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.

Low-energy lateral compression type 1 (LC1) pelvic ring fractures in the middle-aged and elderly affect hospital quality measures and functional outcomes

PURPOSE

The purpose of this study was to examine hospital quality measures and the long-term functional outcomes associated with lateral compression type 1 [LC1] pelvic ring injuries.

METHODS

A query was performed from December 2011 to September 2020 at two institutions within one hospital system for patients with a pelvic fracture diagnosis. Chart review was performed on admitted patients to determine demographic information, medical co-morbidities (to calculate Charlson Co-morbidity Index), in-hospital complications, length of stay [LOS], discharge disposition, and 30-day readmission rates. All patients included were treated nonoperatively. An attempt was made to contact all patients for long-term follow-up to assess current functional status with a Short Musculoskeletal Function Assessment [SMFA].

RESULTS

Two-hundred and eighty-six patients were included, with 172 (65.9%) patients admitted and analyzed with respect to hospital quality measures. Patients admitted were older (83 vs 80 years, p = 0.015) with more medical co-morbidities (p = 0.001) than those discharged from the emergency department. The average LOS was 5.7 ± 3.7 days and 31 (18%) experienced in-hospital complications. The inpatient mortality rate was 1.2%, and the 30-day readmission rate was 8.1%. When comparing admitted patients without concomitant injuries, admitted patients with concomitant injuries, and non-admitted patients, admitted patients with concomitant injuries were found to have more medical co-morbidities (p = 0.001). Forty-three patients were available for long-term follow-up (average 36.6 ± 7.3 months), with an average SMFA score of 29.0 ± 25.7.

CONCLUSIONS

Patients admitted for LC1 pelvic fractures are likely to be older with more medical co-morbidities, and up to 1/5th will experience inpatient complications. Although inpatient mortality remains low, this injury pattern can lead to significant functional disability that persists for several years after injury.

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

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.

Factors affecting quality of life after pelvic fracture

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.

An overview of the key principles and guidelines in the management of pelvic fractures

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.

Patient-reported physical functioning and quality of life after pelvic ring injury: A systematic review of the literature

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.

Prognostic factors and quality of life after pelvic fractures. The Brabant Injury Outcome Surveillance (BIOS) study

Introduction

Pelvic fractures can have long-term consequences for health-related quality of life (HRQoL). The main purpose of this study is to provide insight into short-term HRQoL in the first year after pelvic injury and to identify short-term prognostic factors of decreased outcome.

Methods

This is a prospective, observational, multicenter, follow-up cohort study in which HRQoL and functional outcomes were assessed during 12-month follow-up of injured adult patients admitted to 1 of 10 hospitals in the county of Noord-Brabant, the Netherlands. The data were collected by self-reported questionnaires at 1 week (including preinjury assessment) and 1, 3, 6 and 12 months after injury. The EuroQoL-5D (EQ-5D), visual analog scale (VAS), Merle d’Aubigné Hip Score (MAHS) and Majeed Pelvic Score (MPS) were used. Multivariable mixed models were used to examine the course of the HRQoL and the prognostic factors for decreased HRQoL and functional outcomes over time.

Results

A total of 184 patients with pelvic fractures were identified between September 2015–September 2016; the fractures included 71 Tile A, 44 Tile B and 10 Tile C fractures and 59 acetabular fractures. At the pre-injury, 1 week, and 1, 3, 6 and 12 months after injury time points, the mean EQ-5D Index values were 0.90, 0.26, 0.45, 0.66, 0.77 and 0.80, respectively, and the mean EQ-VAS values were 83, 45, 57, 69, 75 and 75, respectively. At 6 and 12 months after injury, 22 and 25% of the MPS < 65 year group, 38 and 47% of the MPS ≥ 65 year group and 34 and 51% of the MAHS group, respectively, reached the maximum score. Pre-injury score, female gender and high Injury Severity Score (ISS) were important prognostic factors for a decreased HRQoL, and the EQ-5D VAS β = 0.43 (95% CI: 0.31 − 0.57), -6.66 (95% CI: -10.90 − -0.43) and -7.09 (95% CI: -6.11 − -5.67), respectively.

Discussion

Patients with pelvic fractures experience a reduction in their HRQoL. Most patients do not achieve the HRQoL of their pre-injury state within 1 year after trauma. Prognostic factors for decreased HRQoL are a low pre-injury score, high ISS and female gender. We do not recommend using the MAHS and MPS in mid- or long-term follow-up of pelvic fractures because of ceiling effects.

Trial registration number NCT02508675.

Quality of life after pelvic ring fractures: Long-term outcomes. A multicentre study

AIMS

This study was conducted to determine long-term (5-10 years) health-related quality of life (HRQOL) and ceiling effects in patients with a pelvic ring fracture.

PATIENTS AND METHODS

We identified all patients with pelvic ring fractures after high-energy trauma admitted at two level 1 trauma centres in the Netherlands from 2006 to 2011. Patients were asked to complete the Majeed Pelvic Score (MPS), EuroQol-5D (EQ-5D) and Short Musculoskeletal Function Assessment (SMFA) questionnaires. HRQOL analysis used a multiple linear regression model.

RESULTS

In total, 136 patients returned the questionnaires. The median follow-up period was 8.7 years. The mean MPS and EQ-5D-VAS scores were 85.1 and 74, respectively. The mean EQ-5D index scores were 0.87, 0.81 and 0.82 in Tile B, A and C patients, respectively. The mean SMFA index was 24. A ceiling effect was observed for 1/3 of the patients. After multiple linear regression analysis, no differences were identified among the various fracture types for each questionnaire, with the exception of 2 subscales of the MPS.

CONCLUSION

Patients who suffer pelvic ring fractures generally have good HRQOL outcomes after 5-10 years. No significant differences were found among different fracture types. Long-term follow-up of patients with Tile C fractures is warranted.

Differences in the Majeed Pelvic Score Between Injured and Uninjured Patients

OBJECTIVES

To investigate the differences in the Majeed Pelvic Score (MPS) between injured and uninjured patients. Discriminative power and applicability of the MPS in elderly are also investigated, and a norm score for the MPS in the Netherlands is provided.

DESIGN

Cross-sectional cohort study.

SETTING

Urban level 1 trauma center.

PATIENTS/PARTICIPANTS

One hundred ninety-five patients with pelvic ring disruptions; 101 61A, 67 61B, and 27 61C (OTA/AO classification; 6%, 27%, and 82% surgically treated, respectively); mean follow-up 29 months (range 6-61); 554 adults from the Longitudinal Internet Studies for the Social Sciences panel (control group). Participants were divided into 2 age groups: <65 and ≥65 years (respectively, maximum MPS: 100 and 80 points).

MAIN OUTCOME MEASUREMENTS

Majeed Pelvic Score.

RESULTS

Patients <65 years of age (81.6) scored lower on the MPS when compared with the control group (88.3, P < 0.001). Patients ≥65 years of age (68.1) scored lower on the MPS when compared with the control group (72.0, P = 0.006). In the <65 group, the patient group scored worse on the sexual function, work, and standing dimensions (P < 0.001). In the ≥65 group, the patient group scored worse on the dimensions sitting (P = 0.03) and standing (P < 0.001) and better on the dimension pain (P = 0.001).

CONCLUSIONS

Compared with the general population, patients with pelvic ring disruption in both age groups perceived some health problems in almost all MPS domains. The MPS discriminates well enough to provide information about the mobility of elderly patients.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Long-term physical functioning and quality of life after pelvic ring injuries

BACKGROUND

Pelvic ring injuries are serious injuries, often associated with substantial morbidity and mortality rates. The long-term consequences of these injuries might affect the patients' personal life. Our aim was to assess the long-term effects of pelvic ring injuries on physical functioning and quality of life (QoL) using validated patient-reported outcome measures (PROMs) and comparing these results to normative data from the general population.

PATIENTS AND METHODS

A retrospective cohort study was conducted on adults treated for pelvic ring injuries between 2007 and 2016. Demographics, fracture type, injury mechanism, treatment and complications were recorded. PROMs questionnaires concerning physical functioning (SMFA) and quality of life (EQ-5D) were used. Patients were divided according to their age (18-30, 31-64, 65 and older) and fracture type (Tile/AO type A, B or C). Differences in SMFA and EQ-5D scores of the operatively and non-operatively treated patients and between the study population and general population were analyzed.

RESULTS

A total of 413 patients were identified of which 279 were eligible for follow-up. One-hundred and ninety-two (69%) patients responded with a mean follow-up of 4.4 years. Patients reported a median score of 13.9 on the SMFA function index, 16.7 on the bother index, 12.5 on the lower extremity, 18.8 on the activities of daily living and 23.4 on the emotion subscale. A median EQ-5D score of 0.8 was reported. There was no difference in physical functioning and QoL between operatively and non-operatively treated patients. Comparison of these results to normative data of the general population revealed a significant (P < 0.05) decrease in physical functioning and QoL in patients with all types of pelvic ring injuries.

CONCLUSION

Long-term physical functioning and QoL in patients who had sustained a pelvic ring injury seems fair, although significantly decreased in comparison with their peers from the general population.

In-hospital mortality of pelvic ring fractures in older adults now and then: A pelvic registry study

AIM

With the predicted demographic change, the treatment of geriatric patients will become a major issue for health systems worldwide. The majority of pelvic ring fractures occur in older adults, and their treatment might be associated with a distinct mortality. Herein, we analyzed the data of 5665 patients with pelvic ring fractures aged ≥60 years included in the German Pelvic Trauma Registry from 1991 to 2013.

METHODS

The data were collected prospectively, multicentrically in hospitals participating in the German Pelvic Trauma Registry. Demographic data were retrospectively analyzed, stratified for age, sex, type of injury, mode of therapy, injury severity score (ISS) and mortality.

RESULTS

The overall mortality decreased over the 22-year study period from 9.3% to 3.8% (P < 0.05), whereas the median ISS significantly increased. During the observation period, mortality was higher in patients with type B and, particularly, type C fractures when compared with patients with type A fractures. Mortality rates of patients aged >80 years did not significantly differ from those aged >60 or >70 years. Male patients showed a significantly higher mortality compared with female patients, as well as a significantly higher median ISS. The mortality rate of patients with surgically-treated type C fractures decreased over the study period from 35.7% to 6.9% (P < 0.05).

CONCLUSIONS

Over the past two decades, the mortality of older patients after pelvic ring fractures has significantly decreased. The higher overall mortality rate of male patients might mainly be accounted for by the relatively higher fraction of type C fractures and a higher ISS. Geriatr Gerontol Int 2019; 19: 24-29.

Quality of life after pelvic ring fractures: A cross-sectional study

BACKGROUND

Pelvic ring fractures might have consequences for health-related quality of life (HrQoL). The main purpose of this study was to evaluate patients' HrQoL after a pelvic ring fracture, considering the patients' characteristics. A cross-sectional study was conducted using the EuroQoL-5D (EQ-5D) and the Majeed pelvic score (MPS).

METHODS

One hundred ninety-five patients (86%) with pelvic ring fractures who were conservatively or surgically treated in a level 1 trauma centre between 2011 and 2015 were included in this study (mean follow up: 29 months, range 6-61). A telephone survey of all patients was conducted. Multiple logistic and linear regression analyses were used for statistical assessment with the EQ-5D and the MPS. The MPS results were split into two age groups with a cut-off point of 65 years.

RESULTS

EQ-5D: The mean EQ-5D Visual Analogue Scale (VAS) for Tiles A-C was, respectively, 74 (SD 18), 74 (SD 19) and 67 (SD 21), and the mean EQ-5D index score was, respectively, 0.81 (SD 0.23), 0.77 (SD 0.30) and 0.71 (SD 0.26). Compared with Tile A, patients in Tile C experienced significantly more pain (odds ratio 6.28 (1.73-22.82 95% CI), P < 0.01). Clinically relevant differences in EQ-5D scores between Tile A and Tile C were seen in the domains of usual activities and anxiety and in the index score. MPS: The mean MPS of Tiles A-C patients in the <65 group was, respectively, 86 (SD 15), 81 (SD 17), and 74 (SD 16), and in the ≥65 group, it was, respectively, 69 (SD 15), 68 (SD 15) and 66 (SD 9). In the <65 group, significant differences in MPS results between the Tile groups regarding pain (P < 0.01) and the total MPS score (P = 0.04) were seen. Neither significant regression coefficients nor clinically relevant differences were found in the ≥65 group.

CONCLUSIONS

In conclusion, our study showed that pain was increased in patients with Tile C fractures, compared with Tiles A and B. Furthermore, Tile C patients had significantly lower EQ-5D index and total MPS scores. However, these problems were not seen in the ≥65 group.

Development of a German fracture register to assess current fracture care and improve treatment quality: A feasibility study

Continuous evaluation of current treatment methods is crucial in orthopaedic trauma surgery.

Existing fracture registries substantially contribute to improving fracture care and quality of life in trauma patients.

Currently there is no universal German fracture register recording the patient-centred outcome of non-surgical as well as surgical fracture treatment in all anatomical regions.

Conclusions regarding nationwide fracture treatment and quality of care are only significant to a limited extent.

Cite this article: EFORT Open Rev 2017;2:474–477. DOI: 10.1302/2058-5241.2.160086.

Factors Associated With Health-Related Quality of Life in Patients With Open Fractures

OBJECTIVES

To analyze FLOW data to identify baseline patient, injury, fracture, and treatment factors associated with lower health-related quality of life (HRQoL) at 12-month postfracture.

DESIGN

Prognostic study using data from a prospective randomized controlled trial.

SETTING

Thirty-one clinical centers in the United States, Canada, Australia, and India.

PATIENTS/PARTICIPANTS

One thousand four hundred twenty-seven patients with open fracture from the FLOW trial with complete 12-month Short Form-12 (SF-12) follow-up assessment and no missing data for selected baseline factors.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASUREMENT

Physical Component Score (PCS) and the Mental Component Score (MCS) of the SF-12 at 12-month postfracture.

RESULTS

One thousand four hundred twenty-seven patients were included in the SF-12 PCS and MCS linear regression models. Smoking, lower preinjury SF-12 PCS and MCS, and work-related injuries were significantly associated with lower SF-12 PCS and MCS at 12-month postfracture. A lower extremity fracture and a wound that was not closed at initial irrigation and debridement were significantly associated with lower 12-month SF-12 PCS but not MCS. Only the adjusted mean difference for lower extremity fractures approached the minimally important difference for the SF-12 PCS.

CONCLUSIONS

We identified a number of statistically significant baseline factors associated with lower HRQoL; however, only the presence of a lower extremity fracture approached clinical significance. More research is needed to quantify the impact of these factors on patients and to determine whether changes to modifiable factors at baseline will lead to clinically significant improvements in HRQoL after open fractures.

LEVEL OF EVIDENCE

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Surgical treatment of pelvic ring fractures in the elderly now and then: a pelvic registry study

BACKGROUND

With the demographic change, the treatment of elderly patients has become a major issue for health systems worldwide.

AIMS

The aim of this study was to analyze the change in the rate of surgical treatment of pelvic ring fractures in patients with an age of ≥60 years over a 22-year period depending on fracture type, age and sex.

METHODS

Data of 5665 patients with an age of ≥60 years, who were treated for pelvic ring fractures from 1991 to 2013 in one of 31 hospitals participating in the German Pelvic Trauma Registry, were included. The registry is divided into four time periods: t ₁ = 1991-1993, t ₂ = 1997-2000, t ₃ = 2001-2008 and t ₄ = 2009-2013. Data had been collected prospectively and was analyzed retrospectively, stratified for age and sex of the patients as well as type of fracture and mode of therapy (surgical vs. conservative).

RESULTS

There was a significant increase (p < 0.05) in the overall rate of surgical treatment. Nonetheless, during all time periods patients with an age of >70 years were significantly less frequently surgically treated compared to 60- to 70-year-olds. Regardless of the fracture type, the rate of surgical treatment was significantly higher (p < 0.05) in male compared to female patients during t ₁. While this difference persisted for type A and type B fractures, the frequency of surgical treatment of type C fractures approximated in males and females.

CONCLUSIONS

The present data indicate that the rate of surgical treatment of pelvic ring fractures in elderly patients has significantly increased over the 22-year period. Nonetheless, older patients (>70 years) as well as female patients are still less frequently surgically treated.

Pelvic ring fractures in the elderly now and then - a pelvic registry study

OBJECTIVES

To analyze the changes in demographic data stratified for age, sex and type of injury of elderly patients suffering from pelvic ring fractures over a 22-year observation period.

DESIGN/SETTING

Data has been collected prospectively, multi-centrically in hospitals participating in the German Pelvic Trauma Registry.

PATIENTS

We analyzed the data of 5665 patients with an age ≥60years included in the German Pelvic Trauma Registry from 1991 to 2013.

KEY RESULTS

Over the 22-year study period the frequency of type A fractures decreased significantly from 84.8% to 43.9%, while type C and, in particular, type B fractures significantly increased from 7.0% and 8.2% to 14.3% and 41.8%. In patients between 60 and 70 years of age the frequency of type B and C fractures was higher compared to patients >70years. The proportion of female patients, who represent the majority of the cohort (75%), was stable over the entire observation period. Interestingly, type A fractures were found more frequently in females, while type B and C fractures were found more frequently in males.

CONCLUSIONS

With the predicted demographic change and a shift toward more severe injury patterns (type B and C pelvic fractures) in the elderly population, trauma departments will need to develop specific surgical concepts for geriatric patients with pelvic ring fractures.

[Quality of life and job performance resulting from operatively treated tibial plateau fractures]

BACKGROUND

The aim of this article is to present the functional results and the effect on quality of life of surgically treated tibial plateau fractures in physically active and working patients with multiple and serious injuries. In addition, the relationships between functional and radiological outcome were evaluated and compared with activity in daily and professional life.

PATIENTS AND METHODS

In all, 41 injured patients were followed up a mean of 47 months after surgical treatment and examined with radiological, functional, as well as quality of life score.

RESULTS

In the radiological scoring, a mean value of 72 points (max 100 points) was achieved. In the activity score, there was an average of 63.5 points (max 100 points). When evaluating the health-related quality of life, an average score of 69.6 points was achieved. There was a significant relationship between radiological and activity scores and the radiological and life quality scores. Furthermore, the relationship between activity and quality of life scores was considered significant. Surgeon's influence on the functional outcome could be confirmed.

CONCLUSION

The functional and the radiological results were moderate. Quality of life was permanently affected by the consequences of tibial plateau fracture in 12 patients; 11 patients were not re-employed. However, the quality of life was assessed as good or very good and 28 patients had returned to work. The quality of life was firmly linked to the radiological and functional parameters, which tended to be influenced by the quality of the primary surgical treatment when looking at the overall population.

[Registries of the German Society for Orthopaedics and Trauma : Overview and perspectives of the DGU and DGOOC registries]

The register network of the German Society for Orthopaedics and Trauma (DGOU) consists of 14 registries that cover the various fields of traumatology and elective orthopedics. In addition to registries that focus on implants and types of diseases without age limitations, there are also registries dealing with special diseases in children and adolescents as well as the special needs of elderly patients with fractures. The registries serve as instruments for outcome research and quality assurance and can be used to develop treatment recommendations on a high level of evidence. The objective of the network is to exchange experience that facilitates the establishment of new registers, to pool expertise and to conserve resources.