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Elhence A, Netaji J, Yadav SK, Rajnish RK, Gupta S. Functional outcome and analysis of factors affecting health-related quality of life of surgically managed pelvic ring fractures: a cross-sectional study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1917-1925. [PMID: 38459970 DOI: 10.1007/s00590-024-03869-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/16/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION Pelvic ring fractures, particularly those involving the posterior pelvis, pose significant challenges due to their inherent instability. The posterior pelvic ring is critical in providing structural support and stability to the pelvis. This study evaluates the functional outcomes and health-related Quality of life (HRQOL) of patients who underwent internal fixation for unstable pelvic fractures. Various factors influencing the outcomes are also investigated. MATERIAL AND METHODS A single-center cross-sectional study was conducted on patients with unstable sacral fractures treated with posterior tension band plate or sacroiliac plating with or without symphyseal plating between 2016 and 2020. Patient demographics, injury mechanisms, associated injuries, surgical details, complications, and return-to-work data were collected. HRQOL was assessed using specific pelvic fracture instruments and general HRQOL questionnaires. Logistic regression analysis was performed to identify factors associated with lower SF-12 and SF-36 scores RESULTS: The study included 54 patients, predominantly males (55.6%), aged 18-70 years, with high-energy trauma mechanisms, such as road traffic accidents and occupational injuries. The majority of patients had lateral compression pelvic fractures. Overall, the functional outcomes were favorable, with excellent or good outcomes observed in 86.1% of cases. Patients with associated injuries, such as abdominal, chest, or head injuries, were likelier to have lower SF-12 physical component scores. Sexual satisfaction scores remained stable for most patients post-surgery. DISCUSSION This study highlights the favorable functional outcomes and HRQOL for patients undergoing fixation for unstable pelvic ring fractures. Younger, working-age males were the most commonly affected demographic. Associated injuries significantly affected physical HRQOL scores. Despite high-energy trauma, patients generally reported satisfactory sexual function post-surgery.
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Affiliation(s)
- Abhay Elhence
- Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Sandeep Kumar Yadav
- Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, India.
| | - Rajesh Kumar Rajnish
- Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, India
| | - Saurabh Gupta
- Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, India
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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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El Naga AN, Working ZM, Hoogervorst P, Knox R, Marmor MT. Identification of subtle residual sacroiliac joint flexion and extension malreductions in AO/OTA 61-C1.2 (APC3) pelvic injuries after provisional anterior ring reduction. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-03840-x. [PMID: 38376587 DOI: 10.1007/s00590-024-03840-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Hemipelvis reduction in the setting of AO/OTA 61-C1.2 (APC3) pelvic injuries can be challenging. A common strategy is to provisionally reduce or fix the anterior ring prior to definitive fixation of the posterior ring. In this scenario, it is difficult to assess whether residual sacroiliac joint (SIJ) widening is due to hemipelvis flexion/extension or lateral displacement. This simulation sought to identify a radiographic marker for posterior ilium flexion or extension malreduction in the setting of a reduced anterior ring. METHODS Symphyseal and both anterior and posterior SIJ ligaments were cut in 8 cadaveric pelvis. The symphysis was reduced and wired. One centimeter of posterior flexion or extension at the SIJ was created to mimic the clinical scenario of hemipelvis flexion or extension malreduction, and a lateral compressive force was applied. SIJ widening and the direction of anterior or posterior ileal displacement relative to the contralateral joint were assessed via inlet views. SIJ widening and the direction of cranial or caudal ileal displacement were assessed using outlet views. Comparisons between flexion and extension models used Fisher's exact test. RESULTS On outlet views, all flexed hemipelvis demonstrated caudal ileal translation at the superior SIJ, in contrast to all extended hemipelvis demonstrated cranial translation (p < 0.0005); the scenarios were easily distinguishable. Conversely, inlet imaging was unable to identify the direction of malreduction. Flexion/extension scenarios resulted in similar amounts of SIJ widening. CONCLUSION Residual flexion and extension hemipelvis malreductions in APC3 injuries after provisional anterior fixation can be differentiated by the direction of ileal displacement at the superior SIJ on the outlet view.
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Affiliation(s)
- Ashraf N El Naga
- San Francisco-Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California, 2540 23Rd Street, Bldg 7, 3Rd Floor, Rm 310, San Francisco, CA, 94110, USA
| | - Zachary M Working
- Department of Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Paul Hoogervorst
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Riley Knox
- San Francisco-Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California, 2540 23Rd Street, Bldg 7, 3Rd Floor, Rm 310, San Francisco, CA, 94110, USA
| | - Meir T Marmor
- San Francisco-Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California, 2540 23Rd Street, Bldg 7, 3Rd Floor, Rm 310, San Francisco, CA, 94110, USA.
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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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Luo Y, He L, Li Y, Xie J, Gong S, Zhang Q, Yin E, Gu M, Yi C. Sacral osteotomy combined with triangular osteosynthesis in the treatment of malunion and nonunion of vertically displaced pelvic fractures. J Orthop Surg Res 2022; 17:409. [PMID: 36064584 PMCID: PMC9446817 DOI: 10.1186/s13018-022-03296-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 08/24/2022] [Indexed: 11/20/2022] Open
Abstract
Background Malunion and nonunion of vertically displaced pelvic fractures result in lower limb length discrepancies, claudication, and pain. There have been few previous reports of this type of corrective surgery for these old pelvic fractures. We present a surgical technique of sacral osteotomy combined with triangular osteosynthesis in the treatment of malunion and nonunion of vertically displaced pelvic fractures and report on its short-term clinical results. Methods We retrospectively reviewed nine patients (five males and four females) with malunion or nonunion of vertically displaced pelvic fractures treated with sacral osteotomy and triangular osteosynthesis from April 2015 to January 2020. The age ranged from 14 to 45 years (average, 30.7 years). The time from injury to deformity correction surgery ranged from 3 months to 5 years (average, 12.8 months). The vertical displacement of a unilateral hemipelvis was 3.0–4.5 cm (average, 3.80 cm). According to AO/OTA classification at the initial fracture, there are eight cases in type C1.3 and one case in type C3.3. Sacral osteotomy and triangular osteosynthesis were used in all nine patients. The degree of unilateral hemipelvic reduction was assessed postoperatively based on measurements from the anteroposterior (AP) X-ray. Majeed score and pain visual analog scale (VAS) were used to assess the therapeutic effect of the patients during follow-up. Results In all nine patients, postoperative AP X-ray showed correction displacement of 1.7–3.9 cm (average, 3.20 cm). All the patients were followed up for 6–36 months (average, 12.7 months). At the last follow-up, the Majeed score of pelvic fracture increased from an average of 53.9 points (30–84 points) preoperatively to 87.0 points (72–94 points), and the VAS score for pain decreased from an average of 6.0 points (4–8 points) preoperatively to 1.2 points (0–3 points). None had complications like infection, implant broken, screw loosening, iatrogenic nerve, and blood vessel injury. Conclusion Sacral osteotomy combined with triangular osteosynthesis for the treatment of pelvic malunion and nonunion caused by sacral fractures can correct significantly vertical displacement of a unilateral pelvis, prolong limb length, and reconstruct the stability of a pelvic ring, achieving good clinical results.
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Affiliation(s)
- Yangxing Luo
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, 430030, China
| | - Li He
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, 430030, China
| | - Yue Li
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, 430030, China
| | - Jie Xie
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, 430030, China
| | - Song Gong
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, 430030, China
| | - Qian Zhang
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, 430030, China
| | - Enzhi Yin
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, 430030, China
| | - Meiqi Gu
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, 430030, China
| | - Chengla Yi
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, 430030, China.
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Sterkenburg A, Van der Stelt M, Koroma A, Van Gaalen M, Van der Pols M, Grobusch M, Slump C, Maal T, Brouwers L. Quality of life of patients with 3D-printed arm prostheses in a rural area of Sierra Leone. Heliyon 2021; 7:e07447. [PMID: 34286125 PMCID: PMC8273216 DOI: 10.1016/j.heliyon.2021.e07447] [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: 04/06/2021] [Revised: 06/11/2021] [Accepted: 06/28/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION In Sierra Leone, access to prostheses is limited due to absence of practical knowledge, materials, trained staff, and high cost. This paper investigates the impact of a 3D printed prosthesis on the health-related quality of life (HRQoL) in prosthesis recipients. METHODS Patients with upper extremity amputations were included in this case study from December 2018 until July 2019. Data on the HRQoL was gathered until April 2020 in Masanga Hospital, central rural Sierra Leone. At two follow-up moments the HRQoL was assessed by applying the standard EQ-5D-5L questionnaire. These two follow-up moments varied between one week and just over a year after receiving the prosthesis. A second patient questionnaire was used to assess prosthesis satisfaction. RESULTS Seven patients were included. The results of the EQ-5D-5L questionnaire show no deterioration of the HRQoL in any patient and the overall HRQoL increased by almost 20% compared to the null measurement. One patient was lost to follow up after the first re-visit. The responses to the second questionnaire indicated that patients are satisfied with the prosthesis and use it in various situations. Patients often mentioned they feel more included in society when wearing the prosthesis. One patient says wearing the prosthesis helped in accepting the amputation. As a result, enough self-confidence was experienced without the prosthesis and the patients stopped wearing the prosthesis. DISCUSSION The overall HRQoL in patients wearing a 3D-printed prosthesis increases compared to not wearing one. Assessing the HRQoL at regular intervals is important for the long-term follow-up and to safeguard sustainability and long-term success of this project. Nevertheless, defining the HRQoL is challenging due to cultural differences and misunderstandings. Therefore, the use of alternative questionnaires to define the HRQoL should be investigated. To improve and warrant long-term success, identifying long-term problems is important, and the second questionnaire accounts for this need.
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Affiliation(s)
- A.J. Sterkenburg
- Technical Medicine, University of Twente, Enschede, the Netherlands
| | - M. Van der Stelt
- Technical Medicine, University of Twente, Enschede, the Netherlands
| | - A.R. Koroma
- Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
| | - M.D. Van Gaalen
- Technical Medicine, Delft University of Technology, Delft, the Netherlands
| | - M.J. Van der Pols
- Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
| | - M.P. Grobusch
- Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Center, location AMC, Amsterdam Public Health, Amsterdam Infection & Immunity, Amsterdam, the Netherlands
| | - C.H. Slump
- Technical Medicine, University of Twente, Enschede, the Netherlands
| | - T.J.J. Maal
- 3D Lab, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L. Brouwers
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Surgery Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
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Schmid FA, Held U, Eberli D, Pape HC, Halvachizadeh S. Erectile dysfunction and penile rehabilitation after pelvic fracture: a systematic review and meta-analysis. BMJ Open 2021; 11:e045117. [PMID: 34049910 PMCID: PMC8166614 DOI: 10.1136/bmjopen-2020-045117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 05/11/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To investigate the rate of erectile dysfunction (ED) after pelvic ring fracture (PRF). DESIGN Systematic review and meta-analysis. METHODS A systematic literature search of the Cochrane, EMBASE, MEDLINE, Scopus and Web of Science Library databases was conducted in January 2020. Included were original studies performed on humans assessing ED after PRF according to the 5-item International Index of Erectile Function (IIEF-5) questionnaire and fracture classification following Young and Burgess, Tile or Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association. Furthermore, interventional cohort studies assessing the effect of penile rehabilitation therapy with phosphodiesterase-5-inhibitors (PDE-5-I) on IIEF-5 scores compared before and after treatment were included. Results were presented as forest plots of proportions of patients with ED after PRF or mean changes on IIEF-5 questionnaires before and after penile rehabilitation. Studies not included in the quantitative analysis were narratively summarised. Risk of bias assessment was conducted using the revised tool for the Quality Assessment on Diagnostic Accuracy Studies. RESULTS The systematic literature search retrieved 617 articles. Seven articles were included in the qualitative analysis and the meta-analysis. Pooled proportions revealed 37% of patients with ED after suffering any form of PRF (result on probability scale pr=0.37, 95% CI: 0.26 to 0.50). Patients after 3 months of penile rehabilitation therapy reported a higher IIEF-5 score than before (change score=6.5 points, 95% CI: 2.54 to 10.46, p value=0.0013). CONCLUSION Despite some heterogeneity and limited high-quality research, this study concludes that patients suffering from any type of PRF have an increased risk of developing ED. Oral intake of PDE-5-I for the purpose of penile rehabilitation therapy increases IIEF-5 scores and may relevantly influence quality-of-life in these patients. PROSPERO REGISTRATION NUMBER CRD42020169699.
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Affiliation(s)
- Florian A Schmid
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrike Held
- Department of Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sascha Halvachizadeh
- Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Petryla G, Bobina R, Ryliškis S, Uvarovas V, Kurtinaitis J, Sveikata T, Kvederas G, Šatkauskas I. Cross-Cultural Adaptation and Psychometric Properties of the Lithuanian Version of the Majeed Pelvic Score. ACTA ACUST UNITED AC 2021; 57:medicina57050417. [PMID: 33923069 PMCID: PMC8145004 DOI: 10.3390/medicina57050417] [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: 03/11/2021] [Revised: 04/12/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: There are no valid patient-based pelvic ring function assessment tools in Lithuania. The most widely used instrument is the Majeed Pelvic Score (MPS), which is proven to be an effective tool for assessing pelvic function after pelvic injuries. The aims of our study were: (1) the translation and cross-cultural adaptation of the MPS for the Lithuanian-speaking population, (2) to test the psychometric properties of the Lithuanian version of the MPS (MPS-LT) at follow-up two-time points after pelvic fractures. Materials and Methods: The MPS was translated and culturally adapted. Psychometric properties of the MPS-LT were determined in one patient group (n = 40) at two time-points during follow-up examination from 1.5 to 3 months (mean 2 months) and from 11 to 20 months (mean 12 months). Results: At the mean time of 2 months after trauma, Cronbach’s α of the MPS-LT was 0.65. Correlation of the MPS-LT with the Iowa Pelvic Score (IPS) was r = 0.84 (p < 0.001), and with the Lithuanian SF-36, PCS was r = 0.53 (p < 0.001). At the mean time follow-up of 12 months, Cronbach’s α was 0.86, correlation with the IPS was r = 0.92 (p < 0.001), and with the Lithuanian SF-36, PCS – r = 0.82 (p < 0.001). At the 2-month follow-up, neither floor nor ceiling effects were reached, but at 12 months, 27.5% of patients reached the ceiling effect, while none reached the floor effect. The effect size of the MPS-LT was 1.66. Conclusions: The MPS-LT has limited ability to measure functional outcomes at 2 months after pelvic fracture. In contrast, at the 12-month follow-up examination, the MPS-LT had a good ability to assess pelvic function, and it was sensitive to health changes. The MPS-LT can be used as a pelvic function assessment tool after pelvic fractures for the Lithuanian-speaking population.
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Affiliation(s)
- Giedrius Petryla
- Clinic of Rheumatology, Orthopaedics Traumatology and Reconstructive Surgery, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (G.P.); (S.R.); (V.U.); (J.K.); (T.S.); (G.K.); (I.Š.)
- Centre of Orthopaedics and Traumatology, Republican Vilnius University Hospital, Šiltnamių Str. 29, LT-04130 Vilnius, Lithuania
| | - Rokas Bobina
- Clinic of Rheumatology, Orthopaedics Traumatology and Reconstructive Surgery, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (G.P.); (S.R.); (V.U.); (J.K.); (T.S.); (G.K.); (I.Š.)
- Centre of Orthopaedics and Traumatology, Republican Vilnius University Hospital, Šiltnamių Str. 29, LT-04130 Vilnius, Lithuania
- Correspondence:
| | - Sigitas Ryliškis
- Clinic of Rheumatology, Orthopaedics Traumatology and Reconstructive Surgery, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (G.P.); (S.R.); (V.U.); (J.K.); (T.S.); (G.K.); (I.Š.)
- Centre of Orthopaedics and Traumatology, Republican Vilnius University Hospital, Šiltnamių Str. 29, LT-04130 Vilnius, Lithuania
| | - Valentinas Uvarovas
- Clinic of Rheumatology, Orthopaedics Traumatology and Reconstructive Surgery, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (G.P.); (S.R.); (V.U.); (J.K.); (T.S.); (G.K.); (I.Š.)
- Centre of Orthopaedics and Traumatology, Republican Vilnius University Hospital, Šiltnamių Str. 29, LT-04130 Vilnius, Lithuania
| | - Jaunius Kurtinaitis
- Clinic of Rheumatology, Orthopaedics Traumatology and Reconstructive Surgery, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (G.P.); (S.R.); (V.U.); (J.K.); (T.S.); (G.K.); (I.Š.)
- Centre of Orthopaedics and Traumatology, Republican Vilnius University Hospital, Šiltnamių Str. 29, LT-04130 Vilnius, Lithuania
| | - Tomas Sveikata
- Clinic of Rheumatology, Orthopaedics Traumatology and Reconstructive Surgery, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (G.P.); (S.R.); (V.U.); (J.K.); (T.S.); (G.K.); (I.Š.)
- Centre of Orthopaedics and Traumatology, Republican Vilnius University Hospital, Šiltnamių Str. 29, LT-04130 Vilnius, Lithuania
| | - Giedrius Kvederas
- Clinic of Rheumatology, Orthopaedics Traumatology and Reconstructive Surgery, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (G.P.); (S.R.); (V.U.); (J.K.); (T.S.); (G.K.); (I.Š.)
- Centre of Orthopaedics and Traumatology, Republican Vilnius University Hospital, Šiltnamių Str. 29, LT-04130 Vilnius, Lithuania
- Centre of Orthopaedics and Traumatology, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
| | - Igoris Šatkauskas
- Clinic of Rheumatology, Orthopaedics Traumatology and Reconstructive Surgery, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (G.P.); (S.R.); (V.U.); (J.K.); (T.S.); (G.K.); (I.Š.)
- Centre of Orthopaedics and Traumatology, Republican Vilnius University Hospital, Šiltnamių Str. 29, LT-04130 Vilnius, Lithuania
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9
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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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10
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Abstract
BACKGROUND Millions of Americans are injured each year, with 75% suffering orthopedic injuries. Those with orthopedic injury often experience postinjury symptoms, such as anxiety, that negatively influence long-term outcomes. The purpose of this systematic review was to evaluate (1) the prevalence of anxiety symptoms chronologically in relation to time of orthopedic injury, (2) the associations of anxiety symptoms with other symptoms in individuals with orthopedic injury, and (3) the associations between anxiety symptoms and functional performance and mental health outcomes in individuals with orthopedic injury. METHODS The databases CINAHL, Ovid MEDLINE, Ovid PsycInfo, Ovid Embase, ProQuest, and ClinicalTrials.gov were searched on June 25, 2020. Studies were selected for review if (1) participants were 16 years or older, (2) the prevalence of anxiety symptoms was listed, (3) anxiety symptoms were assessed using a validated instrument, (4) the study was published in English, and (5) more than 50% of the participants suffered orthopedic injury to the appendicular skeleton or pelvic ring. RESULTS Anxiety symptoms were present in 11.5%-55.9% of individuals up to 10 years after orthopedic injury and often co-occurred with those of depression, pain, and posttraumatic stress disorder to negatively influence functional performance and mental health outcomes. CONCLUSIONS Anxiety symptoms post-orthopedic injury are highly prevalent and persistent. Anxiety symptoms are associated with other distressing symptoms and influence long-term outcomes. These findings highlight the need to screen for and treat anxiety symptoms following orthopedic injury and may help in designing future self-management interventions.
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Affiliation(s)
- Stephen Breazeale
- Yale University, New Haven, Connecticut (Mr Breazeale and Drs Conley and Redeker); and Yale New Haven Hospital, New Haven, Connecticut (Mr Gaiser)
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11
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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
| | - 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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12
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Brouwers L, de Jongh MAC, de Munter L, Edwards M, Lansink KWW. Prognostic factors and quality of life after pelvic fractures. The Brabant Injury Outcome Surveillance (BIOS) study. PLoS One 2020; 15:e0233690. [PMID: 32525901 PMCID: PMC7289384 DOI: 10.1371/journal.pone.0233690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/10/2020] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- L. Brouwers
- Network Emergency Care Brabant, Elisabeth-Tweesteden Hospital, Tilburg, Noord-Brabant, The Netherlands
- * E-mail:
| | - M. A. C. de Jongh
- Network Emergency Care Brabant, Elisabeth-Tweesteden Hospital, Tilburg, Noord-Brabant, The Netherlands
- Department Trauma Topcare, Elisabeth-Tweesteden Hospital, Tilburg, Noord-Brabant, The Netherlands
| | - L. de Munter
- Department Trauma Topcare, Elisabeth-Tweesteden Hospital, Tilburg, Noord-Brabant, The Netherlands
| | - M. Edwards
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
| | - K. W. W. Lansink
- Department Trauma Topcare, Elisabeth-Tweesteden Hospital, Tilburg, Noord-Brabant, The Netherlands
- Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, Noord-Brabant, The Netherlands
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13
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Abstract
OBJECTIVES To evaluate the accuracy with which the Majeed Pelvic Score has been reported in the English literature. DATA SOURCES Databases used to search for literature were PubMed, Embase, and Ovid, restricted to English language from inception to October 2, 2018. STUDY SELECTION Search words used were: Majeed, pelvis, and outcome. DATA EXTRACTION Articles were assessed for descriptions of scoring and proper reporting of Majeed Pelvic Outcome Score. DATA SYNTHESIS Descriptive statistics were used to report the outcome of our findings. CONCLUSIONS Ninty-two English articles were identified. Twenty-four (26%) articles were identified as including methodology related to the use and scoring of the Majeed Pelvic score. The remaining 68 presented mean Majeed scores with no methodological information. None (0/92) discussed how the range of possible scores for the most severe function was applied. Six (7%) reported adjusted scores for patients not working. Three (3%) included a discussion of the scores as adjusted for patients working before injury compared with those not working. Ten (11%) addressed the categorization of scores by excellent to poor describing what raw scores defined those categories. We observed poor accuracy and notable inconsistency in the use and reporting of the Majeed Pelvic Outcome Score in the literature. These data demonstrate that interpretation and comparison of research reporting this score should be done cautiously. Future studies should include specific information as to how the Majeed instrument calculated to allow for verification of the presented scores and subsequent conclusions.
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14
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Dekimpe C, Andreani O, De Dompsure RB, Lemmex DB, Layet V, Foti P, Amoretti N. CT-guided fixation of pelvic fractures after high-energy trauma, by interventional radiologists: technical and clinical outcome. Eur Radiol 2019; 30:961-970. [PMID: 31628504 DOI: 10.1007/s00330-019-06439-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/07/2019] [Accepted: 09/09/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of our study was to evaluate screw placement accuracy, safety, complications, and clinical outcomes including functional and pain score, in 32 patients treated with CT-guided pelvic ring fixation after high-energy trauma. MATERIALS AND METHODS Consecutive patients who were treated by CT-guided fixation of sacral or acetabular fractures after high-energy trauma were included. All procedures were performed under general anesthesia, with dual CT and fluoroscopic guidance, by interventional radiologists. Fractures were minimally displaced or reduced unstable posterior pelvic ring disruptions, with or without sacroiliac disjunction (Tile B or C) and minimally displaced acetabular fractures. The primary outcome evaluated was screw accuracy. Secondary outcomes included patient radiation exposure, duration of the procedure, complications, clinical functional score (Majeed score), and pain scale (VAS, visual analog scale) evaluation during a follow-up period from 4 to 30 months postoperatively. RESULTS Thirty-two patients were included (mean age 46) and 62 screws were inserted. Screw placement was correct in 90.3% of patients (95% of screws). Mean procedure duration was 67 min and mean patient radiation exposure was 965 mGy cm. Mean follow-up was 13 months and no complications were observed. The mean Majeed score at final follow-up was 84/100 and the mean VAS was 1.6/10. CONCLUSION This technique is an effective and safe procedure in specific cases of pelvic ring and acetabulum fractures. It allows accurate screw placement in a minimally invasive manner, leading to effective management of poly-traumatized patients. KEY POINTS • CT-guided pelvic ring fixation, including sacroiliac and acetabular fractures, is an effective and safe procedure. • It allows accurate and minimally invasive screw placement, leading to effective management of poly-traumatized patients. • Multidisciplinary cooperation is essential to ensure efficiency and safety.
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Affiliation(s)
- Chloé Dekimpe
- Diagnostic and Interventional Radiology Unit, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 Voie Romaine, 06001, Nice, France.
| | - Olivier Andreani
- Diagnostic and Interventional Radiology Unit, Groupe Arnaud Tzank, Saint Laurent du Var, France
| | - Regis Bernard De Dompsure
- University Institute of Locomotion and Sports, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Devin Byron Lemmex
- University Institute of Locomotion and Sports, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Vivien Layet
- University Institute of Locomotion and Sports, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Pauline Foti
- Department of Biostatistics, Hôpital Archet 2, Centre Hospitalo-Universitaire de Nice, Nice, France
| | - Nicolas Amoretti
- Diagnostic and Interventional Radiology Unit, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 Voie Romaine, 06001, Nice, France
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15
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Feasibility of Submillisievert CT of the Skeletal Pelvis Using Iterative Reconstruction: A Human Cadaver Study. AJR Am J Roentgenol 2019; 213:903-911. [PMID: 31287726 DOI: 10.2214/ajr.18.20933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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16
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Hermans E, Brouwers L, van Gent T, Biert J, de Jongh MAC, Lansink KWW, Edwards MJR. Quality of life after pelvic ring fractures: Long-term outcomes. A multicentre study. Injury 2019; 50:1216-1222. [PMID: 31029370 DOI: 10.1016/j.injury.2019.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/19/2019] [Accepted: 04/05/2019] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- E Hermans
- Department of Surgery, Radboudumc, Nijmegen, the Netherlands.
| | - L Brouwers
- Network Emergency Care Brabant, ETZ Hospital, Tilburg, the Netherlands.
| | - T van Gent
- Department of Surgery, Radboudumc, Nijmegen, the Netherlands
| | - J Biert
- Department of Surgery, Radboudumc, Nijmegen, the Netherlands
| | - M A C de Jongh
- Network Emergency Care Brabant, ETZ Hospital, Tilburg, the Netherlands
| | - K W W Lansink
- Network Emergency Care Brabant, ETZ Hospital, Tilburg, the Netherlands; Department of surgery, ETZ Hospital, Tilburg, the Netherlands
| | - M J R Edwards
- Department of Surgery, Radboudumc, Nijmegen, the Netherlands
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17
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Abstract
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.
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