Differences in the Majeed Pelvic Score Between Injured and Uninjured Patients

Mortality and functional outcomes of fragility fractures of the pelvis by fracture type with conservative treatment: a retrospective, multicenter TRON study

PURPOSE

Fragility fractures of the pelvis (FFP) are becoming a commonly encountered disease in aging societies. We aimed to (1) clarify the overall survival rate of FFP, (2) compare survival rates by Rommens and Hofmann classification FFP type, (3) investigate the complications during hospitalization, and (4) investigate walking ability before and after injury depending on the type of fracture in patients with FFP treated conservatively.

METHODS

This retrospective, multicenter study included 867 patients with FFP treated conservatively between 2014 and 2018 and excluded patients with insufficient follow-up for two years, lost data, and operative cases. This is a retrospective multicenter study. We established the database, which is named as TRON. We evaluated survival rate by fracture type using the log-rank test. We compared walking ability as defined by a new mobility score and the modified Majeed Pelvic Score among fracture types.

RESULTS

We reviewed 552 cases (98 males and 454 females) with conservative treatment. The overall survival rates of patients with FFP treated conservatively were 0.90 at 1 year and 0.83 at 2 years. Although the survival rate was the lowest in FFP Type III, there was no significant difference in survival rates between fracture types (P = 0.143). The rates of complications during hospitalization were high for both Type III and Type IV fractures. Walking ability post-injury was worse in the patients with Type III fracture.

CONCLUSIONS

The survival rate of patients treated by conservative treatment was relatively good. Type III in the Rommens and Hofmann classification was related to lower life expectancy and loss of walking ability.

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.