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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; 34:3571-3576. [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] [MESH Headings] [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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Hinz N, Dehoust J, Seide K, Kowald B, Mangelsdorf S, Frosch KH, Hartel MJ. Epidemiology and socioeconomic consequences of work-related pelvic and acetabular fractures recorded in the German Social Accident Insurance. Injury 2023; 54:110848. [PMID: 37258403 DOI: 10.1016/j.injury.2023.110848] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Pelvic and acetabular fractures can result from work-related accidents and frequently require lengthy medical treatments. Consequently, high medical costs as well as delayed or absent return to work can be the consequence. Therefore, we aimed to study the socioeconomic consequences of work-related pelvic and acetabular fractures. MATERIALS AND METHODS This retrospective study investigated work-related pelvic and acetabular fractures recorded in the German Social Accident Insurance in 2011 and 2017, in terms of age, sex, type of accident, duration of incapacity to work, reductions in earning capacity, costs for outpatient and inpatient treatment and costs for pension and severance pay. RESULTS Among a total of 606 injuries in 2011 and 619 injuries in 2017, male patients and patients between 40 and 65 years were predominantly affected. Acetabular fractures caused higher rates of long absence from work of 6-12 months (2011: 24.7% vs. 9.5-16.9%; 2017: 26.1% vs. 6.1-11.0%) and >12 months (2011: 15.8% vs. 9.8-10.2%; 2017: 13.3% vs. 1.9-8.2%) as well as more cases with a reduction in earning capacity of at least 20% (2011: 61 vs. ≤27 cases; 2017: 39 vs. ≤12 cases) compared to pelvic ring fractures. The total costs for pelvic ring and acetabular fractures in the German social accident insurances amounted € 18,726,630 and € 9637,189 in the periods 2011-2020 and 2017-2020, respectively. The average costs per case for treatment and rehabilitation until 2020 was € 19,079 for injuries from 2011 and € 13,629 for injuries from 2017. Acetabular fractures were found to be the most cost-intensive injuries compared to anterior, posterior or complex pelvic ring fractures. CONCLUSIONS Work-related pelvic and especially acetabular fractures have a considerable socioeconomic impact in the German Social Accident Insurance. Measures to prevent work-related accidents and to improve treatment of pelvic injuries can help to reduce their socioeconomic burden.
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Affiliation(s)
- Nico Hinz
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany.
| | - Julius Dehoust
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany
| | - Klaus Seide
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany; Laboratory for Biomechanics, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany
| | - Birgitt Kowald
- Laboratory for Biomechanics, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany
| | - Stefan Mangelsdorf
- Hochschule der DGUV (HGU) - University of Applied Sciences, Seilerweg 54, 10117 Bad Hersfeld, Germany
| | - Karl-Heinz Frosch
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany; Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Maximilian J Hartel
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany; Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Ng HJH, Yong R, Park DH, Premchand AXR. Return to work after surgically treated pelvic ring fractures in Singapore. Singapore Med J 2023:382141. [PMID: 37530378 DOI: 10.4103/singaporemedj.smj-2021-275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Affiliation(s)
- Hannah Jia Hui Ng
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore
| | - Ren Yong
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore
| | - Derek Howard Park
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore
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Monteleone AS, Feltri P, Müller J, Molina MN, Filardo G, Candrian C. Quality of Life from Return to Work and Sport Activities to Sexual Dysfunction after Surgical Treatment of Pelvic Ring Fractures. Healthcare (Basel) 2023; 11:1930. [PMID: 37444764 DOI: 10.3390/healthcare11131930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Pelvic ring fractures are life-threatening injuries that have a severe impact on patients' lives. The aim of this clinical study was to evaluate the outcome of surgical treatment in terms of Quality of Life (QoL), return to work, functional results and sport activities, and post-operative sexual dysfunction. METHODS A retrospective study with patients retrieved from a Level 1 Trauma Center was performed. Minimum patient follow-up was 12 months: QoL was evaluated with the SF-12 (Short Form Survey) questionnaire, return to work with the Workplace Activity Limitation Survey (WALS), functional outcomes and sport activities with the Harris Hip Score and Tegner activity score, respectively, and sexual function damage with a 0-10 NRS. RESULTS Seventy-six patients (41 males and 35 females) were enrolled, with a mean age at surgery of 56.4 years (18-89 years). Overall, their quality of life remained significantly affected, with male patients reporting worse WALS outcomes (p = 0.036), sexual damage (p = 0.001), and SF-12 Bodily Pain (p = 0.046) than females. In particular, 70.7% of men and 45.7% of women reported sexual limitations, and only 53.7% returned to their job, with 35.2% losing their job as a consequence of the pelvic ring disruption. CONCLUSIONS An important deterioration in general health state, return to work, and sexual function was documented in patients treated surgically for pelvic trauma, especially in male patients. There are disabling secondary sequels at all levels beyond the mere functional scores, and both patients and clinicians should be aware and have the correct expectations.
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Affiliation(s)
| | - Pietro Feltri
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland
| | - Jochen Müller
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland
| | - Mauro Natale Molina
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Christian Candrian
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
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Muacevic A, Adler JR, Hormazabal J. Revisiting Non-operative Treatment of Lateral Compression Pelvic Fractures, Analysis of Rehabilitation, and Radiologic Outcomes in a Historical Cohort Using Today's Association of Osteosynthesis (AO) Stability Criteria. Cureus 2022; 14:e32101. [PMID: 36601154 PMCID: PMC9803861 DOI: 10.7759/cureus.32101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Type I lateral compression pelvic fractures (LC-I) have historically been treated conservatively. Inferior outcomes in a distinctive subset of these injuries have been reported, therefore their management has shifted towards surgery. Revisiting the historical series of LC-I allows us to determine whether non-operative management of these unstable patterns results in poorer outcomes. The objective was to evaluate the differences in the rehabilitation progress, fracture consolidation, and displacement in non-operatively treated LC-I fractures that would be considered unstable using today's Association of Osteosynthesis (AO) criteria. METHODS We conducted a retrospective review of conservatively treated LC-I injuries in a single-level I trauma center between June 2010 and June 2014. Patients were distributed in stable (group A) and unstable (group B) groups according to the 2018 AO classification. Time to walk independently (TWI), time to return to work (TRW), fracture consolidation, and displacement were analyzed. RESULTS 34 patients, mean age of 45.5 ±14.5 years, were included. Mean TWI in groups A and B were 71.2 ±31.9 and 105.9 ±50.9 days (p=0.027). Mean TRW was 106 ±51.3 and 157 ±84 days in groups A and B, respectively (p=0.038). A difference in mean TWI and TRW of 34.7 and 51.3 days between groups was observed. No significant differences in fracture consolidation or displacement were observed. CONCLUSION Unstable fractures presented significantly longer TWI and TRW. The revised AO classification contributes to the identification of fracture patterns that correlate with prolonged rehabilitation in which additional treatment strategies might be considered.
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Lai CY, Lai PJ, Tseng IC, Su CY, Hsu YH, Chou YC, Yu YH. Postoperative Reduction Quality May Be the Most Important Factor That Causes Worse Functional Outcomes in Open and Closed Pelvic Fractures. World J Surg 2022; 46:568-576. [PMID: 34973073 PMCID: PMC8803804 DOI: 10.1007/s00268-021-06386-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/26/2022]
Abstract
Background Data on the functional outcomes of patients with open pelvic fractures after osteosynthesis are limited, and whether open fracture is a risk factor for worse outcomes, as compared with closed fracture, remains unclear. This study aimed to compare the functional outcomes of patients with open and closed pelvic fractures and evaluate potential factors that might affect outcomes. Methods Overall, 19 consecutive patients with open pelvic fractures and 78 patients with closed pelvic fractures between January 2014 and June 2018 were retrospectively reviewed. All fractures were surgically treated, with a minimal follow-up period of three years. Patients’ demographic profile, associated injuries, management protocol, quality of reduction, and outcomes were recorded and analyzed. Results Patients with open pelvic fractures had higher new injury severity score, higher incidence of diverting colostomy, and longer length of stay. Both radiological and functional evaluations revealed no significant differences between the two groups at 1-year and 3-year evaluations. Multiple logistic regression analysis identified poor radiological outcomes (using Lefaivre criteria) and longer length of stay as risk factors for worse short-term functional outcomes. At 3-year evaluation, fair-to-poor radiological outcomes (using Matta/Tornetta and Lefaivre criteria) and the presence of diverting colostomy were potential risk factors. Conclusions Compared with closed pelvic fracture, open pelvic fracture was not an indicator of worse functional outcomes. Functional outcomes may be comparable between patients with open and closed pelvic fractures at different time points within three years postoperatively. Achieving anatomical reduction in a fracture is crucial, because it might affect patient satisfaction.
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Affiliation(s)
- Chih-Yang Lai
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University, Tao-Yuan, Taiwan. 5, Fu-Hsin St. Kweishan, 33302, Tao-Yuan, Taiwan
| | - Po-Ju Lai
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University, Tao-Yuan, Taiwan. 5, Fu-Hsin St. Kweishan, 33302, Tao-Yuan, Taiwan
| | - I-Chuan Tseng
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan Branch, Tao-Yuan City, Taiwan
| | - Chun-Yi Su
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Kee-Lung City, Taiwan
| | - Yung-Heng Hsu
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University, Tao-Yuan, Taiwan. 5, Fu-Hsin St. Kweishan, 33302, Tao-Yuan, Taiwan
| | - Ying-Chao Chou
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University, Tao-Yuan, Taiwan. 5, Fu-Hsin St. Kweishan, 33302, Tao-Yuan, Taiwan
| | - Yi-Hsun Yu
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University, Tao-Yuan, Taiwan. 5, Fu-Hsin St. Kweishan, 33302, Tao-Yuan, Taiwan.
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Berger-Groch J, Rueger JM, Czorlich P, Frosch KH, Lefering R, Hoffmann M. Evaluation of Pelvic Circular Compression Devices in Severely Injured Trauma Patients with Pelvic Fractures. PREHOSP EMERG CARE 2021; 26:547-555. [PMID: 34152927 DOI: 10.1080/10903127.2021.1945717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: The role of pelvic circumferential compression devices (PCCD) is to temporarily stabilize the pelvic ring, reduce its volume and to tamponade bleeding. The purpose of this study was to evaluate the effect of PCCDs on mortality and bleeding in severely injured trauma patients, using a large registry database.Methods: We performed a retrospective analysis of all patients registered in the Trauma Register DGU® between 2015 and 2016. The study was limited to directly admitted patients who were alive on admission, with an injury severity score (ISS) of 9 or higher, with an Abbreviated Injury Scale AISpelvis of 3-5, aged at least 16, and with complete status documentation on pelvic circular compression devices (PCCD) and mortality. A cohort analysis was undertaken of patients suffering from relevant pelvic fractures. Data were collected on mortality and requirements for blood transfusion. The observed outcome was compared with the expected outcome as derived from version II of the Revised Injury Severity Classification (RISC II) and adjusted accordingly. A Standardized Mortality Ratio (SMR) was also calculated.Results: A total of 9,910 patients were included. 1,103 of 9,910 patients suffered from a relevant pelvic trauma (AISpelvis = 3-5). Only 41% (454 cases) of these received a PCCD. PCCD application had no significant effect on mortality and did not decrease the need for blood transfusion in the multivariate regression analysis. However, in this cohort, the application of a PCCD is a general indicator for a critical patient with increased mortality (12.0% no PCCD applied vs. 23.2% PCCD applied prehospital vs. 27.1% PCCD applied in the emergency department). The ISS was higher in patients with PCCD (34.12 ± 16.4 vs. 27.9 ± 13.8; p < 0.001).Conclusion: PCCD was applied more often in patients with severe pelvic trauma according to ISS and AISpelvis as well with deterioration in circulatory status. PCCDs did not reduce mortality or reduce the need for blood transfusion.Trial registration: TR-DGU ID 2017-003, March 2017; German clinical trial register DRKS00024948.
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Affiliation(s)
- Josephine Berger-Groch
- Received April 3, 2021 from Department of Trauma and Orthopedic Surgery, University Medical Center, Hamburg, Germany (JB-G, JMR, K-HF, MH); Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (PC); Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany (RL); Department of Orthopaedic and Trauma Surgery, Asklepios St. Georg, Hamburg, Germany (MH). Revised received June 11, 2021; accepted for publication June 15, 2021
| | - Johannes Maria Rueger
- Received April 3, 2021 from Department of Trauma and Orthopedic Surgery, University Medical Center, Hamburg, Germany (JB-G, JMR, K-HF, MH); Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (PC); Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany (RL); Department of Orthopaedic and Trauma Surgery, Asklepios St. Georg, Hamburg, Germany (MH). Revised received June 11, 2021; accepted for publication June 15, 2021
| | - Patrick Czorlich
- Received April 3, 2021 from Department of Trauma and Orthopedic Surgery, University Medical Center, Hamburg, Germany (JB-G, JMR, K-HF, MH); Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (PC); Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany (RL); Department of Orthopaedic and Trauma Surgery, Asklepios St. Georg, Hamburg, Germany (MH). Revised received June 11, 2021; accepted for publication June 15, 2021
| | - Karl-Heinz Frosch
- Received April 3, 2021 from Department of Trauma and Orthopedic Surgery, University Medical Center, Hamburg, Germany (JB-G, JMR, K-HF, MH); Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (PC); Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany (RL); Department of Orthopaedic and Trauma Surgery, Asklepios St. Georg, Hamburg, Germany (MH). Revised received June 11, 2021; accepted for publication June 15, 2021
| | - Rolf Lefering
- Received April 3, 2021 from Department of Trauma and Orthopedic Surgery, University Medical Center, Hamburg, Germany (JB-G, JMR, K-HF, MH); Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (PC); Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany (RL); Department of Orthopaedic and Trauma Surgery, Asklepios St. Georg, Hamburg, Germany (MH). Revised received June 11, 2021; accepted for publication June 15, 2021
| | - Michael Hoffmann
- Received April 3, 2021 from Department of Trauma and Orthopedic Surgery, University Medical Center, Hamburg, Germany (JB-G, JMR, K-HF, MH); Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (PC); Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany (RL); Department of Orthopaedic and Trauma Surgery, Asklepios St. Georg, Hamburg, Germany (MH). Revised received June 11, 2021; accepted for publication June 15, 2021
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- Received April 3, 2021 from Department of Trauma and Orthopedic Surgery, University Medical Center, Hamburg, Germany (JB-G, JMR, K-HF, MH); Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (PC); Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany (RL); Department of Orthopaedic and Trauma Surgery, Asklepios St. Georg, Hamburg, Germany (MH). Revised received June 11, 2021; accepted for publication June 15, 2021
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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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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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Rogich JJ, Kim RY, Chang S, Kaneshige J, Dao L. Pelvic Ring Fracture During a Professional Surfing Event at the Banzai Pipeline. Wilderness Environ Med 2020; 31:91-96. [PMID: 31955986 DOI: 10.1016/j.wem.2019.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 06/28/2019] [Accepted: 08/13/2019] [Indexed: 10/25/2022]
Abstract
We present a case of a 32-y-old male professional surfer who sustained an isolated pelvic ring fracture after wiping out on a large wave and striking the ocean floor during a world championship tour surfing competition in Hawaii. The surfer was rescued by the water patrol lifeguards, evaluated by onsite medical staff, and stabilized for transfer and subsequent surgical management. As surfing and surfing competitions become increasingly popular, medical staff and event organizers must be aware of the possibility for severe, life-threatening injuries during surfing events. Although infrequent, staff must be prepared to manage these injuries, including immediate resuscitation, stabilization, analgesia, and transfer to definitive care. We hope this case encourages not only surf event organizers and medical staff, but also staff of all professional and recreational water sports, to increase their preparedness to stabilize and treat both life-threatening and minor injuries. Expeditious and appropriate treatment of an injured athlete has the potential to decrease morbidity and mortality while maximizing the athletes' functional outcome after injury.
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Affiliation(s)
| | - Reeo Yeop Kim
- The Queen's Medical Center, Department of Emergency Medicine, 301 Punchbowl St., Honolulu, HI, 96813
| | - Spencer Chang
- Hawaii Pacific Health, Department of Orthopedics, 55 Merchant St., Honolulu, HI, 96813
| | - Jason Kaneshige
- Hawaii Pacific Health, Department of Orthopedics, 55 Merchant St., Honolulu, HI, 96813
| | - Leland Dao
- Kaena Kai Clinic, 66-150 Kamehameha Hwy, Haleiwa, HI, 96712
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O’Hara NN, Isaac M, Slobogean GP, Klazinga NS. The socioeconomic impact of orthopaedic trauma: A systematic review and meta-analysis. PLoS One 2020; 15:e0227907. [PMID: 31940334 PMCID: PMC6961943 DOI: 10.1371/journal.pone.0227907] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/02/2020] [Indexed: 02/06/2023] Open
Abstract
The overall objective of this study was to determine the patient-level socioeconomic impact resulting from orthopaedic trauma in the available literature. The MEDLINE, Embase, and Scopus databases were searched in December 2019. Studies were eligible for inclusion if more than 75% of the study population sustained an appendicular fracture due to an acute trauma, the mean age was 18 through 65 years, and the study included a socioeconomic outcome, defined as a measure of income, employment status, or educational status. Two independent reviewers performed data extraction and quality assessment. Pooled estimates of the socioeconomic outcome measures were calculated using random-effects models with inverse variance weighting. Two-hundred-five studies met the eligibility criteria. These studies utilized five different socioeconomic outcomes, including return to work (n = 119), absenteeism days from work (n = 104), productivity loss (n = 11), income loss (n = 11), and new unemployment (n = 10). Pooled estimates for return to work remained relatively consistent across the 6-, 12-, and 24-month timepoint estimates of 58.7%, 67.7%, and 60.9%, respectively. The pooled estimate for mean days absent from work was 102.3 days (95% CI: 94.8-109.8). Thirteen-percent had lost employment at one-year post-injury (95% CI: 4.8-30.7). Tremendous heterogeneity (I2>89%) was observed for all pooled socioeconomic outcomes. These results suggest that orthopaedic injury can have a substantial impact on the patient's socioeconomic well-being, which may negatively affect a person's psychological wellbeing and happiness. However, socioeconomic recovery following injury can be very nuanced, and using only a single socioeconomic outcome yields inherent bias. Informative and accurate socioeconomic outcome assessment requires a multifaceted approach and further standardization.
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Affiliation(s)
- Nathan N. O’Hara
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marckenley Isaac
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Gerard P. Slobogean
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Niek S. Klazinga
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Patterns and Predictors of Return to Work After Major Trauma: A Prospective, Population-based Registry Study. Ann Surg 2020; 269:972-978. [PMID: 29342014 DOI: 10.1097/sla.0000000000002666] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize patterns of engagement in work during the 4-year period after major traumatic injury, and to identify factors associated with those patterns. BACKGROUND Employment is an important marker of functional recovery from injury. There are few population-based studies of long-term employment outcomes, and limited data on the patterns of return to work (RTW) after injury. METHODS A population-based, prospective cohort study using the Victorian State Trauma Registry. A total of 1086 working age individuals, in paid employment or full-time education before injury, were followed-up through telephone interview at 6, 12, 24, 36, and 48 months post-injury. Responses to RTW questions were used to define 4 discrete patterns: early and sustained; delayed; failed; no RTW. Predictors of RTW patterns were assessed using multivariate multinomial logistic regression. RESULTS Slightly more than half of respondents (51.6%) recorded early sustained RTW. A further 15.5% had delayed and 13.3% failed RTW. One in 5 (19.7%) did not RTW. Compared with early sustained RTW, predictors of delayed and no RTW included being in a manual occupation and injury in a motor vehicle accident. Older age and receiving compensation predicted both failed and no RTW patterns. Preinjury disability was an additional predictor of failed RTW. Presence of comorbidity was an additional predictor of no RTW. CONCLUSIONS A range of personal, occupational, injury, health, and compensation system factors influence RTW patterns after serious injury. Early identification of people at risk for delayed, failed, or no RTW is needed so that targeted interventions can be delivered.
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Sridharan SS, You D, Ponich B, Parsons D, Schneider P. Outcomes following pelvic ring fractures in the paediatric population: A systematic review. J Clin Orthop Trauma 2020; 11:963-969. [PMID: 33191997 PMCID: PMC7656524 DOI: 10.1016/j.jcot.2020.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/25/2020] [Accepted: 10/02/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Pelvic fractures represent a small proportion of all paediatric fractures, but are likely to be associated with a high-energy mechanism, multiple injuries, and significant morbidity and mortality. Operative fixation of unstable pelvic fractures is accepted. However, there remains a paucity of data on functional outcomes and complications following pelvic fractures in the skeletally immature. METHODS A PRISMA-compliant systematic review was performed, searching Medline, Embase, and Cochrane central review. The primary outcome was functional outcome after pelvic fractures in the paediatric population following operative or non-operative treatment. Secondary outcomes included mechanism of injury, associated injuries, mortality rate, and method of surgical fixation if required. Where possible, weighted totals of the data set were performed. RESULTS In total, 23 studies were included in this review. Only eight studies reported functional outcomes, with limb length discrepancy and limp being the most common complication. Only 8.8% of all pelvic fractures underwent surgical fixation. Motor vehicle collision was the most common cause of injury, and extremity fracture was the most common associated injury. CONCLUSION Paediatric pelvic fractures are caused by high-energy mechanisms and have significant morbidity and mortality. There remains a paucity of information on functional outcomes after these injuries.
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Affiliation(s)
- Sarup S. Sridharan
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Daniel You
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Brett Ponich
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - David Parsons
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Prism Schneider
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada,Corresponding author. Division of Orthopaedic Trauma, McCaig Tower, 3134 Hospital Drive NW Calgary, Alberta, T2N 5A1, Canada.
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The Longitudinal Short-, Medium-, and Long-Term Functional Recovery After Unstable Pelvic Ring Injuries. J Orthop Trauma 2019; 33:608-613. [PMID: 31335508 DOI: 10.1097/bot.0000000000001588] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Describe the trajectory of functional recovery for patients with surgically treated unstable pelvic ring injuries from baseline to 5 years. DESIGN Prospective cohort study. SETTING Level I Trauma Center. PATIENTS/PARTICIPANTS One hundred eight adult patients with surgically treated pelvic fractures (72% OTA/AO 61 B1-B3 and 28% OTA/AO 61 C1-C3) were enrolled into the institutions orthopaedic trauma database between 2004 and 2015. The cohort was 78% men with a mean age of 44.9 years and injury severity score of 16.9. INTERVENTION Surgical pelvic stabilization. MAIN OUTCOME MEASUREMENTS Function was measured at baseline and prospectively at 6 months, 1, and 5 years postoperatively using the Short Form-36 Physical Component Score (SF-36 PCS). The trajectory was mapped, and the proportion of patients achieving a minimal clinically important difference (MCID) between time points was determined. RESULTS The mean SF-36 PCS improved for the entire group between 6 and 12 months (P = 0.001) and between 1 and 5 years (P = 0.02), but did not return to baseline at 5 years (P < 0.0001). The proportion of patients achieving a MCID between 6 and 12 months and 1 and 5 years was 75% and 60%, respectively. The functional level was similar between type B and C groups at baseline (P = 0.5) and 6 months (P = 0.2); however, the type B cohort reported higher scores at 1 year (P = 0.01) and 5 years (P = 0.01). Neither group regained their baseline function (P < 0.0001). CONCLUSIONS Functional recovery for patients with surgically treated pelvic fractures is characterized by an initial decline in function, followed by sharp improvement between 6 and 12 months, and continued steady improvement between 1 and 5 years. Type B injuries show better early recovery than type C and reach a higher level of function at the final follow-up. Despite the proportion of patients achieving MCID, patients do not regain the preinjury level of function. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Hernefalk B, Eriksson N, Larsson S, Borg T. Patient-reported Outcome in Surgically Treated Pelvic Ring Injuries at 5 Years Post-surgery. Scand J Surg 2019; 110:86-92. [PMID: 31537176 DOI: 10.1177/1457496919877583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Long-term prospective data on patient-reported outcome after surgical treatment of pelvic ring injuries are scarce. This study aimed at describing results at 5 years post-surgery using validated outcome measures. PATIENTS AND METHODS Patients admitted for surgical treatment of pelvic ring injuries were prospectively included and asked to report their outcome at 1, 2 and 5 years post-surgery using two patient-reported outcome measures: the generic Short-Form 36 and the condition-specific pelvic discomfort index. Data were evaluated using mixed-effects linear models. RESULTS There were 108 patients (68 males and 40 females), mean age 38 years. Injury type according to the AO/OTA-classification was B-type in 68 patients and C-type in 40 patients. No domain of the Short-Form 36 reached norm values at 5 years post-surgery. Females reported a worse outcome than males concerning general health (p < 0.01) at 5 years. Recovery of physical function (p < 0.01), mental health (p = 0.04), and pain (p = 0.01) was observed for males at 5 years compared to earlier assessments, while females on the contrary described more pain at this time-point (p = 0.03). Mean pelvic discomfort index at 5 years was 27, indicating moderate residual pelvic discomfort overall. Males reported less pelvic discomfort than females at 5 years (p = 0.02) and improved when compared to results at 2 years (p = 0.02), while females did not. Influence of age, fracture type, and presence of associated injuries on patient-reported outcome was limited. CONCLUSION Surgically treated pelvic ring injuries are associated with long-standing negative effects on patient-reported outcome. Males report a better outcome than females at 5 years post-surgery.
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Affiliation(s)
- B Hernefalk
- Department of Surgical Sciences, Section of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden
| | - N Eriksson
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - S Larsson
- Department of Surgical Sciences, Section of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden
| | - T Borg
- Department of Surgical Sciences, Section of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden
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Long-Term Patient-Reported Functional Outcome of Polytraumatized Patients With Operatively Treated Pelvic Fractures. J Orthop Trauma 2019; 33:64-70. [PMID: 30688835 DOI: 10.1097/bot.0000000000001355] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To report the long-term functional outcome of a cohort of patients with operatively treated unstable pelvic fractures using validated patient-reported outcome measures. DESIGN Long-term observational study using prospective and retrospective data. SETTING Tertiary referral pelvic trauma center, Bristol, United Kingdom. PATIENTS Seventy-four polytraumatized patients with operatively treated unstable pelvic ring injuries (50 OTA/AO type B and 24 OTA/AO type C, mean Injury Severity Score 17) treated between 1994 and 2005. INTERVENTION Sixty-four (86%) patients were treated with internal fixation. The remaining 10 patients (14%) were treated with either combined percutaneous posterior fixation and anterior external fixation or external fixation in isolation. MAIN OUTCOME Patient-reported functional outcome. MEASUREMENTS Short Form-36, with UK norm-based comparator scores and EQ-5D-3L. RESULTS Patients were between 11 and 22 years after injury (mean 15 years). We found no significant association between fracture classification and outcome score, but compared with age- and sex-matched scores for a UK population, differences were statistically significant in 3 of the 8 domains of health: physical function (P = 0.04), bodily pain (P = 0.001), and vitality (P = 0.001). The level of disability remained constant for these patients compared with their patient-reported outcome measure scores reported 8 years previously. CONCLUSION Patients who sustain an unstable pelvic fracture continue to have significant functional limitations compared with an uninjured population. These changes were not found to be related to age, injury pattern, genitourinary injury, or neurological injury. Functional outcome scores did not change over the 2 long-term time points. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Schitter AM, Fleckenstein J. Passive Hydrotherapy WATSU® for Rehabilitation of an Accident Survivor: A Prospective Case Report. Complement Med Res 2018; 25:263-268. [PMID: 29758556 DOI: 10.1159/000487768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND WaterShiatsu (WATSU) is a passive form of hydrotherapy in warm water (35 °C) that aims at relaxation, pain relief, and a sense of security. This case report focuses on a patient's experience of integrating WATSU into her rehabilitative care. CASE REPORT A 52-year-old woman survived a severe motorcycle accident in which she sustained several fractures on the right side of her body, including ribs, the pelvis, and the femur. After discharge from stationary care, she independently scheduled 8 weekly WATSU sessions with an experienced WATSU therapist also trained in physiotherapy and psychosomatics. Quantitative and qualitative data obtained from the patient's diary and the therapist's notes is presented. RESULTS The patient associated WATSU with physical and emotional release, reconciliation with her body, and trunk mobilization (followed by ameliorated breath). She ascribed WATSU lasting effects on her body image and reported continuous improvement by the Patient-Specific Functional Scale. The therapist employed WATSU to equalize awareness throughout the body and for careful mobilization. Due to complications (elevated inflammation markers), only 6 of 8 scheduled sessions were administered. CONCLUSIONS WATSU was experienced as helpful in approaching a condition that the patient felt insufficiently covered by conventional physiotherapy alone. In early rehabilitation, additional medical/physiotherapeutic skills of contributing complementary therapists are advocated.
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Bakhshayesh P, Weidenhielm L, Enocson A. Factors affecting mortality and reoperations in high-energy pelvic fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1273-1282. [PMID: 29675632 PMCID: PMC6132923 DOI: 10.1007/s00590-018-2203-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/05/2018] [Indexed: 01/13/2023]
Abstract
AIM Factors affecting mortality during the first year following high-energy pelvic fractures has not been reported previously. Nor has surgical complications leading to reoperations been reported in a cohort with only high-energy pelvic trauma patients. OBJECTIVES The aim of this study was to report and analyse factors affecting outcome, in terms of mortality and reoperations, up to 1 year after the injury in patients with a traumatic pelvic ring injury due to a high-energy trauma. MATERIALS AND METHODS Data from the SweTrau (Swedish National Trauma Registry) on patients admitted to the Trauma Centre Karolinska in Stockholm, Sweden, were collected. Inclusion criteria were adults (age ≥ 18), trauma with a high-energy mechanism, alive on arrival, Swedish personal identification number, reported pelvic fracture on CT scan. Patient records and radiographies were reviewed. The study period was 2011-2015 with 1-year follow-up time. Univariate and regression analysis on factors affecting mortality was performed. Risk of reoperation was analysed using univariate and case-by-case analysis. RESULTS We included 385 cases with mean age 47.5 ± 20.6 years (38% females): 317 pelvic fractures, 48 acetabular fractures and 20 combined injuries. Thirty-day mortality was 8% (30/385), and 1-year mortality was 9% (36/385). The main cause of death at 1 year was traumatic brain injury (14/36) followed by high age (> 70) with extensive comorbidities (8/36). Intentional fall from high altitude (OR 6, CI 2-17), GCS < 8 (OR 12, CI 5-33) and age > 70 (OR 17, CI 6-51) were factors predicting mortality. Thirty patients (22%, 30/134) were further reoperated due to hardware-related (n = 18) or non-hardware-related complications (n = 12). Hardware-related complications included: mal-placed screws (n = 7), mal-placed plate (n = 1), implant failure (n = 6), or mechanical irritation from the implant (n = 4). Non-hardware-related reasons for reoperations were: infection (n = 10), skin necrosis (n = 1), or THR due to post-traumatic osteoarthritis (n = 1). CONCLUSION Non-survivors in our study died mainly because of traumatic brain injury or high age with extensive comorbidities. Most of the mortalities occurred early. Intentional injuries and especially intentional falls from high altitude had high mortality rate. Reoperation frequency was high, and several of the hardware-related complications could potentially have been avoided.
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Affiliation(s)
- Peyman Bakhshayesh
- Department of Molecular Medicine and Surgery (MMK), Karolinska Institute, 17176 Stockholm, Sweden
| | - Lars Weidenhielm
- Department of Molecular Medicine and Surgery (MMK), Karolinska Institute, 17176 Stockholm, Sweden
| | - Anders Enocson
- Department of Molecular Medicine and Surgery (MMK), Karolinska Institute, 17176 Stockholm, Sweden
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Brouwers L, Lansink KWW, de Jongh MAC. Quality of life after pelvic ring fractures: A cross-sectional study. Injury 2018; 49:812-818. [PMID: 29566985 DOI: 10.1016/j.injury.2018.03.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/28/2018] [Accepted: 03/12/2018] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- L Brouwers
- Brabant Trauma Registry, Network Emergency Care Brabant, The Netherlands.
| | - K W W Lansink
- Brabant Trauma Registry, Network Emergency Care Brabant, The Netherlands; Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - M A C de Jongh
- Brabant Trauma Registry, Network Emergency Care Brabant, The Netherlands
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Fitzgerald M, Esser M, Russ M, Mathew J, Varma D, Wilkinson A, Mannambeth RV, Smit D, Bernard S, Mitra B. Pelvic trauma mortality reduced by integrated trauma care. Emerg Med Australas 2017; 29:444-449. [PMID: 28616867 DOI: 10.1111/1742-6723.12820] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 01/03/2017] [Accepted: 04/30/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES A multidisciplinary approach that emphasised improved triage, early pelvic binder application, early administration of blood and blood products, adherence to algorithmic pathways, screening with focused sonography (FAST), early computed tomography scanning with contrast angiography, angio-embolisation and early operative intervention by specialist pelvic surgeons was implemented in the last decade to improve outcomes after pelvic trauma. The manuscript evaluated the effect of this multi-faceted change over a 12-year period. METHODS A retrospective cohort study was conducted comparing patients presenting with serious pelvic injury in 2002 to those presenting in 2013. The primary exposure and comparator variables were the year of presentation and the primary outcome variable was mortality at hospital discharge. Potential confounders were evaluated using multivariable logistic regression analysis. RESULTS There were 1213 patients with a serious pelvic injury (Abbreviated Injury Scale ≥3), increasing from 51 in 2002 to 156 in 2013. Demographics, injury severity and presenting clinical characteristics were similar between the two time periods. There was a statistically significant difference in mortality from 20% in 2002 to 7.7% in 2013 (P = 0.02). The association between the primary exposure variable of being injured in 2013 and mortality remained statistically significant (adjusted odds ratio 0.10; 95% confidence interval: 0.02-0.60) when adjusted for potential clinically important confounders. CONCLUSIONS Multi-faceted interventions directed at the spectrum of trauma resuscitation from pre-hospital care to definitive surgical management were associated with significant reduction in mortality of patients with severe pelvic injury from 2002 to 2013. This demonstrates the effectiveness of an integrated, inclusive trauma system in achieving improved outcomes.
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Affiliation(s)
- Mark Fitzgerald
- Trauma Service, Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Max Esser
- Orthopaedic Surgery, Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Matthias Russ
- National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia.,Orthopaedic Surgery, Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Joseph Mathew
- Trauma Service, Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia
| | - Dinesh Varma
- Monash University, Melbourne, Victoria, Australia.,Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Andrew Wilkinson
- Orthopaedic Surgery, Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Devilliers Smit
- National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia
| | | | - Biswadev Mitra
- National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia
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Impact of early operative pelvic fixation on long-term self-reported outcome following severe pelvic fracture. J Trauma Acute Care Surg 2017; 82:444-450. [DOI: 10.1097/ta.0000000000001346] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Papasotiriou AN, Prevezas N, Krikonis K, Alexopoulos EC. Recovery and Return to Work After a Pelvic Fracture. Saf Health Work 2016; 8:162-168. [PMID: 28593072 PMCID: PMC5447407 DOI: 10.1016/j.shaw.2016.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 09/07/2016] [Accepted: 10/15/2016] [Indexed: 12/02/2022] Open
Abstract
Background Pelvic ring fractures (PRFs) may influence the daily activities and quality of life of the injured. The aim of this retrospective study was to explore the functional outcomes and factors related to return to work (RTW) after PRF. Methods During the years 2003–2012, 282 injured individuals aged 20–55 years on the date of the accident, were hospitalized and treated for PRFs in a large tertiary hospital in Athens, Greece. One hundred and three patients were traced and contacted; 77 who were on paid employment prior to the accident gave their informed consent to participate in the survey, which was conducted in early 2015 through telephone interviews. The questionnaire included variables related to injury, treatment and activities, and the Majeed pelvic score. Univariate and multiple regression analyses were used for statistical assessment. Results Almost half of the injured (46.7%) fully RTW, and earning losses were reported to be 35% after PRF. The univariate analysis confirmed that RTW was significantly related to accident site (labor or not), the magnitude of the accident's force, concomitant injuries, duration of hospitalization, time to RTW, engagement to the same sport, Majeed score, and complications such as limp and pain as well as urologic and sexual complaints (p < 0.05 for all). On multiple logistic regression analysis, the accident sustained out of work (odds ratio: 6.472, 95% confidence interval: 1.626–25.769) and Majeed score (odds ratio: 3.749, 95% confidence interval: 2.092–6.720) were identified as independent predictive factors of full RTW. Conclusion PRFs have severe socioeconomic consequences. Possible predictors of RTW should be taken into account for health management and policies.
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Affiliation(s)
- Antonios N Papasotiriou
- School of Social Sciences, Hellenic Open University, Patras, Greece.,Academic Department of Trauma and Orthopaedics, Leeds General Infirmary Hospital, Leeds, UK
| | - Nikolaos Prevezas
- Orthopedic Department, Psychiko Clinic, Athens Medical Group, Greece
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25
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Pelvic ring injuries: Surgical management and long-term outcomes. J Clin Orthop Trauma 2016; 7:1-6. [PMID: 26908968 PMCID: PMC4735567 DOI: 10.1016/j.jcot.2015.08.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/14/2015] [Indexed: 11/21/2022] Open
Abstract
Pelvic ring injuries present a therapeutic challenge to the orthopedic surgeon. Management is based on the patient's physiological status, fracture classification, and associated injuries. Surgical stabilization is indicated in unstable injury patterns and those that fail nonsurgical management. The optimal timing for definitive fixation is not clearly defined, but early stabilization is recommended. Surgical techniques include external fixation, open reduction and internal fixation, and minimally invasive percutaneous osteosynthesis. Special considerations are required for concomitant acetabular fractures, sacral fractures, and those occurring in skeletally immature patients. Long-term outcomes are limited by lack of pelvis-specific outcome measures and burden of associated injuries.
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Aprato A, Joeris A, Tosto F, Kalampoki V, Rometsch E, Favuto M, Stucchi A, Azi M, Massè A. Are work return and leaves of absence predictable after an unstable pelvic ring injury? J Orthop Traumatol 2015; 17:169-73. [PMID: 26416030 PMCID: PMC4882299 DOI: 10.1007/s10195-015-0379-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 09/14/2015] [Indexed: 11/30/2022] Open
Abstract
Background Resuming work after surgical treatment of an unstable pelvic ring injury is often impeded because of residual disability. The aim of this study was to test which factors influence return to work, ability to return to the same job function as before the injury, leaves of absence, and incapacitation after sustaining a pelvic fracture. Materials and methods We performed a retrospective study on patients with surgically treated pelvic fractures. Medical records were reviewed to document patients’ demographic data, the extent of follow-up care, diagnosis of the injury (according to the Tile system of classification), type of surgical treatment, injury severity, and the time from trauma to definitive surgery. We also recorded the classification of patients’ physical status according to the American Society of Anesthesiologists (ASA) and details about admission to the intensive care unit (ICU). Patients were interviewed to note the number of days before returning to work and their ability to maintain their previously held jobs. Results Fifty patients were included in the study, and their mean age was 46.3 ± 12.6 years. The median time to return to work was 195 days. Twelve patients (24 %) lost their jobs and 17 (34 %) resumed their previous job with a change of tasks. ICU admission and time from trauma to definitive surgery were negatively correlated with return to the previously held job. Returning to the same job tasks was not associated with any of the factors investigated. Polytrauma, ICU admission, and time from trauma to definitive surgery were associated with longer leaves of absence. Conclusions Work reintegration after pelvic ring injuries is a major issue for patients and health care systems: 58 % of patients were not able to return to or lost their job. Factors correlated with leaves of absence were injury severity, delayed definitive fixation, and ICU admission. Level of evidence IV (case series).
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Affiliation(s)
| | - Alexander Joeris
- Clinical Investigation and Documentation (C.I.D.) Department, AO Foundation, Dübendorf, Switzerland
| | | | - Vasiliki Kalampoki
- Clinical Investigation and Documentation (C.I.D.) Department, AO Foundation, Dübendorf, Switzerland
| | - Elke Rometsch
- Clinical Investigation and Documentation (C.I.D.) Department, AO Foundation, Dübendorf, Switzerland
| | - Marco Favuto
- Medical School, University of Turin, Turin, Italy
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