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Elsissy JG, Ruckle DE, LeBrun C, Johnson JP. Pelvic Ring Injuries: Stable or Not? J Am Acad Orthop Surg 2024; 32:99-107. [PMID: 37816188 DOI: 10.5435/jaaos-d-23-00470] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/29/2023] [Indexed: 10/12/2023] Open
Abstract
Pelvic ring injuries occur in varying severity and in vastly different patient demographics. Knowledge regarding which of these injuries require surgical intervention and which can be managed nonsurgically continues to evolve. Previous studies have shown validated criteria for sacral fractures and the posterior ring, explored the role of examination under anesthesia, and other forms of dynamic imaging. Although there is substantial information available, a comprehensive synthesis of this information is lacking. This article provides a comprehensive review of radiographic markers suggestive of stability, discusses treatment strategies, and proposes a treatment algorithm that is easily understood and applicable to not only those with a trauma background but also the general orthopaedic surgeon who will see these injuries frequently while on call.
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Affiliation(s)
- Joseph G Elsissy
- From the Department of Orthopedic Surgery (Elsissy), Chief of Orthopaedic Traumatology, Arrowhead Regional Medical Center, Colton, CA, the Department of Orthopedic Surgery (Ruckle), Loma Linda University Health Loma Linda, CA, the Department of Orthopedic Surgery (LeBrun), Chief of Orthopaedic Traumatology, Riverside Community Hospital, Riverside, CA, and the Department of Orthopedic Surgery (Johnson), University of Alabama at Birmingham, Birmingham, AB
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Abernathy BR, Huyke-Hernández FA, Rivard RL, Schroder LK, Switzer JA. Exposing the Care Conundrum of Low-Energy Pelvic Ring Fractures in Older Adults: A Review of 322 Patients. Geriatr Orthop Surg Rehabil 2023; 14:21514593231216390. [PMID: 38023063 PMCID: PMC10664424 DOI: 10.1177/21514593231216390] [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: 04/24/2023] [Revised: 01/01/2023] [Accepted: 03/17/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction A care conundrum for low-energy pelvic ring fracture patients in which they face financial burden after not qualifying for an inpatient stay of 3 days or more has been noted in the literature. The purpose of this study was to identify factors that lead to inpatient length of stay (IP LOS) ≥3 days in older adults with nonoperative pelvic ring fragility fractures and to highlight the challenging financial decision-making of those with IP LOS <3 days in the context of the Medicare 3-day rule. Methods This was a retrospective review of 322 patients aged ≥65 presenting from March 2016 and February 2019 to either of 2 emergency departments (EDs) after a ground-level fall resulting in a pelvic ring fracture. Patient demographic, IP LOS, and mortality data were extracted. Case management notes were analyzed to summarize financial decision-making for patients with IP LOS <3 days. Multivariate logistic regression analysis was conducted to identify factors that predicted IP LOS ≥3 days and mortality. Results IP LOS ≥3 days was associated with presentation to level I hospital (OR .30 [.19, 0.50]) and being single (OR 2.50 [1.10, 5.68]). 70.3% required a post-acute skilled nursing facility (SNF) stay. Of patients with LOS <3 days, 25.0% were financially responsible for their SNF stay, while 7.9% elected home care due to financial reasons. Overall 30-day, 90-day, and 1-year mortality were 2.5%, 8.1%, and 20.8%, respectively. For patients with LOS <3 days, returning to assisted living compared to discharging to a SNF increased 90-day mortality risk (HR 8.529, P = .0451). Having Medicare trended towards increased 90-day mortality risk compared to commercial insurance (HR 4.556, P = .0544). Conclusion The current system is failing older adult patients who sustain nonoperative low-energy pelvic ring fractures in terms of financial coverage of necessary post-acute treatment. This care conundrum has yet to be solved.
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Affiliation(s)
| | - Fernando A. Huyke-Hernández
- HealthPartners Institute, Bloomington, MN, USA
- TRIA Orthopedic Center, Bloomington, MN, USA
- Park Nicollet Methodist Hospital, St Louis Park, MN, USA
| | | | | | - Julie A. Switzer
- HealthPartners Institute, Bloomington, MN, USA
- TRIA Orthopedic Center, Bloomington, MN, USA
- Park Nicollet Methodist Hospital, St Louis Park, MN, USA
- University of Minnesota Department of Orthopedics, Minneapolis, MN, USA
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Mroczkowski A, Taiar R. Influence of the Backward Fall Technique on the Transverse Linear Acceleration of the Head during the Fall. SENSORS (BASEL, SWITZERLAND) 2023; 23:3276. [PMID: 36991989 PMCID: PMC10054543 DOI: 10.3390/s23063276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The formation of large accelerations on the head and cervical spine during a backward fall is particularly dangerous due to the possibility of affecting the central nervous system (CNS). It may eventually lead to serious injuries and even death. This research aimed to determine the effect of the backward fall technique on the linear acceleration of the head in the transverse plane in students practicing various sports disciplines. METHODS The study involved 41 students divided into two study groups. Group A consisted of 19 martial arts practitioners who, during the study, performed falls using the side aligning of the body technique. Group B consisted of 22 handball players who, during the study, performed falls using the technique performed in a way similar to a gymnastic backward roll. A rotating training simulator (RTS) was used to force falls, and a Wiva® Science apparatus was used to assess acceleration. RESULTS The greatest differences in backward fall acceleration were found between the groups during the buttocks' contact with the ground. Larger changes in head acceleration were noted in group B. CONCLUSIONS The lower changes in head acceleration obtained in physical education students falling with a lateral body position compared to students training handball indicate their lower susceptibility to head, cervical spine, and pelvis injuries when falling backwards as caused by horizontal force.
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Affiliation(s)
- Andrzej Mroczkowski
- Department of Sports and Health Promotion, University of Zielona Góra, 65-417 Zielona Góra, Poland
| | - Redha Taiar
- MATériaux et IngénierieMécanique (MATIM), Université de Reims Champagne Ardenne, 51100 Reims, France
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Behanova M, Haschka J, Reichardt B, Dimai HP, Resch H, Zwerina J, Kocijan R. Pelvic Fractures-An Underestimated Problem? Incidence and Mortality Risk after Pelvic Fracture in Austria, 2010-2018. J Clin Med 2022; 11:jcm11102834. [PMID: 35628960 PMCID: PMC9146576 DOI: 10.3390/jcm11102834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/16/2022] [Accepted: 05/16/2022] [Indexed: 02/05/2023] Open
Abstract
(1) Background: Pelvic fractures (PFs) are related to osteoporosis, and represent a serious individual and socioeconomic burden. (2) Methods: We examined age- and sex-standardised incidence rates (SIRs) of PF, along with rates of all-cause overall and one-year mortality among patients with PF. We compared the mortality rates between PF patients and a matched fracture-free cohort. Patients ≥50 years old in Austria hospitalised with PF in 2010−2018, along with their dates of death, were recorded. (3) Results: We identified 54,975 patients with PF, of whom 70.9% were women. Between 2010 and 2018 the SIR of PF increased in men by 10.0%—from 125.3 (95% Confidence Interval 118.9−132.0) to 137.8 (95% CI 131.8−144.0) per 100,000—and in women by 2.7%—from 218.7 (95% CI 212.0−225.6) to 224.7 (95% CI 218.3−231.3) per 100,000. The one-year post-PF mortality rate was higher in men than in women (13.0% and 11.1%, respectively; p < 0.001). Pelvic fracture patients aged ≥65 had an elevated mortality risk (Hazard Ratio 1.75, 95% CI 1.71−1.79, p < 0.001) compared to controls. (4) Conclusions: There is a clear increase in the incidence of PF in the elderly population, with a greater increase in men over time. Pelvic fracture itself contributes to increased mortality in individuals aged 65 and above.
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Affiliation(s)
- Martina Behanova
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA, Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, 1140 Vienna, Austria; (J.H.); (J.Z.); (R.K.)
- Correspondence:
| | - Judith Haschka
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA, Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, 1140 Vienna, Austria; (J.H.); (J.Z.); (R.K.)
| | - Berthold Reichardt
- Austrian Social Health Insurance Fund, Österreichische Gesundheitskasse, 7000 Eisenstadt, Austria;
| | - Hans-Peter Dimai
- Division of Endocrinology and Diabetology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria;
| | - Heinrich Resch
- Metabolic Bone Diseases Unit, School of Medicine, Sigmund Freud University Vienna, 1020 Vienna, Austria;
- 2nd Department of Internal Medicine, St. Vincent Hospital Vienna, 1090 Vienna, Austria
| | - Jochen Zwerina
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA, Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, 1140 Vienna, Austria; (J.H.); (J.Z.); (R.K.)
| | - Roland Kocijan
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA, Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, 1140 Vienna, Austria; (J.H.); (J.Z.); (R.K.)
- Metabolic Bone Diseases Unit, School of Medicine, Sigmund Freud University Vienna, 1020 Vienna, Austria;
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Muschitz C, Hummer M, Grillari J, Hlava A, Birner AH, Hemetsberger M, Dimai HP. Epidemiology and economic burden of fragility fractures in Austria. Osteoporos Int 2022; 33:637-647. [PMID: 34622302 PMCID: PMC8497183 DOI: 10.1007/s00198-021-06152-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/07/2021] [Indexed: 12/12/2022]
Abstract
UNLABELLED Fragility fractures are a frequent and costly event. In Austria, 92,835 fragility fractures occurred in patients aged ≥ 50 years in 2018, accruing direct costs of > 157 million €. Due to demographic aging, the number of fragility fractures and their associated costs are expected to increase even further. INTRODUCTION Fragility fractures are frequently associated with long hospital stays, loss of independence, and increased need for care in the elderly, with consequences often leading to premature death. The aim of this study was to estimate the number of fragility fractures and associated healthcare costs in Austria in 2018. METHODS The number of in-patient cases with relevant ICD-10 diagnoses in all Austrian public hospitals was derived from discharge documentation of diagnoses and procedures covering all public hospitals in Austria. Fractures resulting from falls from standing height in patients aged ≥ 50 years were used as a proxy for fragility fractures, and the number of in-patient and out-patient cases was estimated. The direct costs of these cases were calculated using the average cost of the corresponding in-patient hospital stay and the average cost for the out-patient stay. RESULTS The present study estimated the number of fragility fractures (pelvis, thoracic and lumbar vertebra, hip, humerus, rib, forearm, and tibia) for 2018 at 92,835 or just over half of all fractures in patients aged ≥ 50 years, corresponding to a prevalence of 2,600 per 100,000 inhabitants of this age group. A constant increase in the proportion of fragility fractures among all fractures was observed with increasing age in both men and women. These fractures amounted to direct costs of > 157 million €. CONCLUSION Fragility fractures are a frequent and costly event in Austria. Due to the aging of the population, the number of fragility fractures and their associated costs is expected to increase even further.
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Affiliation(s)
- C Muschitz
- Medical Department II-VINFORCE, St. Vincent Hospital, Vienna, Austria
| | - M Hummer
- The Austrian National Public Health Institute, Vienna, Austria
| | - J Grillari
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center, Donaueschingenstraße 13, A-1200, Vienna, Austria.
- Institute for Molecular Biotechnology, BOKU - University of Natural Resources and Life Sciences, Vienna, Austria.
- Austrian Cluster for Tissue Regeneration, Vienna, Austria.
| | - A Hlava
- The Austrian National Public Health Institute, Vienna, Austria
| | - A H Birner
- The Austrian National Public Health Institute, Vienna, Austria
| | | | - H P Dimai
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Low-energy lateral compression type 1 (LC1) pelvic ring fractures in the middle-aged and elderly affect hospital quality measures and functional outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1379-1384. [PMID: 34545463 DOI: 10.1007/s00590-021-03125-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to examine hospital quality measures and the long-term functional outcomes associated with lateral compression type 1 [LC1] pelvic ring injuries. METHODS A query was performed from December 2011 to September 2020 at two institutions within one hospital system for patients with a pelvic fracture diagnosis. Chart review was performed on admitted patients to determine demographic information, medical co-morbidities (to calculate Charlson Co-morbidity Index), in-hospital complications, length of stay [LOS], discharge disposition, and 30-day readmission rates. All patients included were treated nonoperatively. An attempt was made to contact all patients for long-term follow-up to assess current functional status with a Short Musculoskeletal Function Assessment [SMFA]. RESULTS Two-hundred and eighty-six patients were included, with 172 (65.9%) patients admitted and analyzed with respect to hospital quality measures. Patients admitted were older (83 vs 80 years, p = 0.015) with more medical co-morbidities (p = 0.001) than those discharged from the emergency department. The average LOS was 5.7 ± 3.7 days and 31 (18%) experienced in-hospital complications. The inpatient mortality rate was 1.2%, and the 30-day readmission rate was 8.1%. When comparing admitted patients without concomitant injuries, admitted patients with concomitant injuries, and non-admitted patients, admitted patients with concomitant injuries were found to have more medical co-morbidities (p = 0.001). Forty-three patients were available for long-term follow-up (average 36.6 ± 7.3 months), with an average SMFA score of 29.0 ± 25.7. CONCLUSIONS Patients admitted for LC1 pelvic fractures are likely to be older with more medical co-morbidities, and up to 1/5th will experience inpatient complications. Although inpatient mortality remains low, this injury pattern can lead to significant functional disability that persists for several years after injury.
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