Operative treatment of fragility fractures of the pelvis is connected with lower mortality. A single institution experience.

Operative treatment of fragility fractures of the pelvis is connected with lower mortality. A single institution experience.

<h4>Background</h4>Fragility fractures of the pelvis (FFP) represent an increasing clinical entity. Until today, there are no guidelines for treatment of FFP. In our center, recommendation for operative treatment was given to all patients, who suffered an FFP type III and IV and to patie...

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Autores principales: Pol Maria Rommens, Mehdi Boudissa, Sven Krämer, Miha Kisilak, Alexander Hofmann, Daniel Wagner
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Publicado: Public Library of Science (PLoS) 2021
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spelling oai:doaj.org-article:532bd0b29cfb438d8f4d28b2e9b5ae272021-12-02T20:05:08ZOperative treatment of fragility fractures of the pelvis is connected with lower mortality. A single institution experience.1932-620310.1371/journal.pone.0253408https://doaj.org/article/532bd0b29cfb438d8f4d28b2e9b5ae272021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0253408https://doaj.org/toc/1932-6203<h4>Background</h4>Fragility fractures of the pelvis (FFP) represent an increasing clinical entity. Until today, there are no guidelines for treatment of FFP. In our center, recommendation for operative treatment was given to all patients, who suffered an FFP type III and IV and to patients with an FFP type IIwith unsuccessful non-operative treatment. We performed a retrospective observational study and investigated differences between fracture classes and management alternatives. We hypothetized that operative treatment may reduce mortality.<h4>Materials and methods</h4>The medical charts and radiographs of 362 patients were analysed. Patient demographics, FFP-classification, length of hospital stay (LoS), type of treatment, general and surgery-related complications, mortality, Short Form-8 physical component score (SF-8 PCS) and mental component score (SF-8 MCS), Parker Mobility Score (PMS) and Numeric Rating Scale (NRS) were documented.<h4>Results</h4>238 patients had FFP type II and 124 FFP type III and IV. 52 patients with FFP type II (21.8%) and 86 patients with FFP type III and IV (69.4%) were treated operatively (p<0.001). Overall mortality did not differ between the fracture classes (p = 0.127) but was significantly lower in the operative group (p<0.001). Median LoS was significantly higher in FFP type III and IV (p<0.001) and in operated patients (p<0.001). There were more in-hospital complications in patients with FFP type III and IV (p = 0.001) and in the operative group (p = 0.006). More patients of the non-operative group were mobile (p<0.001) and independent (p<0.001) at discharge. Half of the patients could not return in their living environment.203 of the 235 surviving patients (86%) answered the questionnaires after a mean follow-up time of 38 months. SF-8 PCS, SF-8 MCS and PMS did not differ between the fracture classes and treatment groups. Pain perception was higher in the operated group (p = 0.013).<h4>Conclusion</h4>In our study, we observed that operative treatment of FFP provides low mortality rates, although LoS and in-hospital complications were higher in the operative group. At discharge, the non-operative group was more mobile and independent. At follow up, quality of life and mobility were comparable between the groups. Further prospective studies are needed to clarify the impact of operative treatment of FFP on mortality and functional outcome.Pol Maria RommensMehdi BoudissaSven KrämerMiha KisilakAlexander HofmannDaniel WagnerPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0253408 (2021)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Pol Maria Rommens
Mehdi Boudissa
Sven Krämer
Miha Kisilak
Alexander Hofmann
Daniel Wagner
Operative treatment of fragility fractures of the pelvis is connected with lower mortality. A single institution experience.
description <h4>Background</h4>Fragility fractures of the pelvis (FFP) represent an increasing clinical entity. Until today, there are no guidelines for treatment of FFP. In our center, recommendation for operative treatment was given to all patients, who suffered an FFP type III and IV and to patients with an FFP type IIwith unsuccessful non-operative treatment. We performed a retrospective observational study and investigated differences between fracture classes and management alternatives. We hypothetized that operative treatment may reduce mortality.<h4>Materials and methods</h4>The medical charts and radiographs of 362 patients were analysed. Patient demographics, FFP-classification, length of hospital stay (LoS), type of treatment, general and surgery-related complications, mortality, Short Form-8 physical component score (SF-8 PCS) and mental component score (SF-8 MCS), Parker Mobility Score (PMS) and Numeric Rating Scale (NRS) were documented.<h4>Results</h4>238 patients had FFP type II and 124 FFP type III and IV. 52 patients with FFP type II (21.8%) and 86 patients with FFP type III and IV (69.4%) were treated operatively (p<0.001). Overall mortality did not differ between the fracture classes (p = 0.127) but was significantly lower in the operative group (p<0.001). Median LoS was significantly higher in FFP type III and IV (p<0.001) and in operated patients (p<0.001). There were more in-hospital complications in patients with FFP type III and IV (p = 0.001) and in the operative group (p = 0.006). More patients of the non-operative group were mobile (p<0.001) and independent (p<0.001) at discharge. Half of the patients could not return in their living environment.203 of the 235 surviving patients (86%) answered the questionnaires after a mean follow-up time of 38 months. SF-8 PCS, SF-8 MCS and PMS did not differ between the fracture classes and treatment groups. Pain perception was higher in the operated group (p = 0.013).<h4>Conclusion</h4>In our study, we observed that operative treatment of FFP provides low mortality rates, although LoS and in-hospital complications were higher in the operative group. At discharge, the non-operative group was more mobile and independent. At follow up, quality of life and mobility were comparable between the groups. Further prospective studies are needed to clarify the impact of operative treatment of FFP on mortality and functional outcome.
format article
author Pol Maria Rommens
Mehdi Boudissa
Sven Krämer
Miha Kisilak
Alexander Hofmann
Daniel Wagner
author_facet Pol Maria Rommens
Mehdi Boudissa
Sven Krämer
Miha Kisilak
Alexander Hofmann
Daniel Wagner
author_sort Pol Maria Rommens
title Operative treatment of fragility fractures of the pelvis is connected with lower mortality. A single institution experience.
title_short Operative treatment of fragility fractures of the pelvis is connected with lower mortality. A single institution experience.
title_full Operative treatment of fragility fractures of the pelvis is connected with lower mortality. A single institution experience.
title_fullStr Operative treatment of fragility fractures of the pelvis is connected with lower mortality. A single institution experience.
title_full_unstemmed Operative treatment of fragility fractures of the pelvis is connected with lower mortality. A single institution experience.
title_sort operative treatment of fragility fractures of the pelvis is connected with lower mortality. a single institution experience.
publisher Public Library of Science (PLoS)
publishDate 2021
url https://doaj.org/article/532bd0b29cfb438d8f4d28b2e9b5ae27
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AT svenkramer operativetreatmentoffragilityfracturesofthepelvisisconnectedwithlowermortalityasingleinstitutionexperience
AT mihakisilak operativetreatmentoffragilityfracturesofthepelvisisconnectedwithlowermortalityasingleinstitutionexperience
AT alexanderhofmann operativetreatmentoffragilityfracturesofthepelvisisconnectedwithlowermortalityasingleinstitutionexperience
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