Andreas Höch1, Philipp Pieroh2,3, Florian Gras4, Tim Hohmann3, Sven Märdian5, Francis Holmenschlager6, Holger Keil7,8, Hans-Georg Palm9, Steven C Herath10, Christoph Josten2, Hagen Schmal11, Fabian M Stuby12. 1. Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany. Andreas.Hoech@medizin.uni-leipzig.de. 2. Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany. 3. Department of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06097, Halle (Saale), Germany. 4. Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany. 5. Centre for Musculoskeletal Surgery, Charité - University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. 6. Department of Trauma Surgery, Otto-von-Guericke-University, Leipziger Strasse 44, 39120, Magdeburg, Germany. 7. Department for Trauma, Hand Surgery and Orthopedics, Hospital of Karlsruhe, Moltkestrasse 90, 76133, Karlsruhe, Germany. 8. Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany. 9. Trauma Research Group, Department of Orthopedics and Trauma Surgery, Reconstructive and Septic Surgery, and Sports Traumatology, German Armed Forces Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany. 10. Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Building 57, Kirrbergerstr. 1, 66421, Homburg, Germany. 11. Department of Orthopaedics and Traumatology, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, 5000, Odense, Denmark. 12. Department of Trauma Surgery, BG Trauma Centre Murnau, Professor Küntscher Str. 8, 82418, Murnau, Germany.
Abstract
PURPOSE: Pelvic ring fractures in the elderly gain increasing importance. Nonetheless, data on factors influencing treatment decision in relation to fracture classification, age, and the resulting treatment are still rare. METHODS: Prospectively collected data of the German Pelvic Injury Registry from patients aged over 65 years with a pelvic ring fracture were evaluated retrospectively. Acetabular fractures, as well as type A1 and A3 fractures, were excluded. The variables age, injury pattern, type of treatment, the reason for conservative treatment, and Orthopaedic Trauma Association (OTA)/Tile classification were analyzed. Furthermore, the fracture distribution was examined after dividing patients into six age groups. RESULTS: A total of 1814 patients with a mean age of 80.7 ± 7.6 years, predominantly female (79.0%), were available for evaluation. The majority of patients suffered from isolated pelvic ring fractures (70.1%) and 8.2% were severely injured (ISS > 16). The most common fracture types were type A2 (35.4%), type B2 (38.0%), and type C1 (7.3%). Especially pelvic ring fractures of type A2 (96.9%) and type B2 (83.0%) were treated conservatively (overall 76.9%). Fracture instability according to the OTA/Tile classification increased the probability for an operative treatment (generalized odds ratio [OR] 6.90 [5.62; 8.52]). In contrary, increasing age independent of the fracture pattern decreased this probability (OR 0.47 [0.41-0.53]). With increasing fracture instability, general health conditions were up to 50% of the reasons for conservative treatment. CONCLUSION: The results of the present study underline the importance of the factors age and general health besides fracture classification for therapeutic decision-making in the treatment of pelvic ring fractures in the elderly.
PURPOSE:Pelvic ring fractures in the elderly gain increasing importance. Nonetheless, data on factors influencing treatment decision in relation to fracture classification, age, and the resulting treatment are still rare. METHODS: Prospectively collected data of the German Pelvic Injury Registry from patients aged over 65 years with a pelvic ring fracture were evaluated retrospectively. Acetabular fractures, as well as type A1 and A3 fractures, were excluded. The variables age, injury pattern, type of treatment, the reason for conservative treatment, and Orthopaedic Trauma Association (OTA)/Tile classification were analyzed. Furthermore, the fracture distribution was examined after dividing patients into six age groups. RESULTS: A total of 1814 patients with a mean age of 80.7 ± 7.6 years, predominantly female (79.0%), were available for evaluation. The majority of patients suffered from isolated pelvic ring fractures (70.1%) and 8.2% were severely injured (ISS > 16). The most common fracture types were type A2 (35.4%), type B2 (38.0%), and type C1 (7.3%). Especially pelvic ring fractures of type A2 (96.9%) and type B2 (83.0%) were treated conservatively (overall 76.9%). Fracture instability according to the OTA/Tile classification increased the probability for an operative treatment (generalized odds ratio [OR] 6.90 [5.62; 8.52]). In contrary, increasing age independent of the fracture pattern decreased this probability (OR 0.47 [0.41-0.53]). With increasing fracture instability, general health conditions were up to 50% of the reasons for conservative treatment. CONCLUSION: The results of the present study underline the importance of the factors age and general health besides fracture classification for therapeutic decision-making in the treatment of pelvic ring fractures in the elderly.
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