Yasuhisa Ueda1, Takahiro Inui2, Yoshiaki Kurata3, Hideki Tsuji3, Jota Saito3, Yui Shitan3. 1. Division of Orthopaedic Trauma, Sapporo Tokushukai Hospital, Oyachi-higashi 1-1-1, Atsubetsu Ward, Sapporo, Hokkaido, 004-0041, Japan. haruharuka0706@yahoo.co.jp. 2. Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan. 3. Division of Orthopaedic Trauma, Sapporo Tokushukai Hospital, Oyachi-higashi 1-1-1, Atsubetsu Ward, Sapporo, Hokkaido, 004-0041, Japan.
Abstract
PURPOSE: Most fragility fractures of the pelvis (FFPs) are conservatively treated in the early phase. However, the definition of conservative treatment failure and the subsequent treatment protocol is controversial. Fracture progression (FP) sometimes occurs during conservative treatment of FFPs. This study aimed to assess the association between FP and prolonged pain in patients with FFPs receiving conservative treatment. METHODS: Retrospective case series in a single institution in Japan. A total of 192 consecutive FFP patients were identified during study period. Seventy-nine patients met the inclusion and exclusion criteria. FFPs were diagnosed using both CT and MRI and FP was diagnosed with CT. Patients met criteria for prolonged pain if they had persisting pain after 2 weeks of conservative treatment and had lack of improvement in mobility. The relationship between FP and prolonged pain was analyzed using Fisher's exact test. RESULTS: Of the 79 patients, 18 developed FP. Four of the 18 patients with FP met criteria for prolonged pain. Two of 61 patients without FP had prolonged pain (p = 0.022; odds ratio 8.12). In the entire study cohort, six patients (7.6%) met criteria prolonged pain and underwent elective surgery. CONCLUSION: In patients with FFPs, prolonged pain was associated with FP (p = 0.022, OR 8.12). The presence of prolonged pain might help identify FP. If FP is identified, surgical treatment may be required with cautious follow-up particularly in cases, where FFP progresses to type III or IV fracture.
PURPOSE: Most fragility fractures of the pelvis (FFPs) are conservatively treated in the early phase. However, the definition of conservative treatment failure and the subsequent treatment protocol is controversial. Fracture progression (FP) sometimes occurs during conservative treatment of FFPs. This study aimed to assess the association between FP and prolonged pain in patients with FFPs receiving conservative treatment. METHODS: Retrospective case series in a single institution in Japan. A total of 192 consecutive FFP patients were identified during study period. Seventy-nine patients met the inclusion and exclusion criteria. FFPs were diagnosed using both CT and MRI and FP was diagnosed with CT. Patients met criteria for prolonged pain if they had persisting pain after 2 weeks of conservative treatment and had lack of improvement in mobility. The relationship between FP and prolonged pain was analyzed using Fisher's exact test. RESULTS: Of the 79 patients, 18 developed FP. Four of the 18 patients with FP met criteria for prolonged pain. Two of 61 patients without FP had prolonged pain (p = 0.022; odds ratio 8.12). In the entire study cohort, six patients (7.6%) met criteria prolonged pain and underwent elective surgery. CONCLUSION: In patients with FFPs, prolonged pain was associated with FP (p = 0.022, OR 8.12). The presence of prolonged pain might help identify FP. If FP is identified, surgical treatment may be required with cautious follow-up particularly in cases, where FFP progresses to type III or IV fracture.
Entities:
Keywords:
Conservative treatment; Fracture progression; Fragility fractures of the pelvis; Prolonged pain; Surgical indication
Authors: Ludwig Oberkircher; Steffen Ruchholtz; Pol Maria Rommens; Alexander Hofmann; Benjamin Bücking; Antonio Krüger Journal: Dtsch Arztebl Int Date: 2018-02-02 Impact factor: 5.594
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