NorthWest Clinics Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands.
Eur J Trauma Emerg Surg. 2019 Dec;45(6):1021-1029. doi: 10.1007/s00068-018-0971-2. Epub 2018 Jun 12.
Pubic rami fractures are common fractures in a growing osteoporotic geriatric population. Concomitant posterior ring fractures (cPRF) are often found when properly looked for. The pain and consequent immobilization leaves this vulnerable patient group at risk for complications. Conservative therapy is usually sufficient, but with cPRF's surgery can be indicated. Although previous studies have pointed out that mortality rates are high, longer term morbidity outcomes are lacking. This study aims to further establish the longer term consequences of these fractures. Risk factors will be identified for complications, also addressing the possible differences between patients with or without a cPRF.
Retrospective analysis of patients aged over 65 years sustaining a pubic rami fracture in the North-West Hospital Group Alkmaar combined with a survey to establish risk factors for morbidity and mortality after 6 months' post trauma. Multiple logistic regression analysis was used to identify risk factors.
117 patients matched inclusion criteria with a median age of 83 and of which 86% was female. 23 cPRF's were identified. Significant deterioration in ambulation and independency was found. 34% was institutionalized at discharge. 49% lost their independent mobility status and 40% of the patients did not experience a full recovery. One-year mortality rate was 23%. Patients with a cPRF had a significant higher complication rate (44 vs 18% p = 0.02), but mortality and other morbidity outcomes did not statistically differ. The strongest predictor for 1-year mortality was complications during admission and a dependent ambulatory status (OR 5.2 and 4.1 respectively).
Pubic fractures with or without involvement of the posterior pelvic ring in patients aged over 65 have a significant impact on mobility and independency. Mortality rates are similar to hip fracture patients. Careful evaluation of every patient's mobility status is necessary to identify patients at risk for complications and determine their future health care needs. Future studies are needed to achieve consensus on diagnostic and treatment protocols and identify ways to decrease the significant impact of this injury.
耻骨支骨折是骨质疏松老年人群中常见的骨折。如果仔细检查，通常会发现伴发的后环骨折（cPRF）。疼痛和随之而来的固定会使这个脆弱的患者群体面临并发症的风险。通常，保守治疗就足够了，但对于 cPRF，手术可能是必要的。尽管之前的研究指出死亡率很高，但缺乏长期发病结果。本研究旨在进一步确定这些骨折的长期后果。将确定并发症的危险因素，同时探讨伴有或不伴有 cPRF 的患者之间可能存在的差异。
对在阿尔克马尔西北医院集团（North-West Hospital Group Alkmaar）就诊的年龄超过 65 岁的耻骨支骨折患者进行回顾性分析，并结合一项调查，以确定创伤后 6 个月内发病率和死亡率的危险因素。采用多因素逻辑回归分析确定危险因素。
符合纳入标准的 117 名患者的中位年龄为 83 岁，其中 86%为女性。共发现 23 例 cPRF。发现患者的步行和自理能力显著恶化。出院时 34%的患者需要住院治疗。49%的患者失去了独立活动能力，40%的患者没有完全康复。1 年死亡率为 23%。伴发 cPRF 的患者并发症发生率显著更高（44%比 18%，p=0.02），但死亡率和其他发病结果无统计学差异。1 年死亡率的最强预测因素是住院期间并发症和依赖的步行状态（OR 分别为 5.2 和 4.1）。
65 岁以上患者的耻骨支骨折伴或不伴后骨盆环受累，对活动能力和自理能力有显著影响。死亡率与髋部骨折患者相似。仔细评估每位患者的活动能力状态对于识别有并发症风险的患者并确定其未来的医疗保健需求非常重要。需要进一步研究以达成关于诊断和治疗方案的共识，并确定减少这种损伤的显著影响的方法。
