Orthopedic and Trauma Department, AZ Groeninge hospital, Kortrijk, Belgium.
School of Medicine, UZ Leuven, Leuven, Belgium.
BMC Musculoskelet Disord. 2023 Apr 22;24(1):320. doi: 10.1186/s12891-023-06439-1.
Acute low energy pubic rami fractures in the elderly receive primarily conservative treatment. There is debate to what extent posterior ring involvement, which is detected superiorly by CT compared to X-ray, has an impact on outcome and may require modified treatment. We want to demonstrate if posterior ring involvement has an influence on different types of outcome in primarily conservatively treated acute FFP, questioning the usefulness of early CT. Additionally we analysed the early fracture pattern in cases where conservative treatment failed with need for secondary surgery.
A retrospective cohort study of 155 consecutive patients, recruited between 2009 and 2016, aged over 65 years diagnosed with an acute LE-PFr on X-ray at the emergency department of a single, level-one trauma centre and receiving an early CT. A set of outcome parameters was compared between patients with an isolated pubic rami fracture (CTia) and patients who had a combined posterior pelvic ring fracture (CTcp).
There were 155 patients of whom 85.2% were female with a mean age of 83 years. 76.8% of patients living at home returned home and 15.5% moved to a nursing home. Mortality rate during hospitalisation was 6.4% and 14.8% at one year post-trauma. Secondary fracture displacement occurred in 22.6%. Secondary surgery was performed in 6 cases (3.9%). Median hospitalisation length of stay was 21 days (range 0 to 112 days). There was no significant association between the subgroups and change in residential status (p = 0.65), complications during hospitalisation (p = 0.75), mortality rate during admission (p = 0.75) and at 1 year (p = 0.88), readmission within 30 days (p = 0.46) and need for secondary surgery (p = 0.2). There was a significant increased median length of stay (p = 0.011) and rate of secondary displacement (p = 0.015) in subgroup CTcp. Secondary displacement had no impact on in-hospital complications (p = 0.7) nor mortality rate during admission (p = 0.79) or at 1 year (0.77). Early CT in patients who underwent secondary surgery showed stable B2.1 lesions in 4 of 6 cases.
Our data suggest that early CT in patients with conservatively treated acute LE-PFr in order to detect posterior lesions, has limited value in predicting failure of conservative treatment.
老年人急性低能量耻骨支骨折主要采用保守治疗。与 X 射线相比，CT 可更清晰地检测到后环受累，目前对于后环受累对治疗结果的影响存在争议，可能需要改变治疗方法。我们旨在证明主要采用保守治疗的急性 FFP 中，后环受累是否会对不同类型的治疗结果产生影响，从而质疑早期 CT 的必要性。此外，我们还分析了因需要二次手术而导致保守治疗失败的病例的早期骨折模式。
这是一项回顾性队列研究，共纳入 155 例连续患者，均为 2009 年至 2016 年期间在单一一级创伤中心急诊科因 X 射线诊断为急性 LE-PFr 的 65 岁以上老年人，且均在伤后早期行 CT 检查。对接受保守治疗的患者中仅存在耻骨支骨折（CTia）的患者和存在骨盆后环联合骨折（CTcp）的患者的一系列治疗结果参数进行比较。
155 例患者中，85.2%为女性，平均年龄 83 岁。76.8%的居家患者返回家中，15.5%的患者搬至疗养院。住院期间死亡率为 6.4%，1 年后为 14.8%。继发性骨折移位发生率为 22.6%。6 例（3.9%）患者接受了二次手术。中位住院时间为 21 天（范围 0 至 112 天）。两组间在居住状态改变（p=0.65）、住院期间并发症（p=0.75）、住院期间死亡率（p=0.75）和 1 年后死亡率（p=0.88）、30 天内再入院率（p=0.46）和二次手术率（p=0.2）方面无显著差异。CTcp 亚组的中位住院时间延长（p=0.011）和继发性移位发生率增加（p=0.015）。继发性移位对住院期间并发症（p=0.7）或住院期间死亡率（p=0.79）或 1 年后死亡率（p=0.77）无影响。接受二次手术的患者的早期 CT 显示 6 例中有 4 例存在稳定的 B2.1 病变。
我们的数据表明，为了检测后环病变，对接受保守治疗的急性 LE-PFr 患者行早期 CT 检查，对预测保守治疗失败的价值有限。
