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Pelvic Ring Fractures in Older Adult Patients—Assessing Physician Practice Variation among (Orthopedic) Trauma Surgeons

Purpose: Pelvic fractures in older adults are a major public health problem and socioeconomic burden. The standard of care has changed over the past years, and there is limited consensus on which patients benefit from surgical fixation. There is currently no nationwide treatment protocol to guide th...

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Autores principales: Mennen, Anna H. M., Oud, Sharon, Halm, Jens A., Peters, Rolf W., Willems, Hanna C., Van Embden, Daphne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10573883/
https://www.ncbi.nlm.nih.gov/pubmed/37834988
http://dx.doi.org/10.3390/jcm12196344
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author Mennen, Anna H. M.
Oud, Sharon
Halm, Jens A.
Peters, Rolf W.
Willems, Hanna C.
Van Embden, Daphne
author_facet Mennen, Anna H. M.
Oud, Sharon
Halm, Jens A.
Peters, Rolf W.
Willems, Hanna C.
Van Embden, Daphne
author_sort Mennen, Anna H. M.
collection PubMed
description Purpose: Pelvic fractures in older adults are a major public health problem and socioeconomic burden. The standard of care has changed over the past years, and there is limited consensus on which patients benefit from surgical fixation. There is currently no nationwide treatment protocol to guide the decision-making process. Therefore, the aim of this survey was to provide more insight into if, when, and why patients with a fragility fracture of the pelvis (FFPs) would be considered for additional imaging and surgical fixation by treating physicians. Methods: An online clinical vignette-based survey of hypothetical scenarios was sent out to all orthopedic and trauma surgeons in the Netherlands. The questionnaire comprised multiple-choice questions and radiographic images. Differences between subgroups were calculated using the X2 test or the Fisher exact test. Results: 169 surgeons responded to the survey, with varying levels of experience and working in different types of hospitals. In a patient with a simple pubic ramus fracture and ASA 2 or ASA 4, 32% and 18% of the respondents would always advise a CT scan for further analysis. In the same patients, 11% and 31% of the respondents would not advise a CT scan, respectively. When presented with three cases of increasing severity of co-morbidity (ASA) and/or increasing age and/or different clinical presentation of an FFP type 3c on a CT scan, an increasing number of respondents would not consider surgical fixation. There was significant variation in practice patterns between the respondents who do not work in a hospital performing pelvic and acetabular (P&A) fracture surgery and those who do work in a P&A referral hospital. Most respondents (77%) refer patients 1–5 times a year to an expert center for surgical fixation. Conclusion: There is currently a wide variety of clinical practices regarding the imaging and management of FFPs, which seems to be influenced by the type of hospital the patients are presented to. A regional or national evidence-based treatment protocol should be implemented to ensure a more uniform approach.
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spelling pubmed-105738832023-10-14 Pelvic Ring Fractures in Older Adult Patients—Assessing Physician Practice Variation among (Orthopedic) Trauma Surgeons Mennen, Anna H. M. Oud, Sharon Halm, Jens A. Peters, Rolf W. Willems, Hanna C. Van Embden, Daphne J Clin Med Article Purpose: Pelvic fractures in older adults are a major public health problem and socioeconomic burden. The standard of care has changed over the past years, and there is limited consensus on which patients benefit from surgical fixation. There is currently no nationwide treatment protocol to guide the decision-making process. Therefore, the aim of this survey was to provide more insight into if, when, and why patients with a fragility fracture of the pelvis (FFPs) would be considered for additional imaging and surgical fixation by treating physicians. Methods: An online clinical vignette-based survey of hypothetical scenarios was sent out to all orthopedic and trauma surgeons in the Netherlands. The questionnaire comprised multiple-choice questions and radiographic images. Differences between subgroups were calculated using the X2 test or the Fisher exact test. Results: 169 surgeons responded to the survey, with varying levels of experience and working in different types of hospitals. In a patient with a simple pubic ramus fracture and ASA 2 or ASA 4, 32% and 18% of the respondents would always advise a CT scan for further analysis. In the same patients, 11% and 31% of the respondents would not advise a CT scan, respectively. When presented with three cases of increasing severity of co-morbidity (ASA) and/or increasing age and/or different clinical presentation of an FFP type 3c on a CT scan, an increasing number of respondents would not consider surgical fixation. There was significant variation in practice patterns between the respondents who do not work in a hospital performing pelvic and acetabular (P&A) fracture surgery and those who do work in a P&A referral hospital. Most respondents (77%) refer patients 1–5 times a year to an expert center for surgical fixation. Conclusion: There is currently a wide variety of clinical practices regarding the imaging and management of FFPs, which seems to be influenced by the type of hospital the patients are presented to. A regional or national evidence-based treatment protocol should be implemented to ensure a more uniform approach. MDPI 2023-10-03 /pmc/articles/PMC10573883/ /pubmed/37834988 http://dx.doi.org/10.3390/jcm12196344 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Mennen, Anna H. M.
Oud, Sharon
Halm, Jens A.
Peters, Rolf W.
Willems, Hanna C.
Van Embden, Daphne
Pelvic Ring Fractures in Older Adult Patients—Assessing Physician Practice Variation among (Orthopedic) Trauma Surgeons
title Pelvic Ring Fractures in Older Adult Patients—Assessing Physician Practice Variation among (Orthopedic) Trauma Surgeons
title_full Pelvic Ring Fractures in Older Adult Patients—Assessing Physician Practice Variation among (Orthopedic) Trauma Surgeons
title_fullStr Pelvic Ring Fractures in Older Adult Patients—Assessing Physician Practice Variation among (Orthopedic) Trauma Surgeons
title_full_unstemmed Pelvic Ring Fractures in Older Adult Patients—Assessing Physician Practice Variation among (Orthopedic) Trauma Surgeons
title_short Pelvic Ring Fractures in Older Adult Patients—Assessing Physician Practice Variation among (Orthopedic) Trauma Surgeons
title_sort pelvic ring fractures in older adult patients—assessing physician practice variation among (orthopedic) trauma surgeons
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10573883/
https://www.ncbi.nlm.nih.gov/pubmed/37834988
http://dx.doi.org/10.3390/jcm12196344
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