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Focusing on individual morphological fracture characteristics of pelvic ring fractures in elderly patients can support clinical decision making

INTRODUCTION: Pelvic ring fractures in the elderly are often caused by minor trauma. Treatment of these patients is currently based on fracture classification, clinical course, and ability to mobilize. Our aim was to identify morphological fracture characteristics with potential prognostic relevance...

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Autores principales: Ramser, Michaela, Cadosch, Dieter, Vach, Werner, Strub, Nathalie, Saxer, Franziska, Eckardt, Henrik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9245220/
https://www.ncbi.nlm.nih.gov/pubmed/35768764
http://dx.doi.org/10.1186/s12877-022-03222-0
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author Ramser, Michaela
Cadosch, Dieter
Vach, Werner
Strub, Nathalie
Saxer, Franziska
Eckardt, Henrik
author_facet Ramser, Michaela
Cadosch, Dieter
Vach, Werner
Strub, Nathalie
Saxer, Franziska
Eckardt, Henrik
author_sort Ramser, Michaela
collection PubMed
description INTRODUCTION: Pelvic ring fractures in the elderly are often caused by minor trauma. Treatment of these patients is currently based on fracture classification, clinical course, and ability to mobilize. Our aim was to identify morphological fracture characteristics with potential prognostic relevance and evaluate their association with clinical decision making and outcome, as well as their interobserver reliability. METHODS: Five fracture characteristics were investigated as potential variables: 1. Extent of the dorsal pelvic ring fracture (absent, unilateral, bilateral); 2. Extent of the ventral pelvic ring fracture (absent, unilateral, bilateral); 3. Presence of a horizontal sacral fracture; 4. Ventral dislocation; 5. Ventral comminution. These characteristics were assessed retrospectively in a series of 548 patients. The association of their presence with the decision to perform surgery, failure of conservative treatment and the length of hospital stay (LOS) was determined. Further, the inter-observer reliability for the specific characteristics was calculated and the relation with survival assessed. RESULTS: Four of the five evaluated characteristics showed an association with clinical decision making and patient management. In particular the extent of the dorsal fractures (absent vs. unilateral vs. bilateral) (OR = 7.0; p < 00.1) and the presence of ventral comminution/dislocation (OR = 2.4; p = 0.004) were independent factors for the decision to perform surgery. Both the extent of the dorsal fracture (OR = 1.8; p < 0.001) and the presence of ventral dislocation (OR = 1.7; p = 0.003) were independently associated with a prolonged overall LOS. The inter-observer agreement for the fracture characteristics ranged from moderate to substantial. A relevant association with increased mortality was shown for horizontal sacral and comminuted ventral fractures with hazard ratios (HR) of 1.7 (95% CI: 1.1, 2.5; p = 0.008) and HR = 1.5 (95% CI: 1.0, 2.2; p = 0.048). CONCLUSION: In the elderly, the extent of the dorsal fractures and the presence of ventral comminution/dislocation were associated to the decision to undergo surgery, failure of conservative treatment and length of stay. Survival was related to horizontal sacral fractures and ventrally comminuted fractures. These characteristics thus represent a simplified but highly informative approach for the evaluation of pelvic ring fractures in the elderly. This approach can support clinical decision making, promote patient-centred treatment algorithms and thus improve the outcome of individualized care. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-022-03222-0.
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spelling pubmed-92452202022-07-01 Focusing on individual morphological fracture characteristics of pelvic ring fractures in elderly patients can support clinical decision making Ramser, Michaela Cadosch, Dieter Vach, Werner Strub, Nathalie Saxer, Franziska Eckardt, Henrik BMC Geriatr Research INTRODUCTION: Pelvic ring fractures in the elderly are often caused by minor trauma. Treatment of these patients is currently based on fracture classification, clinical course, and ability to mobilize. Our aim was to identify morphological fracture characteristics with potential prognostic relevance and evaluate their association with clinical decision making and outcome, as well as their interobserver reliability. METHODS: Five fracture characteristics were investigated as potential variables: 1. Extent of the dorsal pelvic ring fracture (absent, unilateral, bilateral); 2. Extent of the ventral pelvic ring fracture (absent, unilateral, bilateral); 3. Presence of a horizontal sacral fracture; 4. Ventral dislocation; 5. Ventral comminution. These characteristics were assessed retrospectively in a series of 548 patients. The association of their presence with the decision to perform surgery, failure of conservative treatment and the length of hospital stay (LOS) was determined. Further, the inter-observer reliability for the specific characteristics was calculated and the relation with survival assessed. RESULTS: Four of the five evaluated characteristics showed an association with clinical decision making and patient management. In particular the extent of the dorsal fractures (absent vs. unilateral vs. bilateral) (OR = 7.0; p < 00.1) and the presence of ventral comminution/dislocation (OR = 2.4; p = 0.004) were independent factors for the decision to perform surgery. Both the extent of the dorsal fracture (OR = 1.8; p < 0.001) and the presence of ventral dislocation (OR = 1.7; p = 0.003) were independently associated with a prolonged overall LOS. The inter-observer agreement for the fracture characteristics ranged from moderate to substantial. A relevant association with increased mortality was shown for horizontal sacral and comminuted ventral fractures with hazard ratios (HR) of 1.7 (95% CI: 1.1, 2.5; p = 0.008) and HR = 1.5 (95% CI: 1.0, 2.2; p = 0.048). CONCLUSION: In the elderly, the extent of the dorsal fractures and the presence of ventral comminution/dislocation were associated to the decision to undergo surgery, failure of conservative treatment and length of stay. Survival was related to horizontal sacral fractures and ventrally comminuted fractures. These characteristics thus represent a simplified but highly informative approach for the evaluation of pelvic ring fractures in the elderly. This approach can support clinical decision making, promote patient-centred treatment algorithms and thus improve the outcome of individualized care. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-022-03222-0. BioMed Central 2022-06-30 /pmc/articles/PMC9245220/ /pubmed/35768764 http://dx.doi.org/10.1186/s12877-022-03222-0 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Ramser, Michaela
Cadosch, Dieter
Vach, Werner
Strub, Nathalie
Saxer, Franziska
Eckardt, Henrik
Focusing on individual morphological fracture characteristics of pelvic ring fractures in elderly patients can support clinical decision making
title Focusing on individual morphological fracture characteristics of pelvic ring fractures in elderly patients can support clinical decision making
title_full Focusing on individual morphological fracture characteristics of pelvic ring fractures in elderly patients can support clinical decision making
title_fullStr Focusing on individual morphological fracture characteristics of pelvic ring fractures in elderly patients can support clinical decision making
title_full_unstemmed Focusing on individual morphological fracture characteristics of pelvic ring fractures in elderly patients can support clinical decision making
title_short Focusing on individual morphological fracture characteristics of pelvic ring fractures in elderly patients can support clinical decision making
title_sort focusing on individual morphological fracture characteristics of pelvic ring fractures in elderly patients can support clinical decision making
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9245220/
https://www.ncbi.nlm.nih.gov/pubmed/35768764
http://dx.doi.org/10.1186/s12877-022-03222-0
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