Low-Energy Pelvic Ring Fractures in the Elderly Population: Expected Outcomes and Associated Mortality Rates

Abstract Background Fragility fractures of the pelvis (FFP) encompass two fracture entities: fracture after low-energy trauma and insufficiency fracture without trauma. It is unclear whether the two subgroups differ in terms of diagnosis and therapy. The aim of this retrospective study was to evaluate insufficiency fractures with regard to defined parameters and to compare specific parameters with the fractures after low-energy trauma. Patients and Methods In the period from 2008 to 2017, 203 patients with FFP were recorded at our clinic (Level 1 Trauma Centre DGU, SAV approval). Of these, 25 had an insufficiency fracture and 178 had a pelvic ring fracture after low-energy trauma. Epidemiological, diagnostic and therapeutic parameters were examined. Results There was a relative increase in the insufficiency fracture within the FFP (2008 – 2009: 5.0% vs. 2015 – 2017: 17.8%). In these patients, osteoporosis tended to be more pronounced than in patients after low-energy trauma (t-value: − 3.66 vs. − 3.13). The diagnosis of insufficiency fractures showed increased use of MRI and DECT (60.9% vs. 26.0%) and a high proportion of type IV fractures after FFP (40.0% vs. 7.9%). In terms of therapy, surgical treatment of the insufficiency fracture was sought more often (68,2% vs. 52,1%), with a tendency towards increased use of combined osteosynthesis procedures (14.3% vs. 7.6%). Conclusion We were able to show that as the number of cases increases, the insufficiency fracture becomes more important within FFP. If these patients tend to have more pronounced osteoporosis, particular attention should be paid to the diagnosis and adequate therapy of the osteoporosis, especially in the case of an insufficiency fracture. In addition to the increased diagnostic testing using MRI and DECT to detect oedema and the increased surgical therapy for this type of fracture, it is also noteworthy that the insufficiency fracture can cause higher-grade fractures after FFP.

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Low-Energy Pelvic Ring Fractures: A Care Conundrum

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320985406 ◽

2021 ◽

Vol 12 ◽

pp. 215145932098540

Author(s):

Bailey R. Abernathy ◽

Lisa K. Schroder ◽

Deborah C. Bohn ◽

Julie A. Switzer

Keyword(s):

Acute Care ◽

Patient Population ◽

Pelvic Ring ◽

Fracture Prevention ◽

Low Energy ◽

Care Pathways ◽

Secondary Fracture ◽

Secondary Fracture Prevention ◽

Pelvic Ring Fractures ◽

Rehabilitative Care

Introduction: A need exists for improved care pathways for patients experiencing low-energy pelvic ring fractures. A review of the current literature was performed to understand the typical patient care and post-acute rehabilitation pathway within the US healthcare system. We also sought to summarize reported clinical outcomes worldwide. Significance: Low-energy pelvic ring fracture patients usually do not qualify for inpatient admission, yet they often require post-acute rehabilitative care. The Center for Medicare and Medicaid Services’ (CMS) 3-day rule is a barrier to obtaining financial coverage of this rehabilitative care. Results: Direct admission of some patients to post-acute care facilities has shown promise with decreased cost, improved patient outcomes, and increased patient satisfaction. Secondary fracture prevention programs may also improve outcomes for this patient population. Conclusions: Post-acute care innovation and secondary fracture prevention should be prioritized in the low-energy pelvic fragility fracture patient population. To demonstrate the effect and feasibility of these improved care pathways, further studies are necessary.

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Pelvic ring injury in the elderly: Fragile patients with substantial mortality rates and long-term physical impairment

PLoS ONE ◽

10.1371/journal.pone.0216809 ◽

2019 ◽

Vol 14 (5) ◽

pp. e0216809 ◽

Cited By ~ 5

Author(s):

Hester Banierink ◽

Kaj ten Duis ◽

Rob de Vries ◽

Klaus Wendt ◽

Erik Heineman ◽

...

Keyword(s):

Pelvic Ring ◽

The Elderly ◽

Mortality Rates ◽

Physical Impairment ◽

Pelvic Ring Injury

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Pelvic ring fractures in the elderly now and then – a pelvic registry study

Archives of Gerontology and Geriatrics ◽

10.1016/j.archger.2017.03.007 ◽

2017 ◽

Vol 71 ◽

pp. 83-88 ◽

Cited By ~ 8

Author(s):

Mika F. Rollmann ◽

Steven C. Herath ◽

Florian Kirchhoff ◽

Benedikt J. Braun ◽

Joerg H. Holstein ◽

...

Keyword(s):

Pelvic Ring ◽

The Elderly ◽

Registry Study ◽

Pelvic Ring Fractures

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Surgical treatment of pelvic ring fractures in the elderly now and then: a pelvic registry study

Aging Clinical and Experimental Research ◽

10.1007/s40520-016-0612-8 ◽

2016 ◽

Vol 29 (4) ◽

pp. 639-646 ◽

Cited By ~ 3

Author(s):

Mika F. Rollmann ◽

Steven C. Herath ◽

Joerg H. Holstein ◽

Tim Pohlemann ◽

Michael D. Menger ◽

...

Keyword(s):

Surgical Treatment ◽

Pelvic Ring ◽

The Elderly ◽

Registry Study ◽

Pelvic Ring Fractures

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Associated Pelvic Ring Fractures in Low Energy Pubic Ramus Fracture

International Journal of Surgery ◽

10.1016/j.ijsu.2010.07.111 ◽

2010 ◽

Vol 8 (7) ◽

pp. 539

Author(s):

James Newman

Keyword(s):

Pelvic Ring ◽

Low Energy ◽

Pubic Ramus ◽

Pelvic Ring Fractures

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Femoral neck fracture in association with low-energy pelvic ring fractures in an elderly patient

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2009.09.026 ◽

2010 ◽

Vol 28 (6) ◽

pp. 746.e1-746.e3 ◽

Cited By ~ 2

Author(s):

Samuel B. Adams ◽

Stephanie W. Mayer ◽

Mark G. Hamming ◽

Robert D. Zura

Keyword(s):

Elderly Patient ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Pelvic Ring ◽

Low Energy ◽

Pelvic Ring Fractures ◽

Neck Fracture

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The Effect of COVID-19 Pandemic on the Hip Fractures in Advanced Age

Forbes Journal of Medicine ◽

10.5222/forbes.2021.94830 ◽

2021 ◽

Author(s):

Ahmet Metin Özsezen ◽

Ahmet Burak Bilekli ◽

Anıl Özgür ◽

Onur Denizhan Sivri ◽

Çağrı Neyişçi ◽

...

Keyword(s):

Primary Care ◽

Hip Fractures ◽

The Elderly ◽

Mortality Rates ◽

Demographic Characteristics ◽

Low Energy ◽

Primary Care Unit ◽

Significant Difference ◽

American Society ◽

American Society Of Anesthesiologists

Objective: Hip fractures due to domestic low-energy traumas are common problems that can cause significant morbidity and mortality in the elderly population. Since the Covid-19 outbreak, although the lock-down of older people could decrease contagion,the incidence of domestic traumas did not decrease, and led to development of various comorbidities. In this study, we aimed to compare the epidemiology of hip fractures in 6 months of the pandemic in 2020, with the equivalent 6-month period in the previous year to determine the relationship between lock-down and hip fractures due to domestic falls. Method: In this retrospective study, patients over 65 years old who were hospitalized due to hip fractures between May 1st, 2020 - November 30th, 2020 were compared with the similar cohort hospitalized between May 1st, 2019 - November 30th, 2019. The patients were compared in terms of demographic characteristics, American Society of Anesthesiologists (ASA) scores, type of anesthesia, time until surgery, comorbidities, surgical treatment modality, need for postoperative primary care unit, postoperative complications, and mortality. Results: Overall, 210 patients were included in our study. There was no significant difference between the groups regarding demographic characteristics and ASA scores. In the 2020 group, there were eight patients (8.6%) who were Covid-19 PCR- positive. There was no death proven by PCR that was related to COVID-19 disease. Time to surgery, fracture type, anesthesia type did not differ between the two groups. The need for a postoperative primary care unit was higher in the 2020 group. Ninety-day mortality rates were not significantly different between the two groups. Conclusions: In conclusion, despite higher mortality rates described in the literature, there was no Covid -19 associated mortality in our study. Hip fractures in the elderly did not alter with social mobilization; hence they usually occur due to domestic low- energy traumas. Reporting of the information in this patient group by all centers will provide important data in the management of hip fractures in this special process.

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Diversity in antibody titer at an average of 87 days after the second dose of BNT162b2 mRNA coronavirus disease 2019 vaccine: data from a predominantly elderly population in a practice in Tokyo

10.1101/2021.12.22.21268296 ◽

2021 ◽

Author(s):

Yasuko Fuse-Nagase ◽

Mitsuo Nagase

Keyword(s):

Alcohol Consumption ◽

Antibody Titer ◽

High Mortality ◽

Elderly Population ◽

Vaccine Dose ◽

The Elderly ◽

Mortality Rates ◽

Negatively Associated ◽

Factors Associated ◽

Immunosuppressive Medication

It is very important for the elderly, who tend to have serious COVID-19 infection and high mortality rates, to maintain sufficient immunity. We reviewed the medical charts of predominantly elderly population to obtain the data on serum anti-SARS-CoV-2S antibody titer after complete vaccination with the BNT162b2 mRNA vaccine (two doses) and evaluated the background factors associated with the titer. We enrolled 230 participants (101 men and 129 women). Their average age was 71.9 (SD 12.5) years, and median was 72 years. The anti-SARS-CoV-2S antibody titer varied from 0.55 U/mL to 4920 U/mL. We found that the value of the titer varied widely. The value of the titer was negatively associated with age, alcohol consumption, time elapsed from second vaccine dose, and use of immunosuppressive medication. The result that the titer was negatively associated with aging suggests that the timing of additional shot should be carefully determined especially among elderly population.

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Age separation dramatically reduces COVID-19 mortality rate in a computational model of a large population

10.1101/2020.05.27.20111955 ◽

2020 ◽

Author(s):

Liron Mizrahi ◽

Shani Stern

Keyword(s):

Elderly Population ◽

Large Population ◽

Age Groups ◽

The Elderly ◽

Mortality Rates ◽

Social Connections ◽

Age Group ◽

Efficient Treatment ◽

Age Related ◽

Total Death

AbstractCOVID-19 pandemic has caused a global lock down in many countries throughout the world. Faced with a new reality, and until a vaccine or efficient treatment is found, humanity must figure out ways to keep economy going on one hand, yet keep the population safe on the other hand, especially those that are susceptible to this virus. Here we use a network simulation, with parameters that were drawn from what is known about the virus, to explore 5 different scenarios of partial lock down release. We find that separating age groups by reducing interactions between age groups, protects the general population and reduces mortality rates. Furthermore, addition of new connections within the same age group to compensate for the lost connections outside the age group, still has a strong beneficial influence and reduces the total death toll by 66%. While complete isolation from society may be the most protective scenario for the elderly population, it would have an emotional and possibly cognitive impact that might outweigh its benefit. We therefore propose creating age-related social recommendations or even restrictions, thereby allowing social connections but still strong protection for the older population.

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