Intentional fallers with complex pelvic and acetabular fractures do not have worse radiological and functional outcomes than accidental fallers
Abstract Individuals who fell from heights of > 6 m can suffer from complex pelvic and acetabular fractures. The extent to which an intentional fall correlates with prognosis and outcome after osteosynthesis is unclear. We aimed to investigate the clinical outcomes of fallers with pelvic and acetabular fractures after osteosynthesis and to compare the radiological and functional outcomes between intentional and accidental fallers. We retrospectively reviewed forty-nine fallers who fell from heights of > 6 m, developed pelvic and acetabular fractures, survived after resuscitation, and completed surgical treatments between 2014 and 2017. The fallers were divided into the intentional and accidental fallers. Sixteen patients were intentional fallers, whereas the rest of the patients fell accidentally. Psychiatric counselling was performed for each intentional fallers during their follow ups. All patients who fell intentionally had pre-existing mental disorders, and the major diagnosis was adjustment disorder. The group with intentional fallers had female sex predominance, higher injury and new injury severity scores, and longer hospital stay. However, the early loss of fixation (less than three month) and functional outcomes (Merle d'Aubigné and Majeed hip scores at 6- and 12-month follow-up) did not significantly differ between the intentional and accidental fallers. We found that the intentional fallers with pelvic and acetabular fractures might be accompanied by more severe combined injuries compared to accidental fallers. Under a standardized perioperative protocol and individualized physical and mental rehabilitation program, the functional and radiological outcomes of the intentional fallers could be comparable to those of the accidental fallers.