Long-term outcome after pelvic and acetabular fractures : Does age matter?

Banierink, H. (Hester) (2017) Long-term outcome after pelvic and acetabular fractures : Does age matter? thesis, Medicine.

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Abstract

Background. Fractures of the pelvis and acetabulum are serious injuries, mostly caused by high-energy traumas or due to osteoporosis in the elderly. The fracture type varies from a simple fracture with no instability of the pelvis, to life-threatening “open book” fractures. The ring structure of the pelvis makes isolated fractures rare and gives a high risk of associated acetabular fractures. Pelvic and acetabular fractures can be treated either conservatively or surgically, depending on the type of fracture. The fractures are often associated with several serious complications, like bleeding, infections and nerve injuries. Furthermore, the fractures can have a great effect on the functional outcome and quality of life. The aim of this study was to identify the association between age at time of injury and the long-term outcomes after pelvic and acetabular fractures in terms of physical functioning, quality of life pain, work and social participation. Methods. A total of 621 patients, with a pelvic or acetabular fracture, who were treated in the UMCG between 2007 and 2016 were included in this study. Demographics and data concerning the injury were extracted from electronic patient files, the Dutch Trauma Registry (LTR) and the National Medical Registration (LMR). For general analysis, the patients were divided into three age groups: young- (≤30), middle- (31-65) and high-aged (≥65). However, patients under 18 at time of follow-up were excluded for further analysis and the statistics performed after follow-up only included patients between 18-31 in the young-aged group. This was due to the immature skeleton of these patients and therefore possible different long-term outcomes. The 432 patients that were still alive at time of follow-up received a questionnaire concerning functional outcome (SMFA), quality of life (EQ-5D), pain, return to work and participation (WHODAS). ANOVA, Chi-square, Kaplan-Meier, Independent samples T-test and multiple linear regression analyses were performed for analyzing the results. Results. Significant differences were found between fracture type and injury mechanism compared to age. The 30-day mortality rates and survival analysis showed that middle-aged patients had a lower mortality rate compared to the young- and high-aged group. A total of 298 patients were included for follow-up, with a mean follow-up of 4.5 years (Std. 2.6) after injury, ranging from 1 to 10 years. Irrespective of gender and injury mechanism, statistical differences were found for the SMFA function index, the lower- and upper-extremity subscales, and for the daily activity subscale between the young- and high-aged groups. For the lower-extremity subscale, a significant difference was also found between the young- and middle-aged groups. Similar results were found for the upper-extremity subscale between middle- and high-aged patients. Also, patients with a higher age at time of injury had lower outcomes in WHODAS work scores, compared to the young-aged group. There was no association between age and the scores on the EQ-5D and WHODAS participation subscale. Conclusion. Patients with an age of 65 or higher at the time of injury had both worse long-term functional outcomes and work outcomes, compared to patients with an age of 30 or less at the time of injury. No relation was found between age and quality of life. However, age was related to the type of fracture, which is associated with the fracture mechanism, and significant differences were found in incidence of low- and high-energy traumas between all age groups. At last, 30-day mortality rates and survival analysis showed significantly better outcomes in the middle-aged group, compared to patients in the young- and high-aged group. Further research is necessary to differentiate in outcomes between isolated and combined pelvic and acetabular fractures, and to evaluate long-term outcomes at specific times of follow-up. This could help in the treatment and revalidation for this population.

Item Type:	Thesis (Thesis)
Supervisor name:	University supervisor: and Reininga, Dr. I.H.F. and Clinical supervisors: and IJpma Dr. F.F.A. & and Duis Drs. K. ten UMCG – department of trauma surgery
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:02
Last Modified:	25 Jun 2020 11:02
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2235

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