Closed pelvic fractures: characteristics and outcomes in older patients admitted to medical and geriatric wards
Robert O Morrisa, Adeniyi Sonibareb, Desmond J Greenc, Tahir Masuda
a Department of
Health Care for the Elderly, City Hospital, Nottingham, UK, b Department of Medicine,
Queens Medical Centre, Nottingham, UK, c Department of Radiology, City Hospital,
Nottingham, UK
Correspondence to: Dr R O Morris, 285 Trowell Road, Nottingham NG8 2FE, UK
Submitted 22 September
1999;
Accepted 10 February 2000
OBJECTIVE
To investigate the
characteristics and outcomes of older patients with pelvic fracture
admitted to medical and geriatric wards.
METHODSAll patients admitted to
medical and geriatric wards with a pelvic fracture over a four year
period were identified using the hospital clinical coding database.
Data were collected from casenotes, hospital and Family Health Services
Authority databases. Where available, pelvic radiographs were graded
according to the Singh index.
RESULTSThe casenotes of 148 patients (126 women) were studied; 83% (n=123) of patients suffered a
pelvic fracture in low energy trauma. Mean (SD) length of hospital stay
was 21.3 (17.6) days. Single breaks of the pubic rami accounted for
47.2% (n=68) of all fractures. Inpatient mortality was 7.6% and at
one year was 27%. There was a marked adverse effect on the mobility of
survivors with all patients using at least a walking stick at discharge
and 51.1% (n=70) needing assistance for mobility. Although 70.9%
(n=83) of patients admitted from home (or warden aided accommodation) were able to return there, 84.3% (n=70) of them required extra community support. Rates of institutionalisation rose from 20.9% (n=31) at admission to 35.8% (49/137) of survivors at discharge. Altogether 93% (n=107) of 115 patients, in whom adequate quality pelvic radiographs were available, were assigned a Singh index grade of
4 or less indicating the presence of osteoporosis.
CONCLUSIONSPelvic fractures are
often the result of low energy trauma. They are associated with
appreciable inpatient and considerable one year mortality. They also
have marked negative effects on mobility in the short term. They result
in increased levels of dependency in terms of higher levels of
community support and rates of institutionalisation. On the evidence of
Singh index grading, pelvic fractures are associated with low bone density.
Keywords: pelvis; fractures; elderly; Singh index
© 2000 by The Fellowship of Postgraduate Medicine
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