Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-26T00:26:09.678Z Has data issue: false hasContentIssue false
  • English
  • Français

Low-impact pelvic fractures in the emergency department

Published online by Cambridge University Press:  21 May 2015

Greg Dodge  and
Rob Brison
Greg Dodge
Affiliation:
Department of Emergency Medicine, Queen's University, Kingston, Ont.
Rob Brison*
Affiliation:
Department of Emergency Medicine, Queen's University, Kingston, Ont.
*
Kingston General Hospital, 76 Stuart St., Kingston ON K7L 2V7; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

We examined the records of patients presenting to the emergency department (ED) with low-impact pelvic fractures. We describe frequency, demographics, management and patient outcomes in terms of ambulatory ability, living independence and mortality.

Methods:

Patients treated for a pelvic fracture over a 2-year period in Kingston, Ont., were identified. We performed a retrospective hospital record review to distinguish high- versus low-impact injury mechanisms, and to characterize the injury event, ED management and outcomes for patients with low-impact fractures.

Results:

Of 132 pelvic fractures identified, 77 were low-impact fractures. Patients were predominantly women (82%) with a mean age of 81 years; 96% had some pre-existing medical comorbidity. The pubic rami were most commonly involved (86%). The median length of stay in the ED was 9.4 hours. Twenty-five patients (32%) were admitted to hospital. Ten patients had surgical stabilization, mostly of the acetabulum. Five patients died in hospital, 4 from pneumonia and 1 from myocardial infarction. Eight additional patients died within 1 year of injury. At discharge, only 18% lived independently and 16% walked without aids versus 42% and 38%, respectively, before injury.

Conclusion:

Low-impact pelvic fractures affect predominantly elderly women with pre-existing comorbidities. A substantial amount of time and resources in the ED are used during the workup of these patients and while awaiting their disposition from the ED. These injuries are important because they affect independence and seem associated with an increased risk of death.

Keywords

pelvic fracturelow-impact traumaoutcomesfalls in elderlymorbiditymortality
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 12 , Issue 6 , September 2010 , pp. 509 - 513
Copyright
Copyright © Canadian Association of Emergency Physicians 2010

References

REFERENCES

1.Boufous, S, Finch, C, Lord, S, et al. The increasing burden of pelvic fractures in older people, New South Wales, Australia. Injury 2005;36:1323–9.Google Scholar
2.Kannus, P, Palvanen, M, Parkkari, J, et al. Osteoprotic pelvic fractures in elderly women. Osteoporos Int 2005;16:1304–5.Google Scholar
3.Kannus, P, Pelvanen, M, Niemi, S, et al. Epidemiology of osteoporotic pelvic fractures in elderly people in Finland: sharp increase in 1970–1997 and alarming projections for the new millennium. Osteoporos Int 2000;11:443–8.CrossRefGoogle ScholarPubMed
4.Durkin, A, Sagi, HC, Durham, R, et al. Contemporary management of pelvic fractures. Am J Surg 2006;192:211–23.CrossRefGoogle ScholarPubMed
5.Alost, T, Waldrop, RD. Profile of geriatric pelvic fractures presenting tothe emergency department. Am J Emerg Med 1997;15:576–8.Google Scholar
6.Leung, WY, Ban, CM, Lam, JJ, et al. Prognosis of acute pelvic fractures in elderly patients: retrospective study. Hong Kong Med J 2001;7:139–45.Google Scholar
7.Sanders, AB. Care of the elderly in emergency departments: conclusions and recommendations. Ann Emerg Med 1992;21:830–4.Google Scholar
8.Taillandier, J, Langue, F, Alemanni, M, et al. Mortality and functional outcomes of pelvic insufficiency fractures in older patients. Joint Bone Spine 2003;70:287–9.Google Scholar
9.Koval, KJ, Aharonoff, GB, Schwartz, MC, et al. Pubic rami fracture: A benign pelvic injury? J Orthop Trauma 1997;11:7–9.Google Scholar
10.Cummings, SR, Melton, J. Epidemiology and outcomes of osteoporotic fractures. Lancet 2002;359:1761–7.Google Scholar
11.Malochet-Guinamand, S, Chalard, N, Billault, C, et al. Osteoporosis treatment in postmenopausal women after peripheral fractures: impact of information to general practitioners. Joint Bone Spine 2005;72:562–6.Google Scholar
12.Boufous, S, Finch, C, Close, J, et al. Hospital admissions following presentations to emergency departments for a fracture in older people. Inj Prev 2007;13:211–4.Google Scholar
13.Morris, RO, Sonibare, A, Green, DJ, et al. Closed pelvic fractures: characteristics and outcomes in older patients admitted to medical and geriatric wards. Postgrad MedJ 2000;76:646–50.Google Scholar
14.Chong, KH, DeCoster, T, Osler, T, et al. Pelvic fractures and mortality. Iowa Orthop J 1997;17:110–4.Google Scholar
15.Hill, RMF, Robinson, CM, Keating, JF. Fractures of the pubic rami: epidemiology and five-year survival. J Bone Joint Surg Br 2001;83:1141–4.Google Scholar
16.Henry, SM, Pollak, AN, Jones, AL, et al. Pelvic fracture in geriatric patients: a distinct clinical entity. J Trauma 2002;53:15–20.CrossRefGoogle ScholarPubMed
17.Lim, HJ, Hoffmann, R, Brasel, K.Factors influencing discharge location after hospitalization resulting from a traumatic fall among older persons. J Trauma 2007;63:902–7.Google Scholar
18.Donaldson, MG, Khan, KM, Davis, JC, et al. Emergency department fall-related presentations do not trigger fall risk assessment: a gap in care of high-risk outpatient fallers. Arch Gerontol Geriatr 2005;41:311–7.CrossRefGoogle Scholar
19.Friedmann, PD, Ma, LJ, Karrison, TG, et al. Early revisit, hospitalization, or death among older persons discharged from the ED. Am J Emerg Med 2001;19:125–9.CrossRefGoogle ScholarPubMed
20.Close, J, Ellis, M, Hooper, R, et al. Prevention of falls in the elderly trial (PROFET): a randomized control trial. Lancet 1999;353:93–7.Google Scholar
21.Salter, AE, Khan, KM, Donaldson, MG, et al. Community-dwelling seniors who present to the emergency department with a fall do not receive guideline care and their fall risk profile worsens significantly: a 6-month prospective study. Osteoporos Int 2006;17:67283.Google Scholar