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

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Abstract

Background

With the demographic change, the treatment of elderly patients has become a major issue for health systems worldwide.

Aims

The aim of this study was to analyze the change in the rate of surgical treatment of pelvic ring fractures in patients with an age of ≥60 years over a 22-year period depending on fracture type, age and sex.

Methods

Data of 5665 patients with an age of ≥60 years, who were treated for pelvic ring fractures from 1991 to 2013 in one of 31 hospitals participating in the German Pelvic Trauma Registry, were included. The registry is divided into four time periods: t 1 = 1991–1993, t 2 = 1997–2000, t 3 = 2001–2008 and t 4 = 2009–2013. Data had been collected prospectively and was analyzed retrospectively, stratified for age and sex of the patients as well as type of fracture and mode of therapy (surgical vs. conservative).

Results

There was a significant increase (p < 0.05) in the overall rate of surgical treatment. Nonetheless, during all time periods patients with an age of >70 years were significantly less frequently surgically treated compared to 60- to 70-year-olds. Regardless of the fracture type, the rate of surgical treatment was significantly higher (p < 0.05) in male compared to female patients during t 1. While this difference persisted for type A and type B fractures, the frequency of surgical treatment of type C fractures approximated in males and females.

Conclusions

The present data indicate that the rate of surgical treatment of pelvic ring fractures in elderly patients has significantly increased over the 22-year period. Nonetheless, older patients (>70 years) as well as female patients are still less frequently surgically treated.

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References

  1. National Institute on Aging, Why Population Aging Matters: A Global Perspective. National Institute on Aging (2008) US National Institutes of Health. http://www.nia.nih.gov/health/publication/why-population-aging-matters-global-perspective/trend-1-aging-population. Accessed 17 Sep 17

  2. Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37:691–697

    Article  PubMed  Google Scholar 

  3. Tosounidis G, Holstein JH, Culemann U et al (2010) Changes in epidemiology and treatment of pelvic ring fractures in Germany: an analysis on data of German Pelvic Multicenter Study Groups I and III (DGU/AO). Acta Chir Orthop Traumatol Cech 77:450–456

    CAS  PubMed  Google Scholar 

  4. Culemann U, Oestern HJ, Pohlemann T (2014) Aktuelle Behandlung der Beckenringfraktur. Der Unfallchirurg 117:145–161

    Article  CAS  PubMed  Google Scholar 

  5. Baker SD, Grochow LB (1997) Pharmacology of cancer chemotherapy in the older person. Clin Geriatr Med 13:169–183

    CAS  PubMed  Google Scholar 

  6. Blair SN, Kohl HW 3rd, Barlow CE et al (1995) Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA 273:1093–1098

    Article  CAS  PubMed  Google Scholar 

  7. Jorm AF, Jolley D (1998) The incidence of dementia: a meta-analysis. Neurology 51:728–733

    Article  CAS  PubMed  Google Scholar 

  8. Pohlemann T, Tosounidis G, Bircher M et al (2007) The German Multicentre Pelvis Registry: a template for an European expert network? Injury 38:416–423

    Article  PubMed  Google Scholar 

  9. Isler B, Ganz R (1996) Classification of pelvic ring injuries. Injury 27:3–12

    Article  Google Scholar 

  10. Diel P, Thier C, Aghayev E et al (2010) The international documentation and evaluation system IDES: a single center observational case series for development of an ankle prosthesis documentation questionnaire and study of its feasibility and face validity. J Foot Ankle Res 3:4

    Article  PubMed  PubMed Central  Google Scholar 

  11. Holstein JH, Culemann U, Pohlemann T et al (2012) What are predictors of mortality in patients with pelvic fractures? Clin Orthop Relat Res 470:2090–2097

    Article  PubMed  PubMed Central  Google Scholar 

  12. Holstein JH, Pizanis A, Kohler D et al (2013) What are predictors for patients’ quality of life after pelvic ring fractures? Clin Orthop Relat Res 471:2841–2845

    Article  PubMed  PubMed Central  Google Scholar 

  13. Furey AJ, O’Toole RV, Nascone JW et al (2009) Classification of pelvic fractures: analysis of inter- and intraobserver variability using the Young-Burgess and Tile classification systems. Orthopedics 32:401

    Article  PubMed  Google Scholar 

  14. Barzilay Y, Liebergall M, Safran O et al (2005) Pelvic fractures in a level I trauma center: a test case for the efficacy of the evolving trauma system in Israel. Isr Med Assoc J 7:619–622

    PubMed  Google Scholar 

  15. Crimmins EM, Reynolds SL, Saito Y (1999) Trends in health and ability to work among the older working-age population. J Gerontol B Psychol Sci Soc Sci 54:S31–S40

    Article  CAS  PubMed  Google Scholar 

  16. Manton KG, Gu X, Lamb VL (2006) Change in chronic disability from 1982 to 2004/2005 as measured by long-term changes in function and health in the US elderly population. Proc Natl Acad Sci USA 103:18374–18379

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Sophie S (2007) Anaesthesia for the elderly patient. J Pak Med Assoc 57:196–201

    PubMed  Google Scholar 

  18. Klenk J, Rapp K, Buchele G et al (2007) Increasing life expectancy in Germany: quantitative contributions from changes in age- and disease-specific mortality. Eur J Public Health 17:587–592

    Article  PubMed  Google Scholar 

  19. Wahnert D, Raschke MJ, Fuchs T (2013) Cement augmentation of the navigated iliosacral screw in the treatment of insufficiency fractures of the sacrum: a new method using modified implants. Int Orthop 37:1147–1150

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bartley EJ, Fillingim RB (2013) Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth 111:52–58

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Mogil JS (2012) Sex differences in pain and pain inhibition: multiple explanations of a controversial phenomenon. Nat Rev Neurosci 13:859–866

    Article  CAS  PubMed  Google Scholar 

  22. Paller CJ, Campbell CM, Edwards RR et al (2009) Sex-based differences in pain perception and treatment. Pain Med 10:289–299

    Article  PubMed  PubMed Central  Google Scholar 

  23. Popescu A, LeResche L, Truelove EL et al (2010) Gender differences in pain modulation by diffuse noxious inhibitory controls: a systematic review. Pain 150:309–318

    Article  PubMed  Google Scholar 

  24. Riley JL 3rd, Robinson ME, Wise EA et al (1998) Sex differences in the perception of noxious experimental stimuli: a meta-analysis. Pain 74:181–187

    Article  PubMed  Google Scholar 

  25. Arber S, McKinlay J, Adams A et al (2006) Patient characteristics and inequalities in doctors’ diagnostic and management strategies relating to CHD: a video-simulation experiment. Soc Sci Med 62:103–115

    Article  PubMed  Google Scholar 

  26. Borkhoff CM, Hawker GA, Wright JG (2011) Patient gender affects the referral and recommendation for total joint arthroplasty. Clin Orthop Relat Res 469:1829–1837

    Article  PubMed  PubMed Central  Google Scholar 

  27. Daly C, Clemens F, Lopez Sendon JL et al (2006) Gender differences in the management and clinical outcome of stable angina. Circulation 113:490–498

    Article  PubMed  Google Scholar 

  28. Katz JN, Wright EA, Guadagnoli E et al (1994) Differences between men and women undergoing major orthopedic surgery for degenerative arthritis. Arthr Rheum 37:687–694

    Article  CAS  Google Scholar 

  29. McMurray RJ, Clarke MJAB, Dexanne BC et al (1991) Gender disparities in clinical decision making. Council on Ethical and Judicial Affairs, American Medical Association. JAMA 266:559–562

    Article  Google Scholar 

  30. Valentin A, Jordan B, Lang T et al (2003) Gender-related differences in intensive care: a multiple-center cohort study of therapeutic interventions and outcome in critically ill patients. Crit Care Med 31:1901–1907

    Article  PubMed  Google Scholar 

  31. Hawker GA, Wright JG, Coyte PC et al (2000) Differences between men and women in the rate of use of hip and knee arthroplasty. N Engl J Med 342:1016–1022

    Article  CAS  PubMed  Google Scholar 

  32. Juni P, Low N, Reichenbach S et al (2010) Gender inequity in the provision of care for hip disease: population-based cross-sectional study. Osteoarthr Cartil 18:640–645

    Article  CAS  PubMed  Google Scholar 

  33. Hawker G, Wright J, Coyte P et al (1998) Health-related quality of life after knee replacement. J Bone Joint Surg Am 80:163–173

    Article  CAS  PubMed  Google Scholar 

  34. Holtzman J, Saleh K, Kane R (2002) Gender differences in functional status and pain in a Medicare population undergoing elective total hip arthroplasty. Med Care 40:461–470

    Article  PubMed  Google Scholar 

  35. Parsley BS, Bertolusso R, Harrington M et al (2010) Influence of gender on age of treatment with TKA and functional outcome. Clin Orthop Relat Res 468:1759–1764

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We thank all members of the Pelvic Trauma Working Group of the German Association, who continuously invest a lot of time and effort in scientific projects and the procurement of knowledge, leading to a continuous improvement of the standards of care for patients with pelvic and acetabular fractures. Without their efforts, the German Pelvic Trauma registry and this study would not have been possible. We thank S. Drum, Center for Clinical Studies of the Department of Trauma, Hand and Reconstructive Surgery, University of Homburg for her ongoing support in data entry and processing. Institutions contributing to the German Pelvic Injury Registry Initiative: A Institutions contributing to the German Pelvic Trauma Registry include: ZNA Stuivenberg Antwerpen, Belgium; AZ Groeninge Hospital, Kortrijk, Belgium; Jolimont-Lobbes Hospital, Lobbes, Belgium; University Hospital Aachen, Aachen, Germany; General Hospital Augsburg, Germany; Charité Campus Virchow Hospital, Berlin, Germany; Kreisklinik Biberach, Germany; Municipal Hospital, Braunschweig, Germany; General Hospital, Celle, Germany; General Hospital Dortmund, Germany; Diakonissenkrankenhaus, Flensburg, Germany; University Hospital, Freiburg, Germany; BG Trauma Hospital, Halle, Germany; University Hospital, Halle, Germany; University Hospital, Hamburg, Germany; Friederikenstift Hospital, Hannover, Germany; Medizinische Hochschule, Hannover, Germany; University Hospital, Homburg, Germany; University Hospital, Jena, Germany; Westpfalz Hospital, Kaiserslautern, Germany; Municipal Hospital Karlsruhe, Germany; University Hospital, Kiel, Germany; SKM Hospital, Koblenz, Germany; University Hospital, Leipzig, Germany; General Hospital, Ludwigsburg, Germany; BG Trauma Hospital, Ludwigshafen, Germany; University Hospital, Mainz, Germany; University Hospital, Magdeburg, Germany; Hospital of the Technical University, Munich, Germany; BG Trauma Hospital, Murnau, Germany; University Hospital, Münster, Germany; Municipal Hospital Nuernberg, Germany; University Hospital, Regensburg, Germany; Klinikum Schwerin, Germany; BG Trauma Hospital, Tübingen, Germany; German Army Hospital, Ulm, Germany; University Hospital, Ulm, Germany; and Sahlgrenska University Hospital, Gothenburg, Sweden.

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Authors and Affiliations

  1. Department of Trauma, Hand and Reconstructive Surgery, Saarland University, 66421, Homburg/Saar, Germany

    Mika F. Rollmann, Steven C. Herath, Joerg H. Holstein, Tim Pohlemann & Tina Histing

  2. Institute for Clinical and Experimental Surgery, Saarland University, 66421, Homburg/Saar, Germany

    Michael D. Menger

Authors
  1. Mika F. Rollmann
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  2. Steven C. Herath
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  3. Joerg H. Holstein
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  4. Tim Pohlemann
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  5. Michael D. Menger
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  6. Tina Histing
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Corresponding author

Correspondence to Mika F. Rollmann.

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Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

The study has been approved by the ethics commitee of the Saarland phyisician chamber.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

The pelvic trauma registry of the DGU.

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Rollmann, M.F., Herath, S.C., Holstein, J.H. et al. Surgical treatment of pelvic ring fractures in the elderly now and then: a pelvic registry study. Aging Clin Exp Res 29, 639–646 (2017). https://doi.org/10.1007/s40520-016-0612-8

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  • DOI: https://doi.org/10.1007/s40520-016-0612-8

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