Risk factors for pelvic insufficiency fractures and outcome after conservative therapy
Introduction
Osteoporosis is frequently seen in the general population and its prevalence rises with advancing age. As life expectancy continuously increases in western countries, the burden of osteoporosis is rising, too (Johnell & Kanis, 2006). Osteoporosis is often associated with fractures and given the rising number of osteoporotic patients, the number of patients with osteoporotic fractures who are treated by orthopaedic surgeons are increasing. (Breuil, Roux, & Testa, 2008; Skedros, Holyoak, & Pitts, 2006). Osteoporotic fractures mainly involve fractures of the wrist, hip and spine and so far most attention has been given to these well-known fractures sites. (Breuil et al., 2008). However, especially less frequent osteoporotic fracture sites such as pelvic fractures including public rami and sacral fractures, are increasing rapidly (Soles & Ferguson, 2012). 7 Percent of all osteoporosis related fractures in people aged over 50 years in the United States are pelvic fractures. They are a major health economic factor, accounting for 5% of the total cost burden (Burge et al., 2007). Data from the Finnish population register showed a significant increase in the incidence of osteoporotic pelvic fractures in Finnish women aged over 60. In the years from 1970 to 1997 the number of hospital admitted pelvic fractures rose from 20 to 95 per 100,000 people (Kannus, Palvanen, Niemi, Parkkari, & Jarvinen, 2000). In the highest risk group for pelvic fracture occurring after low impact trauma, women aged over 80, numbers increased from 35,421 in 1970 to 134,727 in 2002. A gross calculation estimated that the numbers will triple by year 2030 (Kannus, Palvanen, Parkkari, Niemi, & Jarvinen, 2005).
The mechanism of trauma, symptoms and treatment differ from other types of adult pelvic trauma (Rommens, Wagner, & Hofmann, 2012a). Fragility or osteoporotic fractures of the pelvis often occur after low energy falls e.g. from standing. However, some patients present with assumed insufficiency fractures of the sacrum without a known trauma (Soles & Ferguson, 2012). Multiple injuries are rare in these patients (Rommens et al., 2012a). Osteoporotic fractures occur in patients with confirmed or suspected osteoporosis and often they are the first sign of undiagnosed osteoporosis (Rommens & Hofmann, 2013). In insufficiency fractures the forces leading to a fracture are very low. The patient́s own body weight can be sufficient to produce fractures, due to an extreme reduction of bone mass (Rommens & Hofmann, 2013).
However, these fractures deserve attention as they lead to a decrease in mobility with an increase in dependency. Moreover, they are associated with a high rate of mortality (Soles & Ferguson, 2012). Apart from a high resting heart rate and osteoporosis, little is known about potential risk factors for pelvic insufficiency fractures (Kado, Lui, Cummings, & Study Of Osteoporotic Fractures Research, 2002; Kelsey, Prill, Keegan, & Sidney, 2005). Furthermore, information on clinical outcome following fracture is scarce.
In view of this rather limited knowledge, we aimed to identify potential risk factors for pelvic insufficiency fractures and to collect information on their short- and long-term outcomes.
Section snippets
Methods
Files of all consecutive patients admitted to the Department of Orthopaedic Surgery of 3 different University Hospitals between January 2010 and December 2013 for a pelvic insufficiency fracture were enrolled to this study. Pelvic fractures that occurred on tumorous bone or after high-energy trauma were excluded. Furthermore, we excluded patients who had to undergo operational stabilization of their pelvic fracture, thus, only patients who underwent conservative treatment got enrolled.
Results
Ninety-three patients with a pelvic insufficiency fracture were identified. Following the Rommens and Hofmann classification for fragility fractures of the pelvis (FFP), 51 were FFP Type Ia lesions (unilateral anterior lesions), 26 were FFP Type IIb lesions (non displaced posterior lesion with a sacral crush and anterior disruption) and 26 were FFP Type IIc lesions (non displaced sacral, sacroiliac or iliac fracture with anterior disruption) (Rommens & Hofmann, 2013). In the analyses of the
Discussion
To the best of our knowledge, this is the first study to evaluate risk factors for pelvic insufficiency fractures. In 93 pelvic insufficiency fractures we found a predominance of women and a preferential unilateral anterior localization of the fracture (FFP Type Ia). These findings are consistent with previous studies reporting on pelvic fractures (Rommens and Hofmann, 2013, Samdani, 2004).
The present study found a high prevalence of vitamin D deficiency in patients with a pelvic insufficiency
Conflict of interest
The authors declare that they have no conflict of interest.
Informed consent
Informed consent was obtained from all individual participants included in the study.
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