Elsevier

Injury

Volume 41, Issue 4, April 2010, Pages 411-414
Injury

Ten-year mortality among hospitalised patients with fractures of the pubic rami

https://doi.org/10.1016/j.injury.2009.12.014Get rights and content

Abstract

In a case–control study, 99 patients aged over 60 years and admitted to hospital with an isolated single fracture of the pubic ramus were compared with age- and gender-matched patients without fractures, in terms of morbidity and mortality. Ten years of follow-up showed that the survival of patients with an isolated pubic ramus fracture was significantly lower than that of controls. The mortality rates of patients with isolated pubic ramus fractures at 1, 5 and 10 years were 24.7%, 64.4% and 93.8%, respectively. One-third of the mortality was due to cardiovascular events. A 20.2% complication rate was found during hospital admission, mainly caused by infectious diseases, including urinary tract infection and pneumonia. Thirty-three percent of the patients were temporarily or permanently admitted to a nursing home, because they were unable to mobilise independently.

In conclusion, our study found significant morbidity and mortality among patients admitted to hospital for an isolated pubic ramus fracture, both during hospital admission and during 10 years of follow-up.

Introduction

Patients with solitary pubic ramus fractures are generally treated on an outpatient basis with pain relief and mobilisation at home. In some cases, however, temporary admission to a hospital may be necessary, because of inadequate pain treatment and lack of opportunity to mobilise independently at home.

The prevalence of patients with pubic ramus fractures is increasing.6, 12 In addition, we have seen an increase in patients needing hospitalisation for fractures of the pubic ramus in recent years, which has been confirmed by other authors.1, 6, 10 For these patients not only considerable resources are consumed during hospitalisation, but after hospital discharge there is also a substantial need for home care services.8, 11

Although, isolated pubic ramus fractures in elderly people were previously considered a benign fracture in view of its inherent stability, recent studies indicate considerable morbidity and mortality.2, 4, 8, 11 However, while previous studies have reported substantial mortality rates in trauma patients who sustained pubic ramus fractures, this elderly patient population generally does not have a considerable life expectancy prior to sustaining the pubic ramus fracture.9, 14 Two studies have compared the mortality rate with that of an age-matched general population. Both studies reported increased morbidity and mortality rates in patients with pubic ramus fractures, although cause of this increased mortality was not reported. In addition, these studies also included patients who sustained other fractures besides those of the pubic rami.4, 16 In this study we addressed two important remaining questions: what is the mortality for isolated pubic ramus fractures in an elderly population admitted to hospital compared with age- and gender-matched hospitalised controls, and what are the causes of mortality and morbidity in hospital and after discharge? These questions are important to answer since we hypothesised that total mortality in patients with isolated pubic ramus fractures would be higher than that of a matched group and that this increase would be mainly related to overall worse medical and cardiovascular conditions. We therefore undertook a case–control study comparing morbidity and mortality rates among hospitalised patients with isolated pubic ramus fractures.

Section snippets

Patients and methods

The study included all consecutive patients with pubic ramus fractures admitted to the Department of Traumatology of the Maastricht University Medical Centre between January 1994 and December 2007 who met the inclusion and exclusion criteria. Individuals were only included in the study when they had sustained an isolated single pubic ramus fracture due to a low energy trauma and were over 60 years of age. Radiographs were analyzed for the configuration of the fracture. Clinical presentation

Results

Over the 14-year inclusion period, we identified 99 patients with a pubic ramus fracture, with a mean age of 80.1 (range: 60–98) years. The characteristics of the pubis fracture group and the control group were comparable. There was a clear predominance of women (n = 88 (88.9%)).

In the vast majority of patients (n = 90 (90.9%)), the cause of the fracture was a simple fall in or around the house. During their admission, 20 patients (20.2%) had serious complications directly attributable to the

Discussion

Our study demonstrates the importance of frailty fractures of the pubic ramus in elderly patients as a marker of subsequent increased morbidity and mortality. To our knowledge, this study is the first to use an extended follow-up of 10 years with specific information of the cause of morbidity and mortality in a matched case–control study. Our findings indicate significant morbidity and mortality after an isolated fracture of the pubic ramus for a patient requiring admission to a hospital.

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