CT-based evaluation of volumetric bone density in fragility fractures of the pelvis—a matched case-control analysis
OBJECTIVE To evaluate 1-year mortality and functional outcomes after pelvic insufficiency fractures in older patients. PATIENTS AND METHODS Retrospective review of medical records of patients 65 years of age or older admitted to our geriatrics department for pelvic fracture related to bone insufficiency over a 10-year period (1990-1999). For each patient, we recorded the circumstances of the fracture, time to diagnosis and imaging studies needed for diagnosis, functional status, place of residence before and after the fracture, general health status, treatment, short-term outcome, complications if any, length of hospital stay, and 1-year outcome. RESULTS Sixty patients (54 women and 6 men) with a mean age of 83 +/- 7.1 years had 49 pubic rami fractures, 16 sacral fractures, and three acetabular fractures. The sacral fractures were usually found only by radionuclide bone scanning, so that time to diagnosis was longer. A history of fracture or risk factor for fracture was found in 45% of the patients. One patient died during the hospital stay. No thromboembolic events were recorded. Twenty-four patients experienced other intercurrent events (urinary retention, lower respiratory tract infection, or urinary tract infection). Mean hospital length of stay was 45 +/- 28 d overall and was longer in the subset of patients who were not fully self-sufficient before the fracture. At discharge, 50% of patients had not recovered their former level of self-sufficiency and 25% had to be institutionalized. The 1-year mortality rate was 14.3%. Pelvic insufficiency fractures are common in older patients. Although they are rarely life threatening, they deserve special attention as a source of functional disability.