Abstract：
Pelvic ring fractures in the elderly are often caused by minor trauma. Treatment of these patients is currently based on fracture classification, clinical course, and ability to mobilize. Our aim was to identify morphological fracture characteristics with potential prognostic relevance and evaluate their association with clinical decision making and outcome, as well as their interobserver reliability.
Five fracture characteristics were investigated as potential variables: 1. Extent of the dorsal pelvic ring fracture (absent, unilateral, bilateral); 2. Extent of the ventral pelvic ring fracture (absent, unilateral, bilateral); 3. Presence of a horizontal sacral fracture; 4. Ventral dislocation; 5. Ventral comminution. These characteristics were assessed retrospectively in a series of 548 patients. The association of their presence with the decision to perform surgery, failure of conservative treatment and the length of hospital stay (LOS) was determined. Further, the inter-observer reliability for the specific characteristics was calculated and the relation with survival assessed.
Four of the five evaluated characteristics showed an association with clinical decision making and patient management. In particular the extent of the dorsal fractures (absent vs. unilateral vs. bilateral) (OR = 7.0; p < 00.1) and the presence of ventral comminution/dislocation (OR = 2.4; p = 0.004) were independent factors for the decision to perform surgery. Both the extent of the dorsal fracture (OR = 1.8; p < 0.001) and the presence of ventral dislocation (OR = 1.7; p = 0.003) were independently associated with a prolonged overall LOS. The inter-observer agreement for the fracture characteristics ranged from moderate to substantial. A relevant association with increased mortality was shown for horizontal sacral and comminuted ventral fractures with hazard ratios (HR) of 1.7 (95% CI: 1.1, 2.5; p = 0.008) and HR = 1.5 (95% CI: 1.0, 2.2; p = 0.048).
In the elderly, the extent of the dorsal fractures and the presence of ventral comminution/dislocation were associated to the decision to undergo surgery, failure of conservative treatment and length of stay. Survival was related to horizontal sacral fractures and ventrally comminuted fractures. These characteristics thus represent a simplified but highly informative approach for the evaluation of pelvic ring fractures in the elderly. This approach can support clinical decision making, promote patient-centred treatment algorithms and thus improve the outcome of individualized care.
Five fracture characteristics were investigated as potential variables: 1. Extent of the dorsal pelvic ring fracture (absent, unilateral, bilateral); 2. Extent of the ventral pelvic ring fracture (absent, unilateral, bilateral); 3. Presence of a horizontal sacral fracture; 4. Ventral dislocation; 5. Ventral comminution. These characteristics were assessed retrospectively in a series of 548 patients. The association of their presence with the decision to perform surgery, failure of conservative treatment and the length of hospital stay (LOS) was determined. Further, the inter-observer reliability for the specific characteristics was calculated and the relation with survival assessed.
Four of the five evaluated characteristics showed an association with clinical decision making and patient management. In particular the extent of the dorsal fractures (absent vs. unilateral vs. bilateral) (OR = 7.0; p < 00.1) and the presence of ventral comminution/dislocation (OR = 2.4; p = 0.004) were independent factors for the decision to perform surgery. Both the extent of the dorsal fracture (OR = 1.8; p < 0.001) and the presence of ventral dislocation (OR = 1.7; p = 0.003) were independently associated with a prolonged overall LOS. The inter-observer agreement for the fracture characteristics ranged from moderate to substantial. A relevant association with increased mortality was shown for horizontal sacral and comminuted ventral fractures with hazard ratios (HR) of 1.7 (95% CI: 1.1, 2.5; p = 0.008) and HR = 1.5 (95% CI: 1.0, 2.2; p = 0.048).
In the elderly, the extent of the dorsal fractures and the presence of ventral comminution/dislocation were associated to the decision to undergo surgery, failure of conservative treatment and length of stay. Survival was related to horizontal sacral fractures and ventrally comminuted fractures. These characteristics thus represent a simplified but highly informative approach for the evaluation of pelvic ring fractures in the elderly. This approach can support clinical decision making, promote patient-centred treatment algorithms and thus improve the outcome of individualized care.
摘要：
老年人的骨盆环骨折通常是由轻微的创伤引起的。这些患者的治疗目前基于骨折分类，临床课程，和动员能力。我们的目的是确定具有潜在预后相关性的形态学骨折特征，并评估其与临床决策和结果的关联。以及他们的观察者间可靠性。
研究了五个断裂特征作为潜在变量:1.骨盆背侧环骨折的程度（无，单边,双边)；2。骨盆腹环骨折的程度（无，单边,双边)；3。水平骶骨骨折的存在；4.腹侧脱位；5.腹侧粉碎。在一系列548例患者中对这些特征进行了回顾性评估。他们的存在与进行手术的决定相关联，确定保守治疗失败和住院时间(LOS).Further,计算了特定特征的观察者间可靠性,并评估了与生存的关系.
五个评估特征中有四个与临床决策和患者管理相关。特别是背侧骨折的程度（缺失与单边vs.双侧）（OR=7.0；p<00.1）和腹侧粉碎/脱位的存在（OR=2.4；p=0.004）是决定进行手术的独立因素。背侧骨折的程度（OR=1.8；p<0.001）和腹侧脱位的存在（OR=1.7；p=0.003）与总LOS延长独立相关。观察者之间对骨折特征的一致性从中度到实质性。水平骶骨和粉碎性腹侧骨折与死亡率增加相关，风险比（HR）为1.7（95％CI：1.1，2.5；p=0.008）和HR=1.5（95％CI：1.0，2.2；p=0.048）。
在老年人中,背侧骨折的程度和腹侧粉碎性/脱位的存在与决定接受手术有关。保守治疗失败和住院时间。生存率与水平骶骨骨折和腹侧粉碎性骨折有关。因此，这些特征代表了评估老年人骨盆环骨折的简化但信息量大的方法。这种方法可以支持临床决策，促进以患者为中心的治疗算法，从而改善个性化护理的结果。
研究了五个断裂特征作为潜在变量:1.骨盆背侧环骨折的程度（无，单边,双边)；2。骨盆腹环骨折的程度（无，单边,双边)；3。水平骶骨骨折的存在；4.腹侧脱位；5.腹侧粉碎。在一系列548例患者中对这些特征进行了回顾性评估。他们的存在与进行手术的决定相关联，确定保守治疗失败和住院时间(LOS).Further,计算了特定特征的观察者间可靠性,并评估了与生存的关系.
五个评估特征中有四个与临床决策和患者管理相关。特别是背侧骨折的程度（缺失与单边vs.双侧）（OR=7.0；p<00.1）和腹侧粉碎/脱位的存在（OR=2.4；p=0.004）是决定进行手术的独立因素。背侧骨折的程度（OR=1.8；p<0.001）和腹侧脱位的存在（OR=1.7；p=0.003）与总LOS延长独立相关。观察者之间对骨折特征的一致性从中度到实质性。水平骶骨和粉碎性腹侧骨折与死亡率增加相关，风险比（HR）为1.7（95％CI：1.1，2.5；p=0.008）和HR=1.5（95％CI：1.0，2.2；p=0.048）。
在老年人中,背侧骨折的程度和腹侧粉碎性/脱位的存在与决定接受手术有关。保守治疗失败和住院时间。生存率与水平骶骨骨折和腹侧粉碎性骨折有关。因此，这些特征代表了评估老年人骨盆环骨折的简化但信息量大的方法。这种方法可以支持临床决策，促进以患者为中心的治疗算法，从而改善个性化护理的结果。
