A new study published in Age & Ageing finds pelvic fracture mortality rates equivalent to those for hip fracture, despite lack of attention or funding.
The study into osteoporotic pelvic fractures in older patients has shown worrying effects on mortality, length of hospital stay and independent living.
It finds that mortality rates for pelvic fractures are comparable to those for hip fractures, but that the issue receives far less attention or funding. It calls for new guidelines and better management of pelvic fractures in older people, helping them to maintain an independent life.
Yousif Shanshal and Sheena Waters, co-authors of the report, said:
“Pelvic fracture patients incur a high cost to an already stretched NHS, with increased lengths of stay and high mortality rates. They are usually frail elderly patients with multiple comorbidities, and often don’t regain normal function after their injury.
Following the work of the National Hip Fracture Database and the Best Practice Tariff, care for hip fracture patients has improved across the country. We now need to do the same thing for pelvic fracture patients.
It’s crucial that these patients are cared for by a geriatrician, in close liaison with their orthopaedic colleagues, and that a multi-disciplinary team is fully involved in each patient’s recovery and discharge.”
Professor Tahir Masud of the British Geriatrics Society’s Falls & Bone Health Special Interest Group, said:
“Although this is a small study and comes from a single hospital, it shows what many geriatricians have long suspected: that large numbers of patients with pelvic fractures do very poorly after they sustain their injury.
Part of this is probably to do with how we structure care. Because there is no operation for most pelvic fractures, it is possible that these patients receive less attention than those with hip fractures. We hope that further research and attention will be concentrated on the issue of osteoporotic pelvic fracture, and services developed to deal with these fractures appropriately.
This study from the team at Gateshead is a welcome call to arms for the profession, as well as to commissioners and funders: we must not let pelvic fracture become a forgotten issue.”
The study, a collaboration between the Queen Elizabeth Hospital in Gateshead and Newcastle University, was based on pelvic fracture patients aged 60 or over, and shows an in-patient mortality rate of 9% and an all-cause mortality rate within 3 months of 13%.
It also shows a reduction in independent living following pelvic fracture: on admission to hospital, 89% of patients lived independently, but this dropped to 64% at point of discharge.
The study concludes that further clinical work is needed, calling for broader research and national guidelines to support the management of osteoporotic pelvic fractures. It cites the recent success of national guidelines for hip fractures as a possible model to follow.
The full paper can be read here.