Geriatrische Beckenringfrakturen durch Niedrigrasanztraumen: Behandlung und Auswirkungen auf die Lebensqualität im 12 Monats Follow Up.

Introduction Due to an aging population in industrialized nations, geriatric fractures are increasing [7, 63]. Pelvic ring fragility fracture (FFP) represents a poorly studied injury of old age due to its low incidence. However, in recent years, due to improved radiological diagnostics and increased research, interest in this particular clinical picture has increased. Nevertheless, prospective studies investigating the impact of these pelvic fractures on the patients' quality of life are still lacking. Methods Data from patients older than 60, who suffered a pelvic ring fracture, was acquired from 2012 to 2016. The fracture had to have been caused by a simple fall or due to pathology. These patients were assessed using the IADL score, Barthel Index, and Harris Hip Score to assess their quality of life at the time before hospital admission, at hospital admission, and at discharge. These tests were repeated prospectively at six weeks, six months, and twelve months after discharge from the hospital. In addition, at each point in time patients were asked to report their subjective health status as a percentage and as pain on the VAS scale. The Harris Hip Score was collected only at discharge and after six weeks. Results The study shown here, included a total of 134 patients, with an average age of 80 years. The fractures can be further subclassified, according to "AO" classifications. We then find, that 44 patients sustained a type A fracture, while 83 patients sustained a type B fracture and 7 patiets a type C fracture. If we apply Rommens/ Hofmann classification system, 41 patients were diagnosed with a FFP type 1 fracture, 81 patients had an FFP type 2 fracture, 10 patients had an FFP type 3 fracture, and only 2 patients had an FFP type 4 fracture. Looking at the IADL score for all patients, the score before the fracture occured, is at 6 points, at admission it is at 2 points and then increases again to 4 points by the 12 month follow-up. The difference is highly significant. The Barthel Index shows the same trajectory Here, the initial value is at 95 points, drops to 35 points at the time of admission and is at 80 points after 12 months. This is again, a significant difference. The Harris Hip Score, measured at patient discharge and after 6 weeks, shows a significant increase within this period (44 to 66 points). The daily score, which was first measured at admission and reported at 50%, increased to 65%, after 12 months, as reported by the patients If the patient collective is divided according to "AO" classification or according to Rommens/ Hofmann (FFP), similar progressions are shown. Only the IADL in the group "AO type A" and "FFP type 1" show no negative development within one year. The Barthel Index in the group "FFP Type 1" has also no significant difference between "baseline" and control after 12 months. Conclusion Based on the described data, pelvic fractures, due to a minor fall or pathological fracture have a significant impact on the quality of life of geriatric patients. As expected, quality of life decreases sharply acutely after the fracture event, improves most during the first weeks, and increases only slowly thereafter, without reaching the number before the fracture event. This trend is evident in all scores collected. Interestingly, patients rate themselves worse after one year than reflected by the measured scores. These observations lead to the conclusion that the treatment of elderly patients after pelvic fracture does not end with acute care, but that great attention must be paid to further rehabilitation. Treatment must be interdisciplinary in the hospital in order to do justice to this complex clinical picture.