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“Most people think that hip fractures are dangerous for elderly patients, but not enough attention is given to falls that result in fractures to the pelvis. This article shows that, while mortality risks are higher for hip fractures, after five years, the mortality rate for hip fractures and fractures of the pubic rami are the same.”
EPIDEMIOLOGY AND FIVE-YEAR SURVIVAL
R. M. F. Hill, C. M. Robinson, J. F. Keating
From the Royal Infirmary of Edinburgh, Scotland
We reviewed 286 consecutive patients with a fracture of a pubic ramus. The overall incidence was 6.9/100 000/year in the total population and 25.6/100 000/year in individuals aged over 60 years. The mean age of the patients was 74.7 years and 24.5% suffered from dementia. Women were affected 4.2 times more often than men. After injury, geriatric rehabilitation was frequently required and although most surviving patients returned to their original place of residence, their level of mobility was often worse. The overall survival rates at one and five years were 86.7% and 45.6%, respectively. Multiple logistic regression analysis showed that age and dementia were the only independent significant factors to be predictive of mortality (p < 0.05).
Patients with a fracture of a pubic ramus had a significantly worse survival than an age-matched cohort from the general population (log-rank test, p < 0.001), but this was better than patients with a fracture of the hip during the first year after injury, although their subsequent mortality was higher. Five years after the fracture there was no significant difference in survival between the two groups.
J Bone Joint Surg [Br] 2001;83-B:1141-4.
Received 7 September 2000; Accepted after revision 4 May 2001
Fractures of a pubic ramus commonly occur in the elderly, and there is evidence that their incidence is increasing. Rehabilitation of such patients requires a multidisciplinary approach and places considerable demands on the restricted resources available. Currently, there is limited information about the epidemiology and prognosis of this injury. Expansion of this knowledge may be of value when planning health care for these patients. We have therefore documented the epidemiology and outcome of a consecutive series of patients with a fracture of the pubic ramus who were treated in our Unit. We also attempted to identify factors associated with a poor prognosis after this injury.
Patients and Methods
Patients with a fracture of a pubic ramus in the Lothian area are initially admitted for assessment to the acute orthopaedic wards of Edinburgh Royal Infirmary. The Unit has a well-defined adult catchment population and provides all the trauma care for it. Between January 1988 and December 1994, details of all patients with a fracture of a pubic ramus were recorded prospectively on a computer database. We subsequently reviewed all the medical records of these patients to obtain more detailed information about their functional status. This included the presence of dementia, the level of mobility before and after injury and their residential status. We also determined the duration of acute hospital stay and the requirement for geriatric orthopaedic rehabilitation. Radiographs were also analysed to verify the presence and configuration of the fracture.
Surviving patients were telephoned and interviewed to assess their residential status and their level of mobility at the time of follow-up. The mortality of those who had sustained a fracture of a pubic ramus was compared with that during the same period for two control groups. These comprised an age-matched cohort of Edinburgh residents from the general population (14 838 individuals of mean age 74.7 years) and residents who had sustained a fracture of the hip (4311 individuals of mean age 79.9 years). The data on mortality for all groups were obtained from the General Register Office for Scotland.
Statistical analysis. We compared the clinical details of the subgroups using one-way analysis of variance and Student’s t-test for numerical parametric data. We used the Mann-Whitney U test for numerical non-parametric and the chi-squared test for categorical data. We undertook a comparison of the information on mortality between the study group and the two control groups using a life-table analysis, with censorship at the end of the follow-up. The log-rank test was used to assess whether there were significant differences in survivorship between the groups.
