Osteoporotic pubic rami fracture: a benign injury?
DOI:
https://doi.org/10.31053/1853.0605.v75.n1.16596Keywords:
osteoporotic fracture, osteoporotic rami fracture, elderly, morbilityAbstract
Objective: We analized patients treated for osteoporotic rami fractures in our hospital.
Methods: We examined the records of patients presenting to the emergency department with osteoporotic low-impact rami fractures. We describe demographic, previously ambulatory ability, diagnosis, associated injuries, comorbility, complications and 1 year mortality.
Results: 60 patients (51 women) with a mean age of 83,5 (range, 65,1-99) years had osteoporotic rami fracture. Six patients had previously a rami fracture and 23 a osteoporotic fracture. 27 patients associated other pelvic fracture. Three pacientes had other extrapelvic fracture and six a craneoencephalic trauma. 41 patients had any complication at follow up. Eigth patients (13,3%) were admitted to hospital with a median length of stay in the hospital of 18 days. Eight (13,3%) patients died within 1 year of injury.
Conclusions: Low-impact rami fractures affect predominantly elderly women with pre-existing comorbidities. A substantial amount of complications are described in this fractures with a high 1 year mortality. Early rehabilitation therapy with adequate analgesic therapy should be recommended.
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[1] Pohlemann T, Tscherne H, Baumgärtel F, Egbers HJ, Euler E, Maurer F, et al. Pelvic fractures: epidemiology, therapy and long-term outcome. Overview of the multicenter study of the Pelvis Study Group. Unfallchirurg 1996;99:160–7.
[2] Morris RO, Sonibare A, Green DJ, Masud T. Closed pelvic fractures: characteristics and outcomes in older patients admitted to medical and geriatric wards. Postgrad Med J 2000;76:646–50.
[3] Kannus P, Palvanen M, Niemi S, Parkkari J, Järvinen M. Epidemiology of osteoporotic pelvic fractures in elderly people in Finland: sharp increase in 1970-1997 and alarming projections for the new millennium. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 2000;11:443–8. doi:10.1007/s001980070112.
[4] Hill RM, Robinson CM, Keating JF. Fractures of the pubic rami. Epidemiology and five-year survival. J Bone Joint Surg Br 2001;83:1141–4.
[5] Taillandier J, Langue F, Alemanni M, Taillandier-Heriche E. Mortality and functional outcomes of pelvic insufficiency fractures in older patients. Jt Bone Spine Rev Rhum 2003;70:287–9.
[6] Browner WS, Pressman AR, Nevitt MC, Cummings SR. Mortality following fractures in older women. The study of osteoporotic fractures. Arch Intern Med 1996;156:1521–5.
[7] Instituto Aragonés de Estadística - Departamentos y Organismos Públicos - Gobierno de Aragón n.d. http://www.aragon.es/iaest (accessed January 15, 2015).
[8] Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet 2002;359:1761–7. doi:10.1016/S0140-6736(02)08657-9.
[9] Koval KJ, Aharonoff GB, Schwartz MC, Alpert S, Cohen G, McShinawy A, et al. Pubic rami fracture: a benign pelvic injury? J Orthop Trauma 1997;11:7–9.
[10] Mears SC, Berry DJ. Outcomes of displaced and nondisplaced pelvic and sacral fractures in elderly adults. J Am Geriatr Soc 2011;59:1309–12. doi:10.1111/j.1532-5415.2011.03455.x.
[11] Isler B, Ganz R. Classification of pelvic ring injuries. Injury 1996;27 Suppl 1:S – A3–12.
[12] Kanberoglu K, Kantarci F, Cebi D, Yilmaz MH, Kurugoglu S, Bilici A, et al. Magnetic resonance imaging in osteomalacic insufficiency fractures of the pelvis. Clin Radiol 2005;60:105–11. doi:10.1016/j.crad.2004.04.021.
[13] Renner JB. Pelvic insufficiency fractures. Arthritis Rheum 1990;33:426–30.
[14] Lau T, Leung F. Occult posterior pelvic ring fractures in elderly patients with osteoporotic pubic rami fractures. J Orthop Surg Hong Kong 2010;18:153–7.
[15] Cosker TDA, Ghandour A, Gupta SK, Tayton KJJ. Pelvic ramus fractures in the elderly: 50 patients studied with MRI. Acta Orthop 2005;76:513–6. doi:10.1080/17453670510044634.
[16] Finiels H, Finiels PJ, Jacquot JM, Strubel D. [Fractures of the sacrum caused by bone insufficiency. Meta-analysis of 508 cases]. Presse Médicale Paris Fr 1983 1997;26:1568–73.
[17] Dodge G, Brison R. Low-impact pelvic fractures in the emergency department. CJEM 2010;12:509–13.
[18] Tornetta P, Hochwald N, Levine R. Corona mortis. Incidence and location. Clin Orthop 1996:97–101.
[19] Kong W-M, Sun C-K, Tsai I-T. Delayed presentation of hypovolemic shock after a simple pubic ramus fracture. Am J Emerg Med 2012;30:2090.e1–4. doi:10.1016/j.ajem.2011.12.030.
[20] Macdonald DJM, Tollan CJ, Robertson I, Rana B, Rana BS. Massive haemorrhage after a low-energy pubic ramus fracture in a 71-year-old woman. Postgrad Med J 2006;82:e25. doi:10.1136/pgmj.2006.047381.
[21] Mouzopoulos G, Tzurbakis M, Mouzopoulos D, Ierodiakonou V, Tsembeli A, Georgilas I. Massive haemorrhage due to minimally displaced pubic ramus fracture. Eur J Emerg Med Off J Eur Soc Emerg Med 2009;16:271–2. doi:10.1097/MEJ.0b013e3282f20e0c.
[22] Krappinger D, Struve P, Schmid R, Kroesslhuber J, Blauth M. Fractures of the pubic rami: a retrospective review of 534 cases. Arch Orthop Trauma Surg 2009;129:1685–90. doi:10.1007/s00402-009-0942-5.
[23] Beall DP, Datir A, D’Souza SL, D’Souza LS, Gunda D, Morelli J, et al. Percutaneous treatment of insufficiency fractures?: principles, technique and review of literature. Skeletal Radiol 2010;39:117–30. doi:10.1007/s00256-009-0722-x.
[24] Beall DP, D’Souza SL, Costello RF, Prater SD, Van Zandt BL, Martin HD, et al. Percutaneous augmentation of the superior pubic ramus with polymethyl methacrylate: treatment of acute traumatic and chronic insufficiency fractures. Skeletal Radiol 2007;36:979–83. doi:10.1007/s00256-007-0313-7.
[25] Kamysz J, Rechitsky M. Pubic bone cement osteoplasty for pubic insufficiency fractures. J Vasc Interv Radiol JVIR 2008;19:1386–9. doi:10.1016/j.jvir.2008.05.026.
[26] Carpintero P, Caeiro JR, Carpintero R, Morales A, Silva S, Mesa M. Complications of hip fractures: A review. World J Orthop 2014;5:402–11. doi:10.5312/wjo.v5.i4.402.
[27] Gänsslen A, Krettek C. Retrograde transpubic screw fixation of transpubic instabilities. Oper Orthop Traumatol 2006;18:330–40. doi:10.1007/s00064-006-1181-3.
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