Clinical outcomes in fragility fractures of the pelvis; what can we tell our patients?

Introduction: Fragility fractures of the pelvis (FFP) can have a profound impact on the older patient, yet the subjective recovery after a FFP is still relatively understudied. The aim of this prospective study was to evaluate patient reported outcome measures such as HRQoL and degree of pain in older patients sustaining an FFP.

Method: A prospective cohort study was conducted at the Northwest clinics in the Netherlands. Patients were included if they were aged 65 or older and sustained a FFP after a low impact trauma. Outcomes were the EuroQol 5D-5L (EQ-5D), pain, mobility, mortality, and complications. Data were acquired at day 1, day 7, day 30, and after 3- and 6-months post-trauma.

Results: Fifty-one patients were included between November 1, 2019 and November 29, 2020 with a median age of 82 years (P25-P75 74-87). The EQ-5D utility score decreased from 1.00 [0.85-1.00] pre-trauma to 0.33 [0.23-0.49] on day one post-trauma (p-value < 0.001) and returned to 0.85 [0.77-0.92] in the patients still alive after six months (n = 38). At day 1 post-trauma the median pain score during mobilization was 8 [6-8] and decreased to 4 [2-6] after 4 weeks. After 3 months post trauma 7 (16%) patients still experienced pain at rest and 17 (38%) patients during mobilization. All but one patient were initially treated non-operatively. Out of the 36 patients admitted to the hospital, 23 (64%) were institutionalized upon hospital discharge. After four weeks 74% of the patients were able to mobilize, most of them with a walker or crutches (86%). More than half of the patients suffered an adverse event (53%).

Conclusion: This study shows that HRQoL was significantly affected in patients with FFP. Also, it has a big impact on ambulation and independency of these patients. Both HRQoL and pain improve significantly after four weeks. This study provides valuable insights of the subjective recovery in patients with FFP and can be used for expectation management and to establish the natural course of FFP.