The impacts of surgically treated acetabular and pelvic fractures on return to work and to sports.

Background: Literature exploring impacts and quality of life limitations of pelvic ring and acetabular fracture is limited. The aim of the study is to evaluate the impact of pelvic ring and acetabular fracture on the return to work (RTW) and sports (RTS) and identify factors associated with difficulties to resume their previous activities.

Hypothesis: Patients with pelvic ring and acetabular fractures will experience difficulties to return to their previous occupation and physical activities.

Patients and methods: This is a retrospective cohort study reviewing the medical and radiological charts under IRB approbation. The patients were contacted for a final questionnaire assessing the RTW and the RTS at a minimum of two years follow-up. All patients admitted for a surgically treated pelvic ring and/or acetabulum fracture between 2009 and 2022 at a level 1 trauma center were included. For RTW, collected information covered an overview of the patients' employment situation and classifying it by level of occupational activity. Global physical activity level was assessed with the UCLA Hip Activity Scale. Other variables of interest included: concomitant injury, trauma type, pelvic ring fracture type, delay for final fracture stabilization, and complications. Initial analysis was carried out based on the ability to resume activities at the level before the trauma (success or failure). Uni- and multivariate analyzes were conducted to identify factors associated with a failed return to their activities.

Results: One hundred and thirteen patients completed the final questionnaire (73% men, average age 51 ± 16.7 years). Among 88 patients still employed at the time of the trauma, 57 patients had a difficult RTW (65%). Forty-eight patients had a difficult RTS (43%). Thirty-four patients (39%) never returned to work and 30 patients (27%) did not return to sports. The presence of other fractures within the initial trauma (OR 3.17; 95%CI 1.24-8.10; p = 0.014) and a concomitant traumatic brain injury (OR 3.78; 95%CI 1.27-11.27; p = 0.013) are significantly associated with a difficult RTW. The presence of marginal impaction on the acetabulum (OR = 7.3; p = 0.014, CI95% 1.44-37.16) is associated with a difficult RTS.

Discussion: Most patients with a surgically treated pelvic and acetabular fracture have a difficult RTW and RTS. Among the factors identified, few are modifiable. The study does not show influence of quality reduction on RTW and RTS.

Level of evidence: III; Retrospective cohort study.