Related Experiment Video
Updated: Nov 10, 2025
Method and Instrumented Fixture for Femoral Fracture Testing in a Sideways Fall-on-the-Hip Position
Published on: August 17, 2017
Factors associated with mortality in older patients sustaining pelvic or acetabular fractures
Anna Harrison1,2, Alejandro Ordas-Bayon3, Mukai Chimutengwende-Gordon3
1Division of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. anna.harrison360@gmail.com.
Insights
Delaying surgery for pelvic or acetabular fractures in older patients did not increase 1-year mortality. However, delayed surgery correlated with longer hospital stays and polytrauma, with age and comorbidities being key mortality predictors.
Area of Science:
- Geriatric Trauma Surgery
- Orthopedic Surgery
- Traumatology
Background:
- Pelvic or acetabular (PA) fractures pose significant mortality risks in older adults.
- Investigating factors influencing outcomes, particularly surgical timing, is crucial for this demographic.
Purpose of the Study:
- To examine the impact of delayed surgical stabilization on 1-year mortality in elderly patients with PA fractures.
- To identify predictors of mortality in this patient cohort.
Main Methods:
- Retrospective review of the UK Trauma Audit and Research Network (TARN) database (2015-2019).
- Inclusion of patients aged 65+ with surgically treated PA fractures.
- Statistical analysis including Chi-squared, Fisher, Kaplan-Meier, and Cox proportional hazard models to compare mortality based on surgical timing (within vs. after 72 hours) and identify predictors.
Main Results:
- No statistically significant difference in 1-year mortality between patients operated on within or after 72 hours.
- Delayed surgery ( >72 hours) was associated with longer hospital stays (p=0.002) and higher incidence of polytrauma (p=0.025).
- Age, Charlson Comorbidities Index (CCI), and pre-operative mobility were significant predictors of overall mortality.
Conclusions:
- Surgical intervention within 72 hours did not decrease 1-year mortality for older patients with PA fractures.
- The 1-year mortality rate for these fractures is comparable to hip fractures.
- A multidisciplinary approach involving orthogeriatric and PA surgical specialists is recommended for optimal patient management.
Introduction:
This study aimed to investigate potential factors, including delay to surgical stabilisation, affecting mortality in older patients sustaining pelvic or acetabular (PA) fractures.
Materials And Methods:
A retrospective review of the Trauma Audit and Research Network (TARN) database was performed to identify older patients (aged 65 and over) sustaining PA fractures treated surgically in a UK Major Trauma Centre (MTC) between 2015 and 2019. Chi-squared and Fisher tests were used to compare 1-year mortality rates following operative intervention between patients treated within 72 h and after 72 h. Kaplan-Meier curves were used to visualise survival probability; significant predictors of survival were found using Cox proportional hazard models.
Results:
Of 564 older patients with PA fractures, 70 met the inclusion criteria. The mean age was 76.1 years. The overall 1-year mortality rate was 20%. When patients were grouped by time to surgery (fracture fixation within or greater than 72 h), there was no statistically significant difference in 1-year mortality. Patients whose surgery was delayed more than 72 h were more likely to have longer hospital stays (p = 0.002) or to have suffered from polytrauma (p = 0.025). Age, Charlson Co-morbidities Index (CCI) and pre-op mobility status were associated with statistically significant differences in overall mortality. The same factors were associated with a significantly increased hazard of death in the multivariate Cox proportional hazards model. Patient gender, mechanism of injury, Injury Severity Score (ISS) > 15 and head injury were not significant predictors of mortality.
Conclusion:
Surgical intervention within 72 h of injury did not result in decreased mortality in older patients with PA fractures. The 1-year mortality rate between older PA fractures and hip fractures was comparable. Consideration should be given to a combined multidisciplinary approach between orthogeriatric and expert PA surgeons for these patients.
More Related Videos
Related Concept Videos
01:29Bone Disorders
Bone deposition is also affected by the levels of sex hormones like estrogen and testosterone that promote osteoblast activity and bone matrix synthesis. When the level of these hormones decreases due to aging, it causes a reduction in bone deposition. As a result, bone resorption by osteoclasts...
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:09Changes in the Appendicular Skeleton with Age
Initially, the limb buds consist of a core of mesenchyme covered by a layer of ectoderm. The ectoderm at the end of the limb bud thickens to form a narrow crest called the apical ectodermal ridge. This ridge stimulates the underlying...
01:24Flail Chest-I
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
01:16Bones of the Lower Limb: Femur and Patella