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Demographic changes in pelvic fracture patterns at a Swiss academic trauma center from 2007 to 2017
Karin Villiger1, Malin Kristin Meier, Rebecca Maria Hasler
1From the Department of Anesthesiology and Pain Therapy (K.V.), Inselspital, Bern University Hospital, University of Bern, Bern; Department of Orthopaedic Surgery and Traumatology (M.K.M., J.D.B., S.D.S.), Inselspital, Bern University Hospital, University of Bern, Bern; Department of Traumatology (R.M.H.), Zürich University Hospital, Zürich; Department of Orthopaedic Surgery and Traumatology (M.T.), Fribourg Cantonal Hospital, University of Fribourg, Fribourg; and Department of Emergency Medicine (A.K.E.), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Background:
Increasing life expectancy has led to higher incidence of fragility fractures of the pelvis. These demographic changes may have a direct impact on fracture patterns. The goal of this study was (1) to evaluate demographical trends in patients with pelvic ring injuries at a tertiary Swiss trauma center and (2) to analyze the influence on fracture patterns.
Methods:
We performed a retrospective cross-sectional study including 958 patients (mean ± SD age, 57 ± 21 years; 48% women) with a pelvic ring injury between 2007 and 2017. Fractures were classified according to Tile, Young and Burgess or Rommens and Hofmann (fragility fractures) using conventional and computer tomography imaging. Low-energy fractures were defined as fractures resulting from fall from standing height or less. Fracture classifications, age, sex, Injury Severity Score, and trauma mechanism were compared using analysis of variance or χ2 test. Cluster analysis was performed to identify groups with similarities in fracture patterns and demographic parameters.
Results:
From 2007 to 2017, the frequency of pelvic ring injuries increased by 115% (increase per decade), and mean age increased by 15% (p = 0.031). A trimodal age distribution was found; highest increase for fractures occurred in the older (265%) patient group. Low-energy fracture was the most common trauma mechanism (43% of all fractures, an increase of 249%). Changes in fracture pattern showed a disproportioned increase of lateral compression (LC) fractures (LC type 1 in 64%) or partially stable fracture (B2, with 39%). In patient older than 65 years, the strongest increase was found for nondisplaced posterior fractures with an overall prevalence of 62%. Five clusters were found with the most frequent cluster representing older female patients with low-energy fracture (LC, Tile type B) in 30%.
Conclusion:
The current results corroborate the trend of increasing frequency of fragility fractures in an aging society. The demographic shift has a direct impact on fracture pattern with a disproportionate increase in partially stable compression fracture of the pelvis.
Level Of Evidence:
Prognostic/Epidemiologic, Level III.