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Lateral Compression Sacral Fractures Have Less Favourable Outcome Compared to Crescent Fractures in Patients Less
Abdullah Said Hammad1, Ghada Ahmed Abu-Sheasha2, Mahmoud Nafady1
1Department of Orthopaedics and Trauma, Faculty of Medicine, El-Hadara University Hospital, University of Alexandria, Egypt.
Insights
Younger patients with lateral compression pelvic ring injuries fare better with crescent fractures than sacral fractures, experiencing higher quality of life and a greater likelihood of returning to work.
Area of Science:
- Orthopedic Surgery
- Trauma Care
- Quality of Life Research
Background:
- Lateral compression (LC) injuries represent a significant portion of pelvic ring injuries (PRIs).
- Assessing long-term functional outcomes is crucial for managing these severe traumas.
Purpose of the Study:
- To compare health-related quality of life (HRQoL) outcomes in young patients (<50 years) with surgically treated LC crescent versus sacral fractures.
- To identify predictors of quality-adjusted life-years (QALYs) following high-energy pelvic trauma.
Main Methods:
- Retrospective review of 37 surgically treated PRI patients (December 2011 - January 2019).
- Utilized the EuroQoL-5D (EQ5D5L) questionnaire for HRQoL assessment.
- Employed multiple linear regression to analyze QALY predictors.
Main Results:
- Patients with crescent fractures reported higher QALYs (0.876 utility value) compared to those with sacral fractures (0.804 utility value).
- Sacral fracture patients had a lower return-to-work probability (71%) versus crescent fracture patients (increased by 40%).
Conclusions:
- Crescent fractures are associated with superior HRQoL and QALYs in young trauma patients compared to LC sacral fractures.
- LC sacral fractures significantly impede return to pre-injury work capacity.
Background:
Lateral compression (LC) accounts for a wide spectrum of pelvic ring injuries (PRIs). The primary aim of this study was to assess the health-related quality of life outcomes of surgically fixed LC crescent versus sacral fractures in patients less than 50 years old after high energy trauma.
Material And Methods:
We retrospectively reviewed the database for PRIs treated surgically from Decem-ber 2011 to January 2019 at our tertiary level trauma centre. The EuroQoL-5D (EQ5D5L) questionnaire was elec-tronically sent to all patients. Multiple linear regression was conducted to determine the predictors of quality-adjusted life-years (QALYs).
Results:
The study included 37 patients. The mean age was 26 SD 9.46 years. The mean duration of follow-up was 3.78 (r:1-9) years. Twenty-one (56.8%) and 16 (43.2%) patients sustained sacral fractures and crescent fractures, respectively. Multi-regression analysis showed that any patient with LC injury without a sacral fracture is expected to have a utility value of QALY= 0.876. A reduction of 0.072 units in QALYs is expected in the presence of sacral fracture. About 71% of patients with sacral fractures were able to return to work and this probability increased by 40% among patients with crescent fractures (RR=1.4, p=.015).
Conclusions:
1. Younger patients with crescent fractures tend to have better quality of life (higher EQ5D and QALYs) compared to those with LC sacral fractures. 2. Moreover, patients with LC sacral fractures have less chan-ce to return to their pre-injury level of work compared to those with crescent fractures.
