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Method and Instrumented Fixture for Femoral Fracture Testing in a Sideways Fall-on-the-Hip Position
Published on: August 17, 2017
Mortality following fragility fractures of the pelvis: Systematic review and meta-analysis
Norio Yamamoto1, Hidehiro Someko2, Yuki Nakashima3
1Department of Orthopedic Surgery, Minato Medical Coop-Kyoritsu General Hospital, Nagoya, Aichi 456-8611, Japan; Scientific Research WorkS Peer Support Group (SRWS-PSG), 1-7-7 Koraibashi, Chuo-ku, Osaka 541-0043, Japan.
Background:
Fragility fractures of the pelvis (FFPs) in older adults are increasingly recognized as serious injuries with substantial morbidity. However, mortality after FFP has not been comprehensively quantified across timepoints or patient subgroups, limiting the ability to inform prognosis and guide clinical strategies. This systematic review and meta-analysis aimed to assess the 1-year mortality following FFP in patients aged ≥60 years. We also assessed the mortality at 30 days, 3 months, 6 months, 2 years, and 5 years after FFP, and the differences in mortality by geographic region, sex, fracture classification, or treatment modality.
Methods:
We conducted a systematic review and meta-analysis of studies published from inception to May 2024 in MEDLINE, Embase, and CENTRAL databases. Eligible studies reported mortality outcomes in patients aged ≥60 years with FFP. A random-effects model was used to estimate pooled mortality at prespecified time points. We assessed the risk of bias using the Joanna Briggs Institute (JBI) Prevalence Critical Appraisal Tool. Subgroup analyses were conducted to assess differences by region, sex, fracture classification, and treatment modality. We conducted a sensitivity analysis including only the high-quality studies according to the JBI assessment. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.
Results:
The pooled 1-year mortality was 17 % (95 % confidence interval, 14 %-19 %). The certainty of this evidence was rated as low because of publication bias and heterogeneity. The mortality at 30 days, 3 months, 6 months, 2 years, and 5 years were 5 %, 10 %, 14 %, 26 %, and 46 %, respectively. Mortality was lower in studies from Asia than in those from Europe or North America. Male sex, lower-grade FFPs, and nonoperative management showed numerically higher mortality, though not statistically significant.
Conclusion:
FFPs are associated with substantial short- and long-term mortality, warranting their recognition as high-risk injuries in older adults. Regional and treatment-related variation highlights the need for individualized management. Future research should clarify causal mechanisms and assess targeted interventions to reduce mortality risk.
