Complications, Blood Transfusion Prediction, and Long-Term Survival in Elderly Patients with Pubic Rami Fractures

The elderly population is steadily increasing, concurrently with the incidence of pubic rami fractures (PRFs), impacting function, morbidity and mortality. We aimed to assess functional background, clinical course, hemoglobin decline, transfusion needs, complications, and long-term survival.

A retrospective cohort study. Data was collected from patients hospitalized in a geriatric internal medicine ward, due to PRFs between 2012 and 2022. Demographic, clinical, and outcome data were recorded and analyzed.

The study comprised 165 patients, mean age 85.9±6.4 years; 138 (83.6%) were women, 133 (80%) had experienced at least one PRF, an additional 32 cases had experienced another pelvic fracture. Functionally, 76 (46%) were independent, 49 (29.7%) partially dependent, and 40 (24.2%) fully dependent. Cognitively, 106 (64.2%) were preserved, 29 (17.6%) experienced a cognitive decline, and 30 (18.2%) suffered from dementia. The complication rate was 15.1%, half from infectious diseases. One-year mortality was 20%. The average maximum decrease in hemoglobin occurred 4.4 days post-fracture, with a difference in average admission hemoglobin between those who required blood transfusions and those who did not (9.81 g/dL and 12.06 g/dL) (p=0.0001). Almost 10% of the elderly needed blood transfusions. Logistic regression analysis identified two independent predictors for blood transfusions: an admission hemoglobin level <10 g/dL and the presence of cognitive decline or dementia. The model showed high accuracy, with a ROC AUC of 0.885, sensitivity of 0.875, and specificity of 0.792. Over half of the patients returned home; 35% were transferred to rehabilitation facilities.

This study provides new and important information on PRFs in the elderly. We recommend closely monitoring these patients because of complications, functional decline, need for rehabilitation, and the high risk of significant blood loss peaking several days post-fracture, thereby, requiring transfusions, particularly, in elderly individuals suffering from cognitive decline or dementia and low initial hemoglobin.