Skip to main content
NCBI home page
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 2000 Oct;76(900):646–650. doi: 10.1136/pmj.76.900.646

Closed pelvic fractures: characteristics and outcomes in older patients admitted to medical and geriatric wards

R Morris 1, A Sonibare 1, D Green 1, T Masud 1
PMCID: PMC1741752  PMID: 11009580

Abstract

OBJECTIVE—To investigate the characteristics and outcomes of older patients with pelvic fracture admitted to medical and geriatric wards.
METHODS—All patients admitted to medical and geriatric wards with a pelvic fracture over a four year period were identified using the hospital clinical coding database. Data were collected from casenotes, hospital and Family Health Services Authority databases. Where available, pelvic radiographs were graded according to the Singh index.
RESULTS—The casenotes of 148 patients (126 women) were studied; 83% (n=123) of patients suffered a pelvic fracture in low energy trauma. Mean (SD) length of hospital stay was 21.3 (17.6) days. Single breaks of the pubic rami accounted for 47.2% (n=68) of all fractures. Inpatient mortality was 7.6% and at one year was 27%. There was a marked adverse effect on the mobility of survivors with all patients using at least a walking stick at discharge and 51.1% (n=70) needing assistance for mobility. Although 70.9% (n=83) of patients admitted from home (or warden aided accommodation) were able to return there, 84.3% (n=70) of them required extra community support. Rates of institutionalisation rose from 20.9% (n=31) at admission to 35.8% (49/137) of survivors at discharge. Altogether 93% (n=107) of 115 patients, in whom adequate quality pelvic radiographs were available, were assigned a Singh index grade of 4 or less indicating the presence of osteoporosis.
CONCLUSIONS—Pelvic fractures are often the result of low energy trauma. They are associated with appreciable inpatient and considerable one year mortality. They also have marked negative effects on mobility in the short term. They result in increased levels of dependency in terms of higher levels of community support and rates of institutionalisation. On the evidence of Singh index grading, pelvic fractures are associated with low bone density.


Keywords: pelvis; fractures; elderly; Singh index

Full Text

The Full Text of this article is available as a PDF (132.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aharonoff G. B., Dennis M. G., Elshinawy A., Zuckerman J. D., Koval K. J. Circumstances of falls causing hip fractures in the elderly. Clin Orthop Relat Res. 1998 Mar;(348):10–14. [PubMed] [Google Scholar]
  2. Browner W. S., Pressman A. R., Nevitt M. C., Cummings S. R. Mortality following fractures in older women. The study of osteoporotic fractures. Arch Intern Med. 1996 Jul 22;156(14):1521–1525. [PubMed] [Google Scholar]
  3. Campbell A. J., Borrie M. J., Spears G. F., Jackson S. L., Brown J. S., Fitzgerald J. L. Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study. Age Ageing. 1990 Mar;19(2):136–141. doi: 10.1093/ageing/19.2.136. [DOI] [PubMed] [Google Scholar]
  4. Campbell A. J., Reinken J., Allan B. C., Martinez G. S. Falls in old age: a study of frequency and related clinical factors. Age Ageing. 1981 Nov;10(4):264–270. doi: 10.1093/ageing/10.4.264. [DOI] [PubMed] [Google Scholar]
  5. Cooper C., Barker D. J., Hall A. J. Evaluation of the Singh index and femoral calcar width as epidemiological methods for measuring bone mass in the femoral neck. Clin Radiol. 1986 Mar;37(2):123–125. doi: 10.1016/s0009-9260(86)80378-6. [DOI] [PubMed] [Google Scholar]
  6. Cumming R. G., Klineberg R. J. Fall frequency and characteristics and the risk of hip fractures. J Am Geriatr Soc. 1994 Jul;42(7):774–778. doi: 10.1111/j.1532-5415.1994.tb06540.x. [DOI] [PubMed] [Google Scholar]
  7. Disen A., Frey H. M., Langholm R., Vågslid T. Appearance of trabecular bone in the femoral neck (Singh index). Relation to vertebral bone mass post mortem. Acta Radiol Diagn (Stockh) 1979;20(2):372–378. doi: 10.1177/028418517902000209. [DOI] [PubMed] [Google Scholar]
  8. Eid A. M. Fractures of the pelvis. Postgrad Med J. 1983 Sep;59(695):560–565. doi: 10.1136/pgmj.59.695.560. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Horsman A., Nordin B. E., Simpson M., Speed R. Cortical and trabecular bone status in elderly women with femoral neck fracture. Clin Orthop Relat Res. 1982 Jun;(166):143–151. [PubMed] [Google Scholar]
  10. Jarnlo G. B., Thorngren K. G. Background factors to hip fractures. Clin Orthop Relat Res. 1993 Feb;(287):41–49. [PubMed] [Google Scholar]
  11. Keene G. S., Parker M. J., Pryor G. A. Mortality and morbidity after hip fractures. BMJ. 1993 Nov 13;307(6914):1248–1250. doi: 10.1136/bmj.307.6914.1248. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Masud T., Jawed S., Doyle D. V., Spector T. D. A population study of the screening potential of assessment of trabecular pattern of the femoral neck (Singh index): the Chingford Study. Br J Radiol. 1995 Apr;68(808):389–393. doi: 10.1259/0007-1285-68-808-389. [DOI] [PubMed] [Google Scholar]
  13. Melton L. J., 3rd, Sampson J. M., Morrey B. F., Ilstrup D. M. Epidemiologic features of pelvic fractures. Clin Orthop Relat Res. 1981 Mar-Apr;(155):43–47. [PubMed] [Google Scholar]
  14. Michelson J. D., Myers A., Jinnah R., Cox Q., Van Natta M. Epidemiology of hip fractures among the elderly. Risk factors for fracture type. Clin Orthop Relat Res. 1995 Feb;(311):129–135. [PubMed] [Google Scholar]
  15. Pogrund H., Rigal W. M., Makin M., Robin G., Menczel J., Steinberg R. Determination of osteoporosis in patients with fractured femoral neck using the Singh index: a Jerusalem study. Clin Orthop Relat Res. 1981 May;(156):189–195. [PubMed] [Google Scholar]
  16. Prudham D., Evans J. G. Factors associated with falls in the elderly: a community study. Age Ageing. 1981 Aug;10(3):141–146. doi: 10.1093/ageing/10.3.141. [DOI] [PubMed] [Google Scholar]
  17. Rossvoll I., Finsen V. Mortality after pelvic fractures in the elderly. J Orthop Trauma. 1989;3(2):115–117. doi: 10.1097/00005131-198906000-00005. [DOI] [PubMed] [Google Scholar]
  18. Singh M., Nagrath A. R., Maini P. S. Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg Am. 1970 Apr;52(3):457–467. [PubMed] [Google Scholar]
  19. Singh M., Riggs B. L., Beabout J. W., Jowsey J. Femoral trabecular-pattern index for evaluation of spinal osteoporosis. Ann Intern Med. 1972 Jul;77(1):63–67. doi: 10.7326/0003-4819-77-1-63. [DOI] [PubMed] [Google Scholar]
  20. Tinetti M. E., Speechley M., Ginter S. F. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988 Dec 29;319(26):1701–1707. doi: 10.1056/NEJM198812293192604. [DOI] [PubMed] [Google Scholar]
  21. Tinetti M. E., Williams C. S. Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med. 1997 Oct 30;337(18):1279–1284. doi: 10.1056/NEJM199710303371806. [DOI] [PubMed] [Google Scholar]
  22. van Weel C., Vermeulen H., van den Bosch W. Falls, a community care perspective. Lancet. 1995 Jun 17;345(8964):1549–1551. doi: 10.1016/s0140-6736(95)91091-3. [DOI] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES