Retrospective Cohort Study
Copyright ©The Author(s) 2024.
World J Orthop. May 18, 2024; 15(5): 418-434
Published online May 18, 2024. doi: 10.5312/wjo.v15.i5.418
Table 1 General characteristics of patients with pelvic fractures, n (%)
Variable
Patients with pelvic fractures (n = 558)
Age, mean (SD)62.0 (22.6)
Geriatric291 (52.2)
Sex (Female/Male)284 (50.9) / 274 (49.1)
Comorbidities423 (75.8)
Anticoagulation152 (27.2)
Mechanism of injury-
    Fall204 (36.6)
    Motor vehicle (Pedestrian/Bicycle/Motorcycle)344 (61.6)
    Other (Assault, Crush)10 (1.8)
Glasgow coma scale, mean (SD)13.7 (3.3)
Injury severity score, mean (SD)15.7 (10.7)
AIS pelvis -
    2386 (69.2)
    362 (11.1)
    484 (15.1)
    526 (4.7)
Any blood transfusion220 (39.6)
Presence of co-injuries286 (51.3)
Co-Injury types-
    Head126 (22.6)
    Spine81 (14.5)
    Thoracic111 (19.9)
    Abdominal93 (16.7)
CT with contrast448 (80.3)
    Contrast blush89 (19.9)
Pelvic angiogram102 (18.3)
    Pelvic embolization61 (59.8)
Pelvic orthopedic surgery74 (13.3)
    Time: Admission to pelvic surgery, mean h75.0
Exploratory laparotomy64 (11.5)
ICU admission321 (57.5)
ICU length of stay, mean days (SD)7.7 (9.3)
Hospital length of stay, mean days (SD)10.9 (17.5)
Do not resuscitate order77 (13.8)
Mortality40 (7.2)
Hospital discharge disposition-
    Expired in hospital14 (2.5)
    Hospice26 (4.7)
    Long term care hospital26 (4.7)
    Skilled nursing facility126 (22.6)
    Rehabilitation facility192 (34.4)
    Home174 (31.2)
Table 2 Comparison of non-geriatric and geriatric patients with pelvic fractures, n (%)
Variable
Non-Geriatric (n = 267)
Geriatric (n = 291)
P values
Age, mean41.980.5< 0.001a
Sex (Female/Male)109 (40.8) / 158 (59.2)175 (60.1) / 116 (39.9)< 0.001a
Comorbidities145 (54.3)278 (95.5)< 0.001a
Anticoagulation14 (5.2)138 (47.4)< 0.001a
Mechanism of injury--< 0.001a
    Fall48 (18.0)156 (53.6)-
    Motor vehicle 211 (79.0)133 (45.7)-
    Other 8 (3.0)2 (0.7)-
Glasgow coma scale, mean12.914.3< 0.001a
Injury severity score, mean17.514.0< 0.001a
AIS pelvis--0.01a
    2170 (63.7)216 (74.2)-
    339 (14.6)23 (7.9)-
    441 (15.4)43 (14.8)-
    517 (6.4)9 (3.1)-
Any blood transfusion108 (40.4)113 (38.8)0.3
Co-injury types---
    Head66 (24.7)60 (20.6)0.2
    Spine37 (13.9)44 (15.1)0.7
    Thoracic51 (19.1)60 (20.6)0.7
    Abdominal58 (21.7)35 (12.0)0.002a
CT with contrast247 (92.5)201 (69.1)< 0.001a
    Contrast blush37 (15.0)36 (17.9)0.4
Pelvic angiogram50 (18.7)52 (17.9)0.8
    Pelvic embolization30 (60.0)31 (59.6)0.9
Pelvic orthopedic surgery58 (21.7)16 (5.5)< 0.001a
Time: Admission to pelvic surgery, mean h66.2106.80.1
Exploratory laparotomy44 (16.5)20 (6.9)< 0.001a
ICU Admission152 (56.9)169 (58.1)0.8
ICU length of stay, mean days8.96.60.03a
Hospital length of stay, mean days14.57.7< 0.001a
Do not resuscitate order12 (4.5)65 (22.3)< 0.001a
Mortality12 (4.5)28 (9.6)0.02a
Hospital discharge disposition--< 0.001a
    Expired in hospital8 (3.0)6 (2.1)-
    Hospice4 (1.5)22 (7.6)-
    Long term care hospital13 (4.9)13 (4.5)-
    Skilled nursing facility18 (6.7)108 (37.1)-
    Rehabilitation facility91 (34.1)101 (34.7)-
    Home133 (49.8)41 (14.1)-
Table 3 Comparison of propensity score matched by abbreviated injury score of pelvis and mechanism of injury non-geriatric and geriatric patients with pelvic fractures, n (%)
Variable
Non-geriatric (n = 183)
Geriatric (n = 183)
P value
Mechanism of injury--0.8
    Fall48 (26.2)48 (26.2)-
    Motor vehicle 134 (73.2)133 (72.7)-
    Other 1 (0.5)2 (1.1)-
AIS pelvis--0.9
    2124 (67.8)127 (69.4)-
    321 (11.5)17 (9.3)-
    429 (15.8)30 (16.4)-
    59 (4.9)9 (4.9)-
Age, mean42.878.8< 0.001a
Sex (Female/Male)75 (41.0)/108 (59.0)105 (57.9)/77 (42.1)0.001a
Comorbidities99 (54.1)172 (94.0)< 0.001a
Anticoagulation10 (5.5)81 (44.3)< 0.001a
Glasgow coma scale, mean12.914.00.002a
Injury severity score, mean16.515.70.4
Any blood transfusion71 (38.8)87 (47.5)0.1
Co-injury types---
    Head52 (28.4)38 (20.8)0.1
    Spine27 (14.8)31 (16.9)0.6
    Thoracic31 (16.9)51 (27.9)0.01a
    Abdominal34 (18.6)30 (16.4)0.6
CT with contrast168 (90.8)149 (80.5)0.005a
    Contrast blush29 (17.5)35 (24.5)0.1
Pelvic angiogram29 (15.8)37 (20.2)0.3
    Pelvic embolization17 (58.6)26 (70.3)0.3
Pelvic orthopedic surgery35 (19.1)14 (7.7)0.001a
Time: Admission to pelvic surgery, mean h37.920.20.1
Exploratory laparotomy24 (13.1)19 (10.4)0.4
ICU admission96 (52.5)114 (62.3)0.1
ICU length of stay, mean days7.38.10.5
Hospital length of stay, mean days11.99.10.04a
Do not resuscitate order6 (3.3)40 (21.9)< 0.001a
Mortality7 (3.8)24 (13.1)0.001a
Hospital discharge disposition--< 0.001a
    Expired in hospital5 (2.7)6 (3.3)-
    Hospice2 (1.1)18 (9.8)-
    Long term care hospital8 (4.4)11 (6.0)-
    Skilled nursing facility12 (6.6)59 (32.2)-
    Rehabilitation facility65 (35.5)68 (37.2)-
    Home91 (49.7)21 (11.5)-
Table 4 Comparison of patients with pelvic fractures with and without abdominal co-injuries, n (%)
Variable
With abdominal co-injuries (n = 93)
Without abdominal co-injuries (n = 465)
P value
Age, mean56.063.30.003a
Geriatric35 (37.6)256 (55.1)0.002a
Sex (Female/Male)38 (40.9)/55 (59.1)246 (52.9)/219 (47.1)0.03a
Comorbidities65 (69.9)358 (77.0)0.1
Mechanism of injury--< 0.001a
    Fall13 (14.0)191 (41.1)-
    Motor vehicle76 (81.7)268 (57.6)-
Glasgow coma scale, mean12.213.9< 0.001a
Injury severity score, mean27.413.3< 0.001a
AIS pelvis--< 0.001a
    243 (46.2)343 (73.8)-
    313 (14.0)49 (10.5)-
    420 (21.5)64 (13.8)-
    517 (18.3)9 (1.9)-
Any blood transfusion71 (76.4)150 (32.2)< 0.001a
Co-injury types---
    Head25 (26.9)101 (21.7)0.3
    Spine22 (23.7)59 (12.7)0.006a
    Thoracic34 (36.6)77 (16.6)< 0.001a
CT with contrast90 (96.8)358 (77.0)< 0.001a
    Contrast blush41 (45.6)32 (8.9)< 0.001a
Pelvic angiogram48 (51.6)54 (11.6)< 0.001a
    Pelvic embolization33 (68.8)28 (51.9)0.1
Pelvic orthopedic surgery27 (29.0)47 (10.1)< 0.001a
Exploratory laparotomy51 (54.8)13 (2.8)< 0.001a
ICU admission83 (89.2)238 (51.2)< 0.001a
ICU length of stay, mean days13.45.7< 0.001a
Hospital length of stay, mean days22.58.6< 0.001a
Mortality17 (18.3)23 (4.9)< 0.001a
Hospital discharge disposition--< 0.001a
    Expired in hospital9 (9.7)5 (1.1)-
    Hospice8 (8.6)18 (3.9)-
    Long term care hospital14 (15.1)12 (2.6)-
    Skilled nursing facility13 (14.0)113 (24.3)-
    Rehabilitation facility26 (28.0)166 (35.7)-
    Home23 (24.7)151 (32.5)-
Table 5 Comparison of propensity score matched by abbreviated injury score of pelvis, age and mechanism of injury patients with pelvic fractures with and without abdominal co-injuries, n (%)
Variable
With abdominal co-injuries (n = 83)
Without abdominal co-injuries (n = 83)
P value
Age, mean56.654.80.3
Mechanism of injury--0.8
    Fall13 (15.7)13 (15.7)-
    Motor vehicle 68 (81.9)69 (83.1)-
AIS pelvis--0.9
    243 (51.8)42 (50.6)-
    313 (15.7)16 (19.3)-
    419 (22.9)17 (20.5)-
    58 (9.6)8 (9.6)-
Geriatric32 (38.6)32 (38.6)1.0
Sex (Female/Male)36 (43.4)/47 (56.6)37 (44.6)/46 (55.4)0.9
Comorbidities59 (71.1)56 (67.5)0.6
Glasgow coma scale, mean12.413.30.1
Injury severity score, mean25.617.5< 0.001a
Any blood transfusion62 (74.7)31 (37.3)< 0.001a
Co-injury types---
    Head22 (26.5)17 (20.5)0.4
    Spine20 (24.1)11 (13.3)0.1
    Thoracic31 (37.3)16 (19.3)0.01a
CT with contrast80 (96.4)72 (86.7)0.02a
    Contrast blush32 (40.0)11 (15.3)< 0.001a
Pelvic angiogram39 (47.0)16 (19.3)< 0.001a
    Pelvic embolization25 (64.1)11 (68.8)0.7
Pelvic orthopedic surgery19 (22.9)19 (22.9)1.0
Time: Admission to pelvic surgery, mean h18.824.40.5
Exploratory laparotomy45 (54.2)4 (4.8)< 0.001a
ICU admission74 (89.2)50 (60.2)< 0.001a
ICU length of stay, mean days13.16.3< 0.001a
Hospital length of stay, mean days22.011.00.002a
Mortality13 (15.7)4 (4.8)0.02a
Hospital discharge disposition--0.04a
    Expired in hospital7 (8.4)1 (1.2)-
    Hospice6 (7.2)3 (3.6)-
    Long term care hospital12 (14.5)4 (4.8)-
    Skilled nursing facility12 (14.5)17 (20.5)-
    Rehabilitation facility25 (30.1)29 (34.9)-
    Home21 (25.3)29 (34.9)-
Table 6 Comparison of patients with pelvic fractures with and without contrast blush, n (%)
Variable
With contrast blush (n = 89)
Without contrast blush (n = 359)
P value
Age, mean61.057.70.2
Geriatric45 (50.6)156 (43.5)0.2
Sex (Female/Male)35 (39.3)/54 (60.7)182 (50.7)/177 (49.3)0.1
Comorbidities66 (74.2)252 (70.2)0.5
Mechanism of injury--0.1
    Fall18 (20.2)104 (29.0)-
    Motor vehicle 67 (75.3)250 (69.6)-
Glasgow coma scale, mean12.913.50.2
Injury severity score, mean24.115.0< 0.001a
AIS pelvis3.32.5< 0.001a
    239 (43.8)256 (71.3)< 0.001a
    36 (6.7)48 (13.4)-
    426 (29.248 (13.4)-
    518 (20.2)7 (1.9)-
Any blood transfusion71 (79.8)125 (34.8)< 0.001a
Co-injury types---
    Head17 (19.1)88 (24.5)0.3
    Spine18 (20.2)50 (13.9)0.1
    Thoracic22 (24.7)80 (22.3)0.6
    Abdominal51 (57.3)39 (10.9)< 0.001a
Pelvic angiogram67 (75.3)28 (7.8)< 0.001a
    Pelvic embolization45 (67.2)10 (35.7)0.005a
Pelvic orthopedic surgery31 (34.8)40 (11.1)< 0.001a
Exploratory laparotomy33 (37.1)28 (7.8)< 0.001a
ICU admission78 (87.6)197 (54.9)< 0.001a
ICU length of stay, mean days11.67.10.003a
Hospital length of stay, mean days17.811.10.003a
Mortality16 (18.0)20 (5.6)< 0.001a
Hospital discharge disposition--< 0.001a
    Expired in hospital6 (6.7)6 (1.7)-
    Hospice10 (11.2)14 (3.9)-
    Long term care hospital13 (14.6)10 (2.8)-
    Skilled nursing facility19 (21.3)61 (17.0)-
    Rehabilitation facility23 (25.8)139 (38.7)-
    Home18 (20.2)129 (35.9)-
Table 7 Comparison of propensity score matched by abbreviated injury score of pelvis, age and abdominal co-injuries patients with pelvic fractures with and without contrast blush, n (%)
Variable
With contrast blush (n = 73)
Without contrast blush (n = 73)
P value
Age, mean61.061.70.8
AIS pelvis--0.7
    239 (53.4)44 (60.3)-
    36 (8.2)5 (6.8)-
    422 (30.1)21 (28.8)-
    56 (8.2)3 (4.1)-
Abdominal co-injuries35 (47.9)27 (37.0)0.2
Geriatric37 (50.7)39 (53.4)0.7
Sex (Female/Male)30 (41.1)/43 (58.9)36 (49.3)/37 (50.7)0.3
Comorbidities56 (76.7)53 (72.6)0.6
Mechanism of injury--0.1
    Fall18 (24.7)29 (39.7)-
    Motor vehicle 53 (72.6)43 (58.9)-
Glasgow coma scale, mean13.013.20.7
Injury severity score, mean20.619.50.5
Any blood transfusion56 (76.7)32 (43.8)< 0.001a
Co-injury types---
    Head16 (21.9)23 (31.5)0.1
    Spine14 (19.2)12 (16.4)0.7
    Thoracic16 (21.9)22 (30.1)0.3
Pelvic angiogram52 (71.2)9 (12.3)< 0.001a
    Pelvic embolization33 (63.5)2 (22.2)0.02a
Pelvic orthopedic surgery22 (30.1)10 (13.7)0.02a
Exploratory laparotomy21 (28.8)13 (17.8)0.1
ICU admission63 (86.3)47 (64.4)0.002a
ICU length of stay, mean days10.510.10.8
Hospital length of stay, mean days17.018.10.8
Mortality10 (13.7)8 (11.0)0.6
Hospital discharge disposition--0.9
    Expired in hospital3 (4.1)2 (2.7)-
    Hospice7 (9.6)6 (8.2)-
    Long term care hospital6 (8.2)3 (4.1)-
    Skilled nursing facility18 (24.7)16 (21.9)-
    Rehabilitation facility21 (28.8)24 (32.9)-
    Home18 (24.7)22 (30.1)-