Pelvic fracture in the elderly: prognosis

walking after inguinal hernia surgery

La pelvic fracture can affect anyone. In the youngest, it generally occurs only after a trauma or a violent accident. On the other hand, among elderly subjects, un lesser shock can lead to this condition. The severity of a fracture hip bone varies by type. However, what is certain is that the older the patient, the greater the damage can be. In this article, we will talk about the prognosis of a pelvic fracture in an elderly person.

General information on the fracture of the pelvis 

Le basin is the part of the skeleton that provides continuity between the upper body and the lower limbs. It plays a crucial role in all our movements. It is made up of several bones and joints. the type of pelvic fracture depends on the bone concerned and also on the affected structures (vessels, nerves, noble organs: genitals, urinary, etc.).

Pelvic fractures can be classified into 3 categories: stable fracture, partially stable fracture and unstable fracture with involvement of other organs. This last category is the most serious.

Many young subjects, especially males, are affected by this type of fracture. It is mainly of traumatic origin. 

For older people, it is rather women who are the most affected. This could be linked to osteoporosis, favored by menopause.

To learn more about osteoporosis, see the following article.

Indeed, when you start to age, the bone structures become fragile which is favorable to various fractures. Moreover, the osteoporotic fractures are risk factors for other fractures. Thus, the skeletal structure could undergo Outputs broken bones. At the the elderly, this could further aggravate the broken bones du basin.

Studies have shown that the pelvic fractures, which occur after the age of 60, are mainly (94%) related to osteoporosis. If you want to know more about the subject, click here.

How does pelvic fracture evolve in the elderly?

The evolution of a fracture du basin is conditioned by prognostic factors, including the type of fracture, its severity and the structures affected.

Patient's age is also an important criterion. The older the person, the more fragile their health status.

Hip fracture in the elderly: prognosis

General prognosis in the absence of treatment

Prognosis for a stable fracture

In the absence of care, the prognosis is rather favorable, in the case of stable fracture (not displaced and less severe). The fracture heals naturally after about 6 to 8 weeks. This is a frequently observed case in elderly subjects.

If it was accompanied by displacement, it would take 3 to 4 months for the bone fragments to consolidate. We can hope for a positive evolution, but with a long period of rest.

Symptoms, especially pain, usually cause the patient to become immobilized. This leads to very rapid muscle wasting and impairs the patient's mobility and functional prognosis.

Prognosis for an unstable fracture

Without treatment, a unstable fracture presents a bad prognosis. Indeed, all ruptures at the level of the pelvic ring cause significant bleeding. Without support, it could threaten the life threatening. Moreover, the fracture is frequently accompanied by complications:

  • blood loss: in 50% of cases;
  • brain damage: 26 to 55% of cases;
  • lung damage;
  • urological lesions: relatively rare. About 4 to 17 out of a hundred patients with pelvic fractures suffer from lower urinary lesions, particularly in the urethra. Bladder involvement is common: 5 to 25% of cases;
  • anorectal or gynecological lesions: these are rare and generally only occur in the event of open trauma;
  • nerve damage: these occur in 10 to 40% of cases;
  • long-term complications: it can promote coxarthrosis, vicious calluses.

Prognosis with treatment

If the fracture du basin is processed as soon as possible, prognosis is definitely better.

With rest and immobilization, the bone healing will be favoured. 

If hygienic measures are neglected, surgical interventions can lead to risks of infections and sepsis, which could threaten the patient's life.

The functional prognosis of an elderly patient who suffers from a pelvic fracture

In all cases, the fracture du basin has considerable functional effects. It even happens that the patient will not really regain his functional abilities before. In addition, the effects of the fracture persist over the long term, which generates a functional prognosis quite negative. Studies have shown that, after 5 years and even beyond, the fracture du basin is not fully recovered.

Personalized functional sequelae may persist:

  • decreased mobility;
  • Autonomy loss ;
  • decreased hip flexibility;
  • addiction ;
  • wanderings;
  • shortening of one of the lower limbs;
  • persistent pain.

These sequelae have negative consequences on the patient's quality of life.

Life prognosis 

It is rare that the fracture du basin alone causes the death of the affected person. This only happens in 12% of cases. 

The risks of death are rather related to the lesions caused by the broken bone. Since the pelvis houses noble organs (vessels, nerves, viscera, etc.), the slightest lesion in these organs can jeopardize the life threatening.

Rupture of the femoral arteries and hemorrhage can lead to death (50% of deaths).

A fracture that occurs following a violent accident (case of a major rupture at the level of the pelvic ring) also represents a rate of high mortality at the elderly patients, because of the sensitivity of their health condition. The same is also true for skin-opening fractures.

From a general point of view, like all traumas of the basin, the mortality rate after a fracture du pelvis in the elderlys does not exceed 50%. About 5 to 15 out of 100 people die from it.

References

https://www.santelog.com/actualites/fractures-des-effets-tres-prolonges-ou-vie-chez-les-personnes-agees

https://www.google.com/url?sa=t&source=web&rct=j&url=http://t2econgress.com/files/127/2019/coms/20-apres-midi/Chassagne.pdf&ved=2ahUKEwirk_muiKL3AhVCZMAKHQw6BY0QFnoECAcQAQ&usg=AOvVaw0Gkcpa68QcugjpxsxYXTn8

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