Fri., 10/5/12 Pelvis & Acetabulum, PAPER #64, 3:57 pm OTA-2012
Predictors of Functional Outcome in Operatively Treated Pelvic Ring Fractures
Patrick D.G. Henry, MD, FRCS(C)1; Richard J. Jenkinson, MD, FRCS(C)2;
Sebastian Rodriguez-Elizalde, MD, FRCS(C)2; David J.G. Stephen, MD, FRCS(C)2;
Hans J. Kreder, MD, FRCS(C)2;
1Division of Orthopaedics, Department of Surgery, St. Michael’s Hospital,
University of Toronto, Toronto Ontario, Canada;
2Division of Orthopaedics, Department of Surgery, Sunnybrook Health Sciences,
University of Toronto, Toronto, Ontario, Canada
Purpose: In patients with unstable pelvic ring fractures, little is known about the relationship of validated functional outcome scores with reduction accuracy and other patient factors. The purpose of this study is to evaluate this relationship.
Methods: 113 patients with operatively treated pelvic ring injuries at a Level I trauma center were prospectively followed for at least 1 year with data collected on demographic, injury, and radiographic parameters. Functional outcome scores were prospectively recorded using the Medical Outcomes Study Short-Form 36-item Health Survey (SF-36). A baseline preinjury score was obtained at the patients’ first follow-up visit. For each patient, pre- and postoperative displacements of pelvic ring were measured on AP, inlet, and outlet radiographs using the methodology described by Tornetta and Matta. Univariate statistical comparisons of final SF-36 scores in each domain were done for age, sex, marital status, educational level, smoking status, body mass index, other major lower extremity injury (eg, pilon fracture), ongoing lawsuit, ongoing disability claim, anterior pelvic ring malreduction >1 cm, and posterior pelvic ring malreduction >5 mm. Linear multivariable models, using the SF-36 physical and mental components as outcome variables, were then used to estimate the effects of pelvic ring malreduction while controlling for the above variables and baseline SF-36 scores.
Results: Baseline (preinjury) SF-36 scores in each domain were significantly better than SF-36 scores at final follow-up (P <0.001). Baseline SF-36 scores were better than published population normative SF-36 data (P <0.001); however, SF-36 scores at final follow-up among the pelvic fracture patients were similar to population norms. Univariate comparisons showed a trend to worse physical function score with posterior ring malreduction (P = 0.08) while anterior ring malreduction showed significantly worse physical function (P = 0.006), social function(P = 0.015), and pain (P = 0.036) scores. Both ongoing lawsuits and disability claims predicted worse SF-36 outcomes. Other major lower extremity injuries were relatively rare and despite a large difference in outcome (physical function 49.9 vs 28.6) did not reach statistical significance (P = 0.069). Age, sex, marital status, smoking, and body mass index were not significant. In the multivariable model of physical component SF-36 scores, anterior malreduction (P = 0.03), ongoing disability claim (P = 0.001), and baseline SF-36 score (P = 0.004) were the only significant predictors of outcome. For the mental component score, anterior malreduction(P = 0.038), ongoing lawsuit(P = 0.04), and baseline mental component score (P = 0.01) were the only predictive variables.
Conclusion: Patients with unstable pelvic ring disruptions do not return to their baseline level of function but regain similar function to age-matched peers. Obtaining a good surgical reduction of the pelvic ring, especially of the anterior component, should lead to better functional results.
Alphabetical Disclosure Listing (808K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.