The increasing burden of pelvic fractures in older people, New South Wales, Australia
Introduction
Injury continues to be a source of considerable morbidity and mortality in older people as life expectancy has increased in most industrialised countries.24 Hip fracture is the most documented fracture sustained by older people, though there have also been reports on spine, wrist and humeral neck fractures.3, 6 Whilst less common, occurring with a frequency of between one third to one fifth of that of hip fractures,26 pelvic fractures are associated with significant pain, require long hospital stay and substantial health care resources.27 Long-term complications of pelvic fractures include genitourinary and reproductive dysfunction, non-healing fractures and chronic disability resulting in an inability to return to independent living and to long admissions to sub-acute health care and residential facilities.9, 30, 5, 21 Mortality associated with pelvic fractures in older people results from associated injuries as well as severe bleeding from the fracture site itself or the adjacent arterial structures.12, 30 Mortality rates have been reported to range from 5% to 20% at 1 year.13, 12, 18
Despite their significant burden, epidemiological information regarding pelvic fractures is scarce. The few reports which have examined the incidence of pelvic fractures demonstrated an increase in the number and age-specific rates in both males and females during the 1970s and 1980s.26, 27 In Australia, while pelvic fracture is among the five most common fractures in older people,3 no study has previously investigated trends in their incidence. In this study, we examine trends in admission for pelvic fracture to public and private acute hospitals in New South Wales, Australia between July 1988 and June 2000 using routinely collected hospital separations statistics. We also examine trends in the mechanism/etiology of injury, length of stay and transfer to other institutions following a pelvic fracture. The findings will inform the planning of future health care delivery and prevention strategies aimed at reducing the burden of this type of injury in older people.
Section snippets
Methods
Information on pelvic fracture cases was obtained from the Inpatient Statistics Collection (ISC) which covers all inpatient separations/discharges from acute hospitals in New South Wales (NSW) between July 1988 and June 2000. The ISC is a financial year collection which enumerates periods of stay in hospital that end with a discharge, transfer or death of a patient.8
Estimates of the total number of hospital admissions across NSW, for each financial year between 1 July 1988 and 30 June 1993,
Results
Over the period July 1988 to June 2000, the number of admissions to NSW acute hospitals for pelvic fractures increased by 58% in men and 111% in women (Table 2). The increase was observed for all age groups but was highest among those aged over 85 years in both men (270%) and women (245%).
In every year, most pelvic fractures were due to falls with the remainder resulting mainly from transport injuries (Fig. 1). The number and proportion of transport related pelvic fractures decreased
Discussion
This study represents the first assessment of pelvic fracture trends in older people over time in Australia. The number of pelvic fractures steadily increased during the period of study, particularly in women. The rise was even higher for those aged 85 years and over, where there was more than a four-fold increase. Similar findings were reported in a Finnish study indicating an average increase of 17% per year during the seventies and eighties.26 Such trends are likely to continue unabated for
Conclusions
The number and age-specific admission rates of pelvic fractures are on the rise in New South Wales, particularly among older age groups. Falls are increasingly becoming the single most important cause of pelvic injuries suggesting that preventive measures aimed at reducing the risk of falls, need to be pursued and strengthened. Research into the impact of various factors that contribute to falls such as human balance is warranted. Factors which contribute to pelvic fractures as a result of a
Acknowledgments
Both C. Finch and S. Lord are supported by National Health and Medical Research Council Principal Research Fellowships. S. Boufous is supported by the Injury Risk Management Research Centre, with core funding provided by the NSW Department of Health, the NSW Roads and Traffic Authority and the Motor Accidents Authority. The authors wish to thank the Centre for Epidemiology and Research at the NSW Health Department, for providing the data analysed in this study, and to Dr. Owen Williamson, an
References (33)
- et al.
Good outcomes of open pelvic fractures
Injury
(1999) - et al.
Epidemiology of pelvic ring injuries
Injury
(1996) - et al.
Mortality and functional outcomes of pelvic insufficiency fractures in older patients
Joint Bone Spine
(2003) - et al.
Falls: a community care perspective
Lancet
(1995) - et al.
Statistical methods in medical research
(2001) - et al.
Trends in hospital admissions for fractures of the hip and femur in England, 1989–1990 to 1997–1998
J Public Health Med
(2001) - et al.
Characteristics and outcomes of older patients presenting to the emergency department after a fall: a retrospective analysis
Med J Aust
(2000) - et al.
The incidence of hip fracture in NSW: are our efforts having an effect?
Med J Aust
(2004) - et al.
Effect of trauma and pelvic fracture on female genitourinary, sexual, and reproductive Function
J Trauma Inj Infect Crit Care
(1997) - et al.
Epidemiology of osteoporosis and osteoporotic fractures
Epidemiol Rev
(1985)
Public health and traffic safety: a collaborative success
Inj Prev
Pelvic fracture in geriatric patients: a distinct clinical entity
J Trauma
Fractures of the pelvic rami. Epidemiology and five-year survival
J Bone Joint Surg Br
Fall-induced injuries and deaths among older adults
JAMA
Cited by (79)
Trends in non-operative management of low-energy pelvic fracture: An analysis of the Nationwide Inpatient Sample
2023, Journal of OrthopaedicsTwo cases of pelvic trauma with survival in the necropolis of Qubbet el-Hawa (Egypt)
2023, International Journal of PaleopathologyA Review on Management of Insufficiency Fractures of the Pelvis and Acetabulum
2022, Orthopedic Clinics of North AmericaCitation Excerpt :Of note, almost 50% of the aforementioned fractures were noted to be the result of a low-energy fall. Two other retrospective reviews out of Sweden and Australia noted 10% and 11% incidences of geriatric acetabular fractures over a 10-year period, respectively.10,11 Any condition that weakens bone or decreases bone density may predispose a patient to an insufficiency fracture such as osteopenia, or more commonly, osteoporosis.
Falls as risk factors for fracture
2020, Marcus and Feldman’s Osteoporosis