Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2009; 76(5):404-409 | DOI: 10.55095/achot2009/077

Multicentrická studie pacientů s poraněním pánve: základní analýza souboruPůvodní práce

V. DŽUPA^1,*, J. CHMELOVÁ², T. PAVELKA³, P. OBRUBA⁴, P. WENDSCHE⁵, P. ŠIMKO⁶, CISP Investigators

¹ Ortopedicko-traumatologická klinika 3. LF UK a FNKV, Praha

² Radiodiagnostický ústav FNsP, Ostrava

³ Klinika ortopedie a traumatologie pohybového ústrojí LF UK a FNsP, Plzeň

⁴ Traumacentrum Masarykovy nemocnice, Ústí nad Labem

⁵ Klinika traumatologie, Úrazová nemocnice, Brno

⁶ Traumatologická klinika SZU a FNsP, Bratislava

PURPOSE OF THE STUDY:
The aim of the study was to make a basic analysis of the patients treated for pelvic fractures in the year 2007 at 14 institutions in the Czech Republic and Slovakia.

MATERIAL AND METHODS:
The group investigated consisted of 474 patients treated in 2007. In a one-year prospective descriptive study, patients' data were recorded according to a unified protocol. They included age, gender, mechanism of injury, fracture type, associated injuries, method of treatment, post-operative complications, length of hospital stay, injury/surgery-to-standing time and number of deaths during primary hospitalization. The χ2 test of independence in a contingency table was used to compare categorical data. The level of significance for the test was set at 5%.

RESULTS:
The group comprised 192 women and 282 men with an average age of 45.9 years (range, 15 to 95). In men, the frequency of pelvic fractures was significantly higher (p<0.001), because men significantly outnumbered women in the largest middle-age categories (30 to 59 years). Pelvic fractures were significantly higher only in women over 80 years of age.
The most frequent cause of injury was a road traffic accident (237 patients, 50%). Significantly more men than women were injured in motorbike accidents (p=0.015), due to a fall from height (p=0.001) or by a falling object (p=0.040). Women more frequently suffered injury as a result of a suicidal attempt by jumping (p=0.051) or a simple fall (p<0.001).
Type A2.2 fractures (115 patients, 24%; average age, 51.8 years) and type B2.1 (77 patients, 16%; average age, 43.5 years) were most frequent.
In 248 patients (52%), a pelvic fracture was part of multiple trauma. These patients had an average ISS of 30 points.
Conservative treatment was used in 287 patients (61%). In 71 patients, skeletal traction (30 patients, 6%), C-clamp (19 patients, 4%) or external fixation (22 patients, 5%) was temporarily applied during the primary treatment. Surgery was carried out in 187 patients (39%). The average operative time was 114 minutes (range, 45 to 315).
Post-operative complications were recorded in 58 patients (30% of the surgically treated). The most frequent local complication was wound infection (11 patients, 6%).
The average hospital stay was 27 days (range, 2 to 266); 181 patients (38%) required care at an anaesthesia and acute care department for an average of 14 days (range, 1 to 127). The injury/surgery-to-standing time was 30 days on average (range, 2 to 118 days).
Twenty-six patients; nine women and 17 men (5%), died during primary hospitalization. Their average age was 62.5 years (74.1 years in women and 56.4 years in men).

DISCUSSION:
The higher number of injured men in the middle-age categories suggests a more risky behaviour of these men in driving motor cars and motorbikes and at work (falls from height, objects falling on them). Women significantly outnumbered men in simple falls (which can be explained by a higher occurrence of pubic ramus fractures due to osteoporosis in women at a higher age) and a difference at the margin of statistical significance was recorded in suicidal attempts (any explanation is beyond the scope of this study as well as beyond the field of trauma medicine).
The higher number of type A2.2 and also type B2.1 fractures can too be explained by a higher occurrence of these fractures due to simple falls in elderly women with osteoporosis.

CONCLUSIONS:
The evaluation of the basic demographic and epidemiologic data of patients with pelvic fractures included in this multicentre study revealed the following facts: pelvic fractures were significantly more frequent in men; the most frequent cause of pelvic fracture was a road traffic accident; the number of injured men was highest at age 40 to 50, in motorbike accidents, falls from height and in injuries by falling objects; women outnumbered men at the age category over 80 and in suicidal jumping from a height; the most frequent types of fractures were those affecting osteoporotic bone in elderly women (A2.2, B2.1); surgical treatment of pelvic fractures was associated with a relatively high number of complications; death during primary hospitalization was higher in elderly patients.

Klíčová slova: pelvic fracture, demography, epidemiology, type of fracture, associated injuries

Zveřejněno: 1. říjen 2009  Zobrazit citaci