FUNCTION AND QUALITY OF LIFE DECREASE OVER TIME FOLLOWING STABLE NONOPERATIVE FRAGILITY FRACTURES OF THE PELVIS

With an aging population and increasing rates of osteoporosis, fragility fractures of the pelvis (FFPs) have become increasingly common in adults, accounting for ~7% of all fragility fractures [1]. This study aims to document functional outcomes and quality of life measures in individuals with FFPs treated non-operatively and examine if a relationship exists between these parameters and healing status. This study is a retrospective analysis of a prospectively collected cohort found at a high-volume single institution (Pelvic and Acetabular Database - REB PIN 5528). All elderly patients (age ≥ 65 years) who fell from standing height and sustained a non-operative FFP as diagnosed on x-ray were identified. Functional outcomes (MFA) and quality of life measures (SF-36) were collected over a two-year period. Healing was assessed on available follow up x-ray imaging by two senior orthopaedic surgeons and two orthopaedic residents and categorized as one (less than 50% healed), two (50-75% healed) or three (>75% healed). We identified 53 elderly patients who sustained a low energy non-operative FFP. Patient MFA scores increased from baseline for all categories (except fine motor and employment) indicating worsening function. Additionally, SF-36 scores decreased from baseline, but generally maintained status from 6 to 24 months, with some variability in Role Limitation due to Physical Problems category. Follow up x-ray imaging was only available on a subset of these individuals (N=35). Substantial agreement was found between all four raters (Fleiss Kappa = 0.65) with respect to healing status. Confirmation of fracture healing on x-ray (>75% healed) was found for only 7 individuals at 12 months post-fracture. There was no relationship demonstrated between MFA and SF-36 scores with fracture healing status for patients with coincident reporting (N=16). Functional outcomes and health status in elderly patients with stable FFPs treated non-operatively did not show improvements in any MFA or SF-36 categories from baseline levels (reported within ~4 weeks post-fracture), with many categories demonstrating a steady decline out to 24 months post-fracture. Despite a limited number of follow-up x-rays, this cohort highlights impaired healing which may occur in non-operatively treated FFPs. While patient function and quality of life decreased post stable FFP, no relationship was evident between these measures and fracture healing status. Lack of routine follow-up pelvic x-ray imaging is not surprising as no current treatment exists to address delayed fracture healing or non-unions and as such management is unchanged. Fibrous non-union may also provide sufficient stability in these patients, allowing some individuals without union to report low MFA and high SF-36 scores. It is important to acknowledge that the age-related decline in health elderly patients experience may contribute to patients reporting high MFA and low SF-36 scores post pelvic fracture. These comorbidities indicate that the use of functional outcomes and quality of life measures may not be appropriate in assessing elderly populations.