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Quality of life poor 2 years after pelvic, acetabular fracture
Patients’ physical, mental and sexual satisfaction scores were still low at 2 years post-fracture.
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SAN FRANCISCO — Swedish investigators studying individuals who sustained pelvic or acetabular fractures found that their quality of life remained poor at 2 years postinjury, even if radiological and clinical outcomes were acceptable.
Since quality-of-life (QOL) results are frequently overlooked when following patients with such severe injuries, Tomas Borg, MD, and colleagues evaluated QOL at short-term follow-up by surveying patients who sustained these two types of fractures.
Investigators found that although the fractures seemed to have healed, the patients’ physical and mental domain scores and sexual life based on the validated SF-36 and LiSat-11 questionnaires never really recovered from the injury.
“These are severely injured patients with low QOL even after 2 years in both the physical and mental domains. We believe patients would benefit from multidisciplinary rehabilitation programs,” Borg said.
He presented results of the survey at the American Academy of Orthopaedic Surgeons 75th Annual Meeting, here.
Lead investigator Sune Larsson, MD, PhD, told Orthopaedics Today International, “My idea was that the orthopaedic community has focused far too much on radiographs and the surgical technique, while we have not at all paid the patients and their quality of life, etc., any major attention.”
Follow-up radiographs
Investigators conducted the prospective observational study by surveying 102 individuals at 2 years’ postop from throughout Sweden, who were referred to Uppsala University Hospital for fracture treatment between 2003 and 2004. The minimum age was 15 years.
Two-thirds of the patients were men and there was a 2:1 ratio of acetabular-to-pelvic fractures. Eighty-four patients completed and returned both questionnaires. Psychological issues accounted for most nonrespondents, Borg noted.
To check fracture healing, all respondents had 2-year follow-up radiographs taken locally.
Patients completed the SF-36 questionnaire’s mental/physica function domains to assess their QOL and reported their life satisfaction using the LiSat-11 instrument. The LiSat-11 is a life satisfaction questionnaire with 10 domains and one component that focuses on overall life satisfaction, he said.
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| Figure 1: Radiograph of the pelvis in a 77-year-old man 2 years after surgical treatment for an acetabular fracture following a fall from 3 meters. Figure 2: Radiograph of the pelvis in a young woman 19 years of age 2 years after surgical fixation of an unstable pelvic ring injury sustained when falling 10 meters from a bridge. Images: Borg T | |
Better social scores
“The SF-36 scores in acetabular fractures were lower in all eight domains,” Borg said. Scores for the same eight domains were similarly low for those with pelvic fractures, with the lowest scores returned for the sexual function domain.
Investigators compared all QOL scores to those for a reference population.
Patients returned the highest scores for the SF-36 social domain. They were 66 for those with pelvic fractures and 75 for those with acetabular fractures, according to the study’s abstract.
“In acetabular fractures, life satisfaction scores were lower in all domains, including sexual, compared to the regular population,” Borg said.
Since SF-36 scores showed considerable dissatisfaction with sexual function, investigators asked individuals to grade various aspects of their sex life on a 6-point scale from very satisfied to very unsatisfied. According to the abstract, 31% of patients with pelvic fractures and 34% with acetabular fractures were satisfied with their sexual life compared to 58% of the reference population.
The number of patients being followed in this study has increased since the data were reported at the meeting, according to Larsson. “We are following all patients prospectively and we will follow them at least 5 years,” he said.
He noted that the outcomes component of the study needed to be especially rigorous in order to sufficiently describe results, like QOL status, from the patients’ perspective.
For more information:
- Tomas Borg, MD, can be reached at the Department of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden SE-751 85; +46-18-611-0000.
- Sune Larsson, MD, PhD, is director of research and development at Uppsala University Hospital. He can be reached at +46-18-302-586; e-mail: sune.larsson@surgsci.uu.se. Drs. Borg and Larsson have no financial conflicts to report.
Reference:
- Borg T, Berg P, Fugl-Meyer K, Larsson S. Quality of life following pelvic and acetabular fractures. #421. Presented at the American Academy of Orthopaedic Surgeons 75th Annual Meeting. March 5-9, 2008. San Francisco.