Clinical Course and Prognostic Factors of Isolated Pubic Ramus Fractures in Geriatric Patients

Year 2025, Volume: 7 Issue: 3, 591 - 5, 09.09.2025

Sönmez Sağlam , Zekeriya Okan Karaduman , Mehmet Arıcan , Mücahid Osman Yücel , Yunus Emre Bulum , Raşit Emin Dalaslan

Abstract

Aim: This study aims to evaluate the clinical outcomes of geriatric patients with pubic ramus fractures managed conservatively, assessing parameters such as length of hospitalization, blood loss, and accompanying comorbidities, and to investigate the impact of these factors on one-year mortality rates.
Material and Method: A retrospective evaluation was conducted on patients aged 65 and older diagnosed with pubic ramus fractures and admitted to a tertiary care center between 2012 and 2024. Demographic data, existing systemic diseases, laboratory findings, hospitalization duration, and mortality outcomes within a one-year follow-up were examined in detail.
Results: 60 patients were evaluated in the study, with a mean age of 78.00±7.32 years, and 71.7% of the participants were female. The mean hospitalization was calculated as 3.28±2.62 days. A statistically significant relationship was found between the burden of comorbidities and the duration of hospitalization (p<0.001). The change in hemoglobin data was 2.36±1.03 g/dL. The fractures of the pubic ramus were 85% unilateral. Among the comorbid conditions, heart failure was the most frequently observed, affecting 71% of the patients. Deep vein thrombosis was present in 9 patients. The mortality rate was 10 percent during the twelve-month follow-up period.
Conclusion: Isolated pubic ramus fractures in older adults should be considered a significant clinical concern due to their association with increased morbidity and mortality. Prompt identification of risk factors influencing hospitalization duration and mortality underscores the necessity of a multidisciplinary approach in patient management.

Keywords

Geriatric , pubic ramus fracture , fall-related fracture , risk factor

Ethical Statement

Approval for the study was obtained from the Düzce University Non-Interventional Clinical Research Ethics Committee (Date: 21.04.2025, Number: 2024/115).

References

• Dong J, Hao W, Wang B, et al. Management and outcome of pelvic fractures in elderly patients: a retrospective study of 40 cases. Chin Med J (Engl). 2014;127:2802-7.
• Forssten MP, Sarani B, Mohammad Ismail A, et al. Adverse outcomes following pelvic fracture: the critical role of frailty. Eur J Trauma Emerg Surg. 2023;49:2623-31.
• Rommens PM, Hopf JC, Herteleer M, et al. Isolated pubic ramus fractures are serious adverse events for elderly persons: an observational study on 138 patients with fragility fractures of the pelvis type I (FFP Type I). J Clin Med. 2020;9:2498.
• Behanova M, Haschka J, Reichardt B, et al. Pelvic fractures-an underestimated problem? incidence and mortality risk after pelvic fracture in Austria, 2010-2018. J Clin Med. 2022;11:2834.
• Burge R, Dawson-Hughes B, Solomon DH, et al. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res. 2007;22:465-75.
• Kannus P, Palvanen M, Niemi S, et al. Epidemiology of osteoporotic pelvic fractures in elderly people in Finland: sharp increase in 1970-1997 and alarming projections for the new millennium. Osteoporos Int. 2000;11:443-8.
• Loggers SAI, Joosse P, Jan Ponsen K. Outcome of pubic rami fractures with or without concomitant involvement of the posterior ring in elderly patients. Eur J Trauma Emerg Surg. 2019;45:1021-9.
• Ramser M, Vach W, Strub N, et al. The impact of specific fracture characteristics of low-energy fractures of the pelvis on mortality. BMC Geriatr. 2022;22:669.
• Sassara GM, Smakaj A, De Mauro D, et al. Evaluating treatment outcomes for pelvic insufficiency fractures: a systematic review. J Clin Med. 2024;13:3176.
• Hamilton CB, Harnett JD, Stone NC, et al. Morbidity and mortality following pelvic ramus fractures in an older Atlantic Canadian cohort. Can J Surg. 2019;62:270-4.
• Dechert TA, Duane TM, Frykberg BP, et al. Elderly patients with pelvic fracture: interventions and outcomes. Am Surg. 2009;75:291-5.
• Yoon YC, Sohn HS, Song HK, et al. Risk factors for pubic ramus fracture nonunion after conservative treatment of pelvic ring injuries: a retrospective cohort multicenter study. Eur J Orthop Surg Traumatol. 2024;34:1073-8.
• Reito A, Kuoppala M, Pajulammi H, et al. Mortality and comorbidity after non-operatively managed, low-energy pelvic fracture in patients over age 70: a comparison with an age-matched femoral neck fracture cohort and general population. BMC Geriatr. 2019;19:315.
• Özel Z, Karaduman ZO, Arıcan M, et al. Early mortality rates and types of surgery in geriatric patients with hip fractures undergoing surgical treatment. Value Health Sci. 2024;14:100-5.
• Maier GS, Kolbow K, Lazovic D, et al. Risk factors for pelvic insufficiency fractures and outcome after conservative therapy. Arch Gerontol Geriatr. 2016;67:80-5.
• Swenson RA, Paull TZ, Yates RA, et al. Comparison of Operative and Nonoperative Management of Elderly Fragility Pelvic Ring Fractures. J Orthop Trauma. 2024;38:472-6.
• Kanis JA, Johnell O, Oden A, et al. Long-term risk of osteoporotic fracture in Malmö. Osteoporos Int. 2000;11:669-74.
• Attoh-Mensah E, Pothier K, Loggia G, et al. Involvement of cognitive abilities in the occurrence of fractures in fallers aged 55 years or older: a cross-sectional study. Aging Clin Exp Res. 2024;36:180.
• Tsutsumimoto K, Doi T, Makizako H, et al. Cognitive frailty is associated with fall-related fracture among older people. J Nutr Health Aging. 2018;22:1216-20.
• Ha YC, Cha Y, Yoo JI, et al. Effect of dementia on postoperative mortality in elderly patients with hip fracture. J Korean Med Sci. 2021;36:e238.
• Wheatley BM, Amin A, Miller MC, et al. Does operative treatment of geriatric pelvic ring injuries lead to a high risk of one-year mortality?. Injury. 2021;52:2973-7.
• Tucker NJ, Scott B, Mauffrey C, et al. Geriatric patients presenting with isolated pubic rami fractures and inability to mobilize may have occult lateral compression pelvic ring injuries with dynamic instability. J Orthop Trauma. 2023;37:356-60.
• Roßler A, Lukhaup L, Seidelmann M, et al. Hemorrhage in pelvic ring fractures after low-energy trauma: a systematic review. J Clin Med. 2024;13:7223.
• Sng M, Gentle J, Asadollahi S. Bleeding risk associated with hemodynamically stable low-energy pelvic fracture. Geriatr Orthop Surg Rehabil. 2020;11:2151459320911868.