Increasing number of aged people is having a profound impact on pelvic fracture management. As the number of elderly people increases, so would be old patients with increasing number of injuries.
Pelvic trauma in young individuals occur due to severe trauma in young individuals. However, the elderly people can get fractures with minor trauma due to weakened skeletal framework as a result of osteoporosis.The elderly experience higher mortality and late morbidity than younger patients with comparable injuries.
In the elderly person, the potential for intensive care management and the duration of hospitalization and rehabilitation are likely to be much greater.
Certain problems in the elderly people impact heavily on the management of the pelvic fracture.
Preexisting cardiac disease compromises the cardiac reserve during the stressful early posttraumatic period and renders the patient vulnerable to serious arrhythmia and myocardial infarction.
Posttraumatic atelectasis, possibly in association with multiple rib fracture or a pneumothorax, is immeasurably aggravated by pretraumatic pulmonary disease.
Hepatic dysfunction in alcoholics may impair co-angulation and compromise the prognosis for retroperitoneal hemorrhage.
Following are the common comorbidities that occur with pelvic fractures
- Ischemic heart disease
- Obstructive airway disease
- Hepatic dysfunction with resultant coagulopathy
- Peripheral vascular disease
- Central neurologic impairment
The trauma may dislodge a preexisting plaque in the common or external iliac artery, resulting in a cold, pulseless limb that requires medical or surgical intervention. With central neurologic impairment, such as pretraumatic senility, intention tremor, or generalized weakness, the rehabilitation after a pelvic fracture may be greatly impeded.
After an extensive open reduction, the elderly and infirm have a higher incidence, and necrosis of flaps. External fixation pins tend to loosen quickly.
It is wise to limit the use of definitive fixation. Extensile approaches and large wounds should be minimized. If possible percutaneous internal fixation should be carried. Surgery should be performed at the earliest because chances of occuring a complication increases with time.
Join Discussions