title: Combined pubic rami and sacral osteoporotic fractures: a prospective study.
abstract: BACKGROUND
  Pelvic osteoporotic fractures (POFs) are often associated with considerable morbidity and mortality mainly as a result of infections and cardiovascular events. Patients usually need prolonged institutionalization, rehabilitation, and follow-up, with a high rate of dependency and cost. The most common sites of POFs include the pubic rami, sacrum, ilium, and acetabulum. Combined pubic rami (PROFs) and sacral osteoporotic fractures (SOFs) have been reported, mostly in retrospective studies, describing the mechanism of injury and incidence. The aim of this study was to evaluate the association between PROFs and SOFs and to assess the effect of combined PROFs and SOFs on patients' mobility, discharge destination, and length of stay.
  
  
  METHODS
  We prospectively studied 67 patients with low-impact PROFs and/or SOFs. There were 54 (80.4%) female and 13 (19.6%) male patients, and the average age was 87.5 (range 65-96) years. All patients were assessed by the fracture liaison service. Patients had magnetic resonance imaging or bone scan when there was history of low back pain following the injury or lumbosacral tenderness on clinical examination.
  
  
  RESULTS
  The mean length of stay for all patients was 45 (± 35) days. Mortality rate was 10.4%. A significant relationship was found between low back pain and a positive finding of sacral fracture. Patients with combined PROFs and SOFs showed significantly longer length of stay than those with isolated PROFs.
  
  
  CONCLUSIONS
  The presence of low back pain and tenderness in patients who had low-impact pelvic injuries was highly suggestive of the presence of an associated SOF. There was a high association between sacral and PROFs. The length of stay of patients with PROFs associated with sacral osteoporotic fractures was significantly longer than that of patients with PROFs only. Therefore, we recommend considering the high association between SOFs and PROFs in planning the management and rehabilitation of patients with POFs.
authors.affiliation: Gateshead Health NHS Foundation Trust, Gateshead, UK. alnaib@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Alnaib
authors.forename: S
authors.initials: S
authors.lastname: Waters
authors.forename: Y
authors.initials: Y
authors.lastname: Shanshal
authors.forename: N
authors.initials: N
authors.lastname: Caplan
authors.forename: S
authors.initials: S
authors.lastname: Jones
authors.forename: A
authors.initials: A
authors.lastname: St Clair Gibson
authors.forename: D
authors.initials: D
authors.lastname: Kader
mesh_terms: D000058:Accidental Falls; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D011630:Pubic Bone / Q000293:injuries*; D012307:Risk Factors; D012447:Sacrum / Q000293:injuries*; D006113:United Kingdom / Q000453:epidemiology