title: Preinjury ambulatory status is associated with 1-year mortality following lateral compression Type I fractures in the geriatric population older than 80 years.
abstract: BACKGROUND
  Lateral compression pelvic Type I fractures in the elderly population are most often low-energy osteoporosis related fractures. Previous literature comparing pelvic fractures in young versus elderly patients called into question the general consideration of these injuries as benign injuries with favorable prognoses; however, the geriatric population older than 80 years is often underrepresented. This article focuses on the mortality and functional outcomes after low-energy pelvic fractures in a population of patients older than 80 years.
  
  
  METHODS
  We prescreened potential subjects in a Level I trauma institution's electronic medical record database between January 1, 2002, and April 30, 2012, to identify isolated lateral compression Type 1 fractures treated nonoperatively in patients older than 80 years. This study was composed of a retrospective review of medical records followed by a prospective survey data collection to examine mechanisms of injury, length of hospital stay, complications, medical comorbidities, ambulatory function, living situation, pain, and 1 year mortality rates.
  
  
  RESULTS
  We present a large case series of 85 patients older than 80 years and report a 1-year mortality rate of 20%. We found that patients who were household ambulators or nonfunctional ambulators were five times more likely (24.4% vs. 6.1%) to die within 1 year after injury. Multivariate logistic regression confirmed that the risk of 1-year mortality was significantly higher for household-bound patients compared with community ambulators, independent of sex, smoking, Charlson comorbidity index, or length of hospital stay.
  
  
  CONCLUSIONS
  This is the first study to demonstrate a difference in 1-year mortality between patients who were community ambulators versus those who were household ambulators or nonfunctional ambulators before injury. With our aging population, these findings have important implications. Maintenance of general conditioning and early mobilization with physical therapy after injury is a key part of geriatric orthopedic rehabilitation.
  
  
  METHODS
  Prognostic and epidemiologic, level IV.
authors.affiliation: From the Harvard Combined Orthopedic Residency Program (B.T.), Massachusetts General Hospital, Boston Massachusetts; Departments of Anesthesia and Surgery (D.Z.), Children's Hospital, Boston, Massachusetts; Department of Orthopedic Surgery (L.H., K.W., P.A., E.K.R.), Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Beverlie
authors.initials: B
authors.lastname: Ting
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Lindsay
authors.initials: L
authors.lastname: Herder
authors.forename: Katiri
authors.initials: K
authors.lastname: Wagner
authors.forename: Paul
authors.initials: P
authors.lastname: Appleton
authors.forename: Edward K
authors.initials: EK
authors.lastname: Rodriguez
mesh_terms: D000203:Activities of Daily Living; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods / Q000401:mortality; D050815:Fractures, Compression / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*