title: Functional and return to work outcomes following major trauma involving severe pelvic ring fracture.
abstract: BACKGROUND
  There is limited evidence describing the long-term outcomes of severe pelvic ring fractures. The aim of this study was to describe the longer term independent living and return to work outcomes following severe pelvic ring fracture.
  
  
  METHODS
  Adult survivors to discharge from two major trauma centres with AO/Tile type B and C fractures were followed up at 6, 12 and 24-months post-injury to capture functional (Glasgow Outcome Scale-Extended [GOS-E]) and return to work data. Multivariable, mixed effects models were used to identify predictors of outcome.
  
  
  RESULTS
  A total of 111 of 114 (97%) cases were followed up. The mean (SD) age of participants was 41.9 (18.9) years, 77% were male, 81% were transport-related and 90% were multi-trauma patients. Further, 11% were managed conservatively, 10% with external fixation and 79% with open reduction and internal fixation. At 24 months, 77% were living independently (GOS-E > 4) and 59% had returned to work. Higher Injury Severity Scores (ISS) were associated with lower risk-adjusted odds of return to work (P = 0.04) and independent living (P = 0.06). Post-operative infection was associated with living independently (P = 0.02).
  
  
  CONCLUSIONS
  Despite the severity of the injuries sustained, 77% of severe pelvic ring fracture patients were living independently and 59% had returned to work, 2-years post-injury. Fracture type and management were not key predictors of outcome. Large-scale multi-centre studies are needed to fully understand the burden of severe pelvic ring fractures and to guide clinical management.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.|College of Medicine, Swansea University, Swansea, UK.
authors.forename: Belinda J
authors.initials: BJ
authors.lastname: Gabbe
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Dirk-Jan
authors.initials: DJ
authors.lastname: Hofstee
authors.affiliation: Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Max
authors.initials: M
authors.lastname: Esser
authors.affiliation: Department of Orthopaedics, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bucknill
authors.affiliation: Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.|Department of Surgery, Monash University, Melbourne, Victoria, Australia.
authors.forename: Matthias K
authors.initials: MK
authors.lastname: Russ
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.|Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cameron
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Handley
authors.affiliation: Department of Surgery, Epworth Healthcare, Melbourne, Victoria, Australia.|Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Richard N
authors.initials: RN
authors.lastname: de Steiger
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods; D005593:Fracture Fixation, Internal / Q000379:methods; D050723:Fractures, Bone / Q000534:rehabilitation* / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000209:etiology / Q000534:rehabilitation* / Q000601:surgery*; D010384:Pelvic Bones / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D012189:Retrospective Studies; D062707:Return to Work; D014193:Trauma Centers; D016896:Treatment Outcome
keywords: cohort study; function; long-term outcome; pelvic fracture; return to work