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Pelvic Ring Injuries and Acetabular Fractures: Quality of Life Following Surgical Treatment
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim was to study outcome following surgery of the injured pelvis with focus on assessment from the patient’s perspective. All adult patients operatively treated for pelvic ring injuries or acetabular fractures at the Department of Orthopaedics, Uppsala University, starting 2003 were prospectively included and followed with quality of life (QoL) instruments for 2 years. The most common trauma mechanism was motor vehicle accident (MVA). Study I included 54 patients with pelvic ring injuries during the three-year period 2003-2005. The two instruments, SF-36 and LiSat-11, were used. In 45 responders lower than normative QoL and life satisfaction prevailed at two years after the injury. Study II included 12 patients with pelvic ring injuries or acetabular fractures sustained following a jump from height in an attempt to commit suicide. At four years all patients were still alive and SCID-interviews performed by a psychiatrist revealed low recurrence of self-destructive behaviour and high QoL in the younger patients. Study III included 136 patients with acetabular fractures where 52 had elementary and 84 associated fracture patterns. Fracture reduction was 0-1 mm in 106 patients and 2 mm or more in 30. QoL was significantly higher in patients with anatomically reduced fractures. Physical SF-36 domains improved with time, albeit QoL was lower than norm. Study IV had the aim to construct a condition-specific outcome instrument for patients with acetabular fractures. Closed and open questions were sent to 127 consecutive acetabular fracture patients at 6, 12 and 24 months following surgery. Responses were validated through factor analysis, scree tests, item reduction and principal component analysis which resulted in a multi-item verbal descriptive scale (VDS) with six condition-specific questions related to “Pain”, “Walking”, “Hip motion”, “Leg numbness”, “Sexual life”, “Operation scar” and a global question concerning impact on daily life activities for acetabular fracture assessment.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2011. , 63 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 659
National Category
Surgery
Research subject
Orthopaedics
Identifiers
URN: urn:nbn:se:uu:diva-149168ISBN: 978-91-554-8041-7OAI: oai:DiVA.org:uu-149168DiVA: diva2:406621
Public defence
2011-05-13, Skoogsalen, ing 78-79, Uppsala University Hospital, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-04-20 Created: 2011-03-15 Last updated: 2011-09-15Bibliographically approved
List of papers
1. Health-related quality of life and life satisfaction in patients following surgically treated pelvic ring fractures: A prospective observational study with two years follow-up
Open this publication in new window or tab >>Health-related quality of life and life satisfaction in patients following surgically treated pelvic ring fractures: A prospective observational study with two years follow-up
2010 (English)In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 41, no 4, 400-404 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Pelvic ring fractures caused by high-energy trauma are severe injuries with well described radiological and clinical outcomes, whereas description from the patient's perspective is less well documented. The purpose of this study was to investigate patient-reported outcome following surgical treatment of pelvic fractures using quality of life instruments. METHODS: All 54 patients (28 male/26 female, ages 16-68) with pelvic fractures referred to our institution for surgical treatment 2003-2005 were prospectively included. The most common trauma was motor vehicle accident (44%). Additional injuries were seen in 74% and in 31% the ISS was >or=16. There were 31 B and 23 C type fractures. Patients were followed for two years using two validated questionnaires, SF-36 and LiSat-11, the latter an instrument consisting of 11 questions for evaluation of satisfaction with different aspects of life. RESULTS: 45 patients could be followed according to the study protocol for two years while 2 were untraceable and 1 died from unrelated causes. Of 6 nonresponders, 5 were unable due to psychiatric disorder. At two years pelvic fracture patients scored lower than the reference population in both physical and mental domains (SF-36). Highest mean score, 68, was in the domain Social Function (norm 89) while lowest mean score, 38, was in the domain Role Physical (norm 86). The mean score closest to the normative was for general health with 61 for patients and 78 for the normative group. In LiSat-11 pelvic fracture patients scored lower than the reference population in all areas. Satisfaction with life as a whole was 31% compared with 60% in the normative group. CONCLUSIONS: Two years after surgical treatment of pelvic ring fractures, patients reported substantially lower quality of life for both physical and mental domains, when compared with a reference population, even when radiological and clinical outcomes were considered favourable.

Place, publisher, year, edition, pages
Elsevier, 2010
National Category
Orthopedics
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-129584 (URN)10.1016/j.injury.2009.11.006 (DOI)000276447900019 ()20005513 (PubMedID)
Available from: 2010-08-19 Created: 2010-08-19 Last updated: 2011-09-14Bibliographically approved
2. Quality of life in patients operated for pelvic fractures caused by suicide attempt by jumping
Open this publication in new window or tab >>Quality of life in patients operated for pelvic fractures caused by suicide attempt by jumping
2010 (English)In: Scandinavian Journal of Surgery, ISSN 1457-4969, Vol. 99, no 3, 180-186 p.Article in journal (Refereed) Published
Abstract [en]

Background and Aims: Jumping from great height is an aggressive method of suicide attempt where the frequent combination of psychiatric disorder and somatic injuries makes treatment difficult. Our aim was to evaluate survival rate and get patient-reported outcome in patients operated for a pelvic or acetabular fracture sustained when jumping from a height as a suicide attempt. Patients and Methods: During the period 2003-2004, 12 patients (11 women) of whom eight were below 30 years of age, were prospectively included. At two years HRQoL (Health-Related Quality of Life) questionnaires (SF-36 and LiSat-11) were used to describe outcome, and at four years a structured psychiatric interview SCID-I (Structured Clinical Interview for DSM-IV Axis I Disorders) was done. Results: At four years all patients were alive. One patient had made a new suicide attempt. Eight patients gave adequate reply on SF-36 and LiSat-11 at two years. In all domains patients scored lower than a norm group with the relatively lowest values in physical domains. Younger patients assessed life as better when compared with middle aged patients. Conclusions: This study showed a very low recurrence rate into suicidal behaviour in a group of jumpers and all patients were alive at four years after a suicidal attempt by jumping. The high proportion of psychiatric disorder in these patients highlights the need for a combined treatment effort between orthopaedic and psychiatric expertise.

Keyword
Jumpers, suicidal attempt, pelvic fractures, SF-36, LiSat-11, SCID
National Category
Medical and Health Sciences
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-134817 (URN)000282111700014 ()21044937 (PubMedID)
Available from: 2010-12-02 Created: 2010-12-01 Last updated: 2011-07-08Bibliographically approved
3. Quality of life in patients operated for pelvic fractures caused by suicide attempt by jumping
Open this publication in new window or tab >>Quality of life in patients operated for pelvic fractures caused by suicide attempt by jumping
2010 (English)In: Scandinavian Journal of Surgery, ISSN 1457-4969, Vol. 99, no 3, 180-186 p.Article in journal (Refereed) Published
Abstract [en]

Background and Aims: Jumping from great height is an aggressive method of suicide attempt where the frequent combination of psychiatric disorder and somatic injuries makes treatment difficult. Our aim was to evaluate survival rate and get patient-reported outcome in patients operated for a pelvic or acetabular fracture sustained when jumping from a height as a suicide attempt. Patients and Methods: During the period 2003-2004, 12 patients (11 women) of whom eight were below 30 years of age, were prospectively included. At two years HRQoL (Health-Related Quality of Life) questionnaires (SF-36 and LiSat-11) were used to describe outcome, and at four years a structured psychiatric interview SCID-I (Structured Clinical Interview for DSM-IV Axis I Disorders) was done. Results: At four years all patients were alive. One patient had made a new suicide attempt. Eight patients gave adequate reply on SF-36 and LiSat-11 at two years. In all domains patients scored lower than a norm group with the relatively lowest values in physical domains. Younger patients assessed life as better when compared with middle aged patients. Conclusions: This study showed a very low recurrence rate into suicidal behaviour in a group of jumpers and all patients were alive at four years after a suicidal attempt by jumping. The high proportion of psychiatric disorder in these patients highlights the need for a combined treatment effort between orthopaedic and psychiatric expertise.

Keyword
Jumpers, suicidal attempt, pelvic fractures, SF-36, LiSat-11, SCID
National Category
Medical and Health Sciences
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-134817 (URN)000282111700014 ()21044937 (PubMedID)
Available from: 2010-12-02 Created: 2010-12-01 Last updated: 2011-07-08Bibliographically approved
4. On the construction of a questionnaire for assessment of outcome following surgical treatment of acetabular fractures
Open this publication in new window or tab >>On the construction of a questionnaire for assessment of outcome following surgical treatment of acetabular fractures
(English)Manuscript (preprint) (Other academic)
National Category
Surgery
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-149078 (URN)
Available from: 2011-03-15 Created: 2011-03-15 Last updated: 2011-05-04

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