# Patient-Reported Outcome Measures in the Elderly: Do These Reflect Healing Post-Fragility Fracture of the Pelvis?

## TL;DR

This study finds that elderly patients with non-operatively treated pelvic fractures experience declining function and quality of life over two years, with no clear link to healing status.

## Contribution

The study introduces new evidence that patient-reported outcomes worsen over time regardless of healing in non-operatively managed fragility fractures of the pelvis.

## Key findings

- Patient-reported function and quality of life measures declined over two years post-injury.
- X-ray evidence of healing was confirmed in only seven out of 53 patients.
- No association was found between healing status and patient-reported outcome measures.

## Abstract

Background and objective

Fragility fractures of the pelvis (FFPs) have become increasingly common in the geriatric population. The prolonged healing process associated with current non-operative management of FFPs has a significant negative impact on patient mobility, independence, and quality of life (QoL). This study aimed to document functional outcomes and QoL measures in individuals with non-operatively treated FFPs and examine if a relationship exists between these parameters and healing status.

Methods

This was a prospective case series involving a cohort from a single level 1 trauma center. Fifty-three elderly patients (age ≥65 years) who, after a fall from less than 5 feet, sustained a non-operative FFP as diagnosed on X-ray between 2008 and 2019. Functional outcomes using Musculoskeletal Function Assessment (MFA) and QoL measures based on 36-Item Short Form Health Survey (SF-36) were collected over two years. Healing was assessed per available follow-up X-ray imaging by four orthopaedic surgeons.

Results

Health status and function did not improve in elderly patients with stable FFPs treated non-operatively from reported baseline levels, with many MFA and SF-36 categories demonstrating a steady decline out to approximately 24 months. Follow-up X-ray imaging was only available for a subset of these individuals (n = 35). Substantial agreement was found between all four surgeon raters (Fleiss Kappa = 0.65) with respect to their evaluation of healing status. Confirmation of bone healing on X-ray (level 3) was found for only seven individuals. There was no association found between any MFA or SF-36 category and healing status for patients with coincident reporting (n = 16).

Conclusions

Overall, patient function and QoL decrease post-stable FFP, with no relationship evident between these measures and healing status. Worsening patient-reported outcome measures (PROMs) regardless of healing status should prompt discussions and further investigations regarding the need for continued monitoring of non-operative FFPs post-injury.