Are work return and leaves of absence predictable after an unstable pelvic ring injury?

Impact of COVID-19 pandemic outbreak on pelvic trauma surgical management

The aim of this study was to investigate the impact of the COVID-19 pandemic on pelvic trauma surgery in Poland. This study comprises 132 consecutive patients admitted for pelvic fracture surgery from 2019 to 2022, separating them into 2 groups; pre-COVID (1 year before the outbreak of pandemic - 2019) and COVID period (in Poland 2020-2022). The data was collected respectively in a single trauma center. Demographic data was collected, additionally, the type of fracture according to Young-Burgess and Letournel-Judet classification system, date of the injury and surgery, the surgical approach and stabilization methods, mechanism of trauma, concomitant injuries, body mass index (BMI), blood transfusions, number of days spent in the hospital, and surgery duration. Patients during the pandemic had statistically significantly shorter duration of hospital stay, and lesser amount of blood units transfused comparing to the non- pandemic group, 4.50 days vs. 6.90 days (p < 0.001) and 1.20 units vs. 1.40 units (p = 0.0401) respectively. Patients with acetabulum fractures required more blood transfusion units (p < 0.0001), comparing to those with pelvic ring injuries. Moreover, the acetabulum fractures were more time demanding comparing to pelvic ring injury (151 min vs. 128 min, respectively) (p < 0.0001) as well as length of hospital stay was longer (5.18 days, 3.85 days (respectively) (p = 0.042). During the COVID-19 period, comparing patients with acetabulum fractures to those with pelvic ring injuries, they required more blood transfusion units, the acetabulum fractures were more time demanding with increased days of hospitalization. Additionally, patients during the COVID-19 period remained hospitalized for a shorter period of time and received lesser amount of blood transfusions with pelvic ring injuries.

[Accident pension after fracture of the pelvic ring and acetabulum : Changes in pension claims and costs following isolated fractures of the pelvic ring and acetabulum in work-related accidents from 2013 to 2019-A DGUV registry analysis]

BACKGROUND

It is known that fractures of the pelvic ring and acetabulum in work-related accidents are associated with long periods of incapacity to work, a high rate of reduction in earning capacity (MdE) and high costs for pension/severance pay.

OBJECTIVE

Investigation of changes in pension claims and costs from 2013 to 2019 after isolated fractures of the pelvic ring and acetabulum in work-related accidents in Germany.

MATERIAL AND METHODS

For all patients from the German Social Accident Insurance (DGUV) registry with isolated fractures of the pelvic ring or acetabulum in work-related accidents, linear trend analyses were carried out among others for the proportion of MdE ≥20%, the proportion of cases receiving pension/severance pay and total costs for pension/severance pay from 2013 to 2019. A logistic regression analysis for the likelihood of receiving a pension was also performed.

RESULTS

The proportion of MdE ≥20% decreased for fractures of the pelvic ring and acetabulum in total from 14.3% for 2013 to 8.2% for 2019 and there was a decreasing trend for the proportion of cases receiving pension/severance pay for fractures of the pelvic ring and acetabulum in total from 23.1% for 2013 to 13.6% for 2019 as well as for both fracture types individually. There was also a decrease in the costs for pensions/severance pay for fractures of the pelvic ring and acetabulum in total from € 1,542,531 for 2013 to € 1,006,887 for 2019. The likelihood of receiving a pension decreased by 8% per subsequent accident year between 2013 and 2019.

CONCLUSION

The proportion of pension claims and thus the costs for pensions/severance pay decreased for isolated fractures of the pelvic ring and acetabulum in work-related accidents from 2013 to 2019. The DGUV seems to fulfil its guideline Rehabilitation before pension.

Return to work following traumatic hip dislocation: a prognostic outcome study

BACKGROUND

Traumatic hip dislocations are associated with high morbidity and overall limitations of daily living activities. Residual disability inhibits returning to work after severe injuries and minimizes financial independence and social involvement, which are both related to well-being and good health. The aim of this study was to analyze epidemiological and socioeconomic status following traumatic hip dislocations to identify predictors for return to work.

PATIENTS AND METHODS

Patients with traumatic hip dislocations from three level one trauma centers from 2009 to 2021 were followed up in terms of epidemiological data, return to work, change of work, and predictors of socioeconomic outcome. Inclusion criteria were age ≥ 18 years, employed patients, and a minimum follow-up of ≥ 2 years. Patients with incomplete or missing medical records, including radiological imaging and retired patients, were excluded. 107 patients met the inclusion criteria and 67 (63%) patients were available for follow-up.

RESULTS

A total of 81 male and 26 female patients with a mean age of 41.82 years (SD ± 15.65) were finally evaluated. A work-related accident was found in 28 patients (26%). Demographic data and treatment course did not differ significantly between the work-related and non-work-related accidents. Sixty-seven (63%) patients (51 male and 16 female) with a mean age of 42 years (SD ± 15.79) were included in the follow-up. Eighteen patients (27%) had not returned to their previous job and 12 patients (18%) had reduced income. Higher age and Body Mass Index (BMI) were significantly associated with a lower return rate to the pre-accident job (p < 0.05). Furthermore, lower Tegner Activity Scale, pain score, and modified Harris Hip Score were also significantly associated with lower return to work rate (p < 0.001) and reduced income.

CONCLUSION

Traumatic hip dislocations are associated with high rates of work-related injury and unsatisfactory low rates of return to previous work. Younger age, lower BMI, higher Patient reported outcome measures and lower pain levels may predict a successful return to previous job and a reduced risk of reduction in earning capacity. Understanding the predictive factors is crucial to identify patients at risk of not returning to work and to develop strategies that may help improve their chances of successfully returning to their previous employment.

Work Productivity Loss After Minimally Displaced Complete Lateral Compression Pelvis Fractures

OBJECTIVE

To quantify work impairment and economic losses due to lost employment, lost work time (absenteeism), and lost productivity while working (presenteeism) after a lateral compression pelvic ring fracture. Secondarily, productivity loss of patients treated with surgical fixation versus nonoperative management was compared.

METHODS

DESIGN

Secondary analysis of a prospective, multicenter trial.

SETTING

Two level I academic trauma centers.

PATIENT SELECTION CRITERIA

Adult patients with a lateral compression pelvic fracture (OTA/AO 61-B1/B2) with a complete posterior pelvic ring fracture and less than 10 mm of initial displacement. Excluded were patients who were not working or non-ambulatory before their pelvis fracture or who had a concomitant spinal cord injury.

OUTCOME MEASURES AND COMPARISONS

Work impairment, including hours lost to unemployment, absenteeism, and presenteeism, measured by Work Productivity and Activity Impairment assessments in the year after injury. Results after non-operative and operative treatment were compared.

RESULTS

Of the 64 included patients, forty-seven percent (30/64) were treated with surgical fixation, and 53% (30/64) with nonoperative management. 63% returned to work within 1 year of injury. Workers lost an average of 67% of a 2080-hour average work year, corresponding with $56,276 in lost economic productivity. Of the 1395 total hours lost, 87% was due to unemployment, 3% to absenteeism, and 10% to presenteeism. Surgical fixation was associated with 27% fewer lost hours (1155 vs. 1583, P = 0.005) and prevented $17,266 in average lost economic productivity per patient compared with nonoperative management.

CONCLUSIONS

Lateral compression pelvic fractures are associated with a substantial economic impact on patients and society. Surgical fixation reduces work impairment and the corresponding economic burden.

LEVEL OF EVIDENCE

Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Epidemiology and socioeconomic consequences of work-related pelvic and acetabular fractures recorded in the German Social Accident Insurance

INTRODUCTION

Pelvic and acetabular fractures can result from work-related accidents and frequently require lengthy medical treatments. Consequently, high medical costs as well as delayed or absent return to work can be the consequence. Therefore, we aimed to study the socioeconomic consequences of work-related pelvic and acetabular fractures.

MATERIALS AND METHODS

This retrospective study investigated work-related pelvic and acetabular fractures recorded in the German Social Accident Insurance in 2011 and 2017, in terms of age, sex, type of accident, duration of incapacity to work, reductions in earning capacity, costs for outpatient and inpatient treatment and costs for pension and severance pay.

RESULTS

Among a total of 606 injuries in 2011 and 619 injuries in 2017, male patients and patients between 40 and 65 years were predominantly affected. Acetabular fractures caused higher rates of long absence from work of 6-12 months (2011: 24.7% vs. 9.5-16.9%; 2017: 26.1% vs. 6.1-11.0%) and >12 months (2011: 15.8% vs. 9.8-10.2%; 2017: 13.3% vs. 1.9-8.2%) as well as more cases with a reduction in earning capacity of at least 20% (2011: 61 vs. ≤27 cases; 2017: 39 vs. ≤12 cases) compared to pelvic ring fractures. The total costs for pelvic ring and acetabular fractures in the German social accident insurances amounted € 18,726,630 and € 9637,189 in the periods 2011-2020 and 2017-2020, respectively. The average costs per case for treatment and rehabilitation until 2020 was € 19,079 for injuries from 2011 and € 13,629 for injuries from 2017. Acetabular fractures were found to be the most cost-intensive injuries compared to anterior, posterior or complex pelvic ring fractures.

CONCLUSIONS

Work-related pelvic and especially acetabular fractures have a considerable socioeconomic impact in the German Social Accident Insurance. Measures to prevent work-related accidents and to improve treatment of pelvic injuries can help to reduce their socioeconomic burden.

Quality of Life from Return to Work and Sport Activities to Sexual Dysfunction after Surgical Treatment of Pelvic Ring Fractures

BACKGROUND

Pelvic ring fractures are life-threatening injuries that have a severe impact on patients' lives. The aim of this clinical study was to evaluate the outcome of surgical treatment in terms of Quality of Life (QoL), return to work, functional results and sport activities, and post-operative sexual dysfunction.

METHODS

A retrospective study with patients retrieved from a Level 1 Trauma Center was performed. Minimum patient follow-up was 12 months: QoL was evaluated with the SF-12 (Short Form Survey) questionnaire, return to work with the Workplace Activity Limitation Survey (WALS), functional outcomes and sport activities with the Harris Hip Score and Tegner activity score, respectively, and sexual function damage with a 0-10 NRS.

RESULTS

Seventy-six patients (41 males and 35 females) were enrolled, with a mean age at surgery of 56.4 years (18-89 years). Overall, their quality of life remained significantly affected, with male patients reporting worse WALS outcomes (p = 0.036), sexual damage (p = 0.001), and SF-12 Bodily Pain (p = 0.046) than females. In particular, 70.7% of men and 45.7% of women reported sexual limitations, and only 53.7% returned to their job, with 35.2% losing their job as a consequence of the pelvic ring disruption.

CONCLUSIONS

An important deterioration in general health state, return to work, and sexual function was documented in patients treated surgically for pelvic trauma, especially in male patients. There are disabling secondary sequels at all levels beyond the mere functional scores, and both patients and clinicians should be aware and have the correct expectations.

Algo-Functional Indexes and Spatiotemporal Parameters of Gait after Sacroiliac Joint Arthrodesis

Aims of the study were to evaluate the reliability and validity of the Italian version of the Majeed and Iowa questionnaires and to investigate the long-term surgical outcomes following sacroiliac joint arthrodesis. Twenty one patients who underwent a sacroiliac joint arthrodesis and 21 healthy subjects were evaluated. The experimental procedure consisted of gait analysis and a physical activity assessment (in both groups) and of administration of outcome questionnaires and pain assessment (in the patient group). The Majeed and Iowa questionnaires showed excellent reliability, excellent (for the Majeed questionnaire) and good (for the Iowa questionnaire) construct validity, and poor convergent validity (for both questionnaires) relative to walking speed. Most of the patients reported no pain and minimum pain-related disability and their physical activity profile was comparable to healthy controls. Patients showed an impaired walking performance (i.e., they walked slower and using shorter steps) compared with healthy controls. Long-term walking pattern abnormalities following sacroiliac joint arthrodesis may occur despite excellent clinical results. Given their excellent reliability and construct validity, the Majeed and Iowa questionnaires can be used in combination with the assessment of spatiotemporal gait parameters for the prognostic assessment and/or follow-up of surgical patients.

Inaccuracies in the Use of the Majeed Pelvic Outcome Score: A Systematic Literature Review

OBJECTIVES

To evaluate the accuracy with which the Majeed Pelvic Score has been reported in the English literature.

DATA SOURCES

Databases used to search for literature were PubMed, Embase, and Ovid, restricted to English language from inception to October 2, 2018.

STUDY SELECTION

Search words used were: Majeed, pelvis, and outcome.

DATA EXTRACTION

Articles were assessed for descriptions of scoring and proper reporting of Majeed Pelvic Outcome Score.

DATA SYNTHESIS

Descriptive statistics were used to report the outcome of our findings.

CONCLUSIONS

Ninty-two English articles were identified. Twenty-four (26%) articles were identified as including methodology related to the use and scoring of the Majeed Pelvic score. The remaining 68 presented mean Majeed scores with no methodological information. None (0/92) discussed how the range of possible scores for the most severe function was applied. Six (7%) reported adjusted scores for patients not working. Three (3%) included a discussion of the scores as adjusted for patients working before injury compared with those not working. Ten (11%) addressed the categorization of scores by excellent to poor describing what raw scores defined those categories. We observed poor accuracy and notable inconsistency in the use and reporting of the Majeed Pelvic Outcome Score in the literature. These data demonstrate that interpretation and comparison of research reporting this score should be done cautiously. Future studies should include specific information as to how the Majeed instrument calculated to allow for verification of the presented scores and subsequent conclusions.

The socioeconomic impact of orthopaedic trauma: A systematic review and meta-analysis

The overall objective of this study was to determine the patient-level socioeconomic impact resulting from orthopaedic trauma in the available literature. The MEDLINE, Embase, and Scopus databases were searched in December 2019. Studies were eligible for inclusion if more than 75% of the study population sustained an appendicular fracture due to an acute trauma, the mean age was 18 through 65 years, and the study included a socioeconomic outcome, defined as a measure of income, employment status, or educational status. Two independent reviewers performed data extraction and quality assessment. Pooled estimates of the socioeconomic outcome measures were calculated using random-effects models with inverse variance weighting. Two-hundred-five studies met the eligibility criteria. These studies utilized five different socioeconomic outcomes, including return to work (n = 119), absenteeism days from work (n = 104), productivity loss (n = 11), income loss (n = 11), and new unemployment (n = 10). Pooled estimates for return to work remained relatively consistent across the 6-, 12-, and 24-month timepoint estimates of 58.7%, 67.7%, and 60.9%, respectively. The pooled estimate for mean days absent from work was 102.3 days (95% CI: 94.8-109.8). Thirteen-percent had lost employment at one-year post-injury (95% CI: 4.8-30.7). Tremendous heterogeneity (I2>89%) was observed for all pooled socioeconomic outcomes. These results suggest that orthopaedic injury can have a substantial impact on the patient's socioeconomic well-being, which may negatively affect a person's psychological wellbeing and happiness. However, socioeconomic recovery following injury can be very nuanced, and using only a single socioeconomic outcome yields inherent bias. Informative and accurate socioeconomic outcome assessment requires a multifaceted approach and further standardization.

Recovery and Return to Work After a Pelvic Fracture

Background

Pelvic ring fractures (PRFs) may influence the daily activities and quality of life of the injured. The aim of this retrospective study was to explore the functional outcomes and factors related to return to work (RTW) after PRF.

Methods

During the years 2003–2012, 282 injured individuals aged 20–55 years on the date of the accident, were hospitalized and treated for PRFs in a large tertiary hospital in Athens, Greece. One hundred and three patients were traced and contacted; 77 who were on paid employment prior to the accident gave their informed consent to participate in the survey, which was conducted in early 2015 through telephone interviews. The questionnaire included variables related to injury, treatment and activities, and the Majeed pelvic score. Univariate and multiple regression analyses were used for statistical assessment.

Results

Almost half of the injured (46.7%) fully RTW, and earning losses were reported to be 35% after PRF. The univariate analysis confirmed that RTW was significantly related to accident site (labor or not), the magnitude of the accident's force, concomitant injuries, duration of hospitalization, time to RTW, engagement to the same sport, Majeed score, and complications such as limp and pain as well as urologic and sexual complaints (p < 0.05 for all). On multiple logistic regression analysis, the accident sustained out of work (odds ratio: 6.472, 95% confidence interval: 1.626–25.769) and Majeed score (odds ratio: 3.749, 95% confidence interval: 2.092–6.720) were identified as independent predictive factors of full RTW.

Conclusion

PRFs have severe socioeconomic consequences. Possible predictors of RTW should be taken into account for health management and policies.

Are work return and leaves of absence after acetabular fractures predictable? : A retrospective study of 108 patients

BACKGROUND

To test if complexity of acetabular fractures, pre-trauma health status, time from trauma to definitive surgery, severity of injury or job characteristics influence work resumption, return to the same professional position and time out of work.

MATERIALS AND METHODS

We performed a retrospective study on patients with surgically treated acetabular fractures. Medical records were reviewed to analyse demographics, follow-up, diagnosis (Letournel classification), type of surgical treatment, co-morbidities, time from trauma to definitive surgery, American Society of Anesthesiologists physical status classification (ASA) and associated injuries. Patients were interviewed about the amount of leaves of absence and whether they returned to the same professional position.

RESULTS

The study included 108 patients whose mean age was 44 ± 11 years. Median time out of work was 180 days. Eleven patients lost their job and 23 patients returned to a different professional position. Univariable analysis showed: (a) the risk of losing the job was higher for patients who had been admitted to intensive care unit (ICU) (p = 0.018), (b) returning to the identical position was more likely in patients who were older (p = 0.006), sedentary workers (p = 0.003), and with shorter time from trauma to definitive surgery (p = 0.003). Multivariable linear regression showed that leaves of absence were longer in patients with higher ASA scores, who had been admitted to ICU, or were not sedentary workers.

CONCLUSIONS

Work reintegration after acetabular fractures is a main issue for the patient and social systems: only 69 % of patients returned to their previously held professional position. Time out of work was not found to be related to fracture type but to pre-trauma health status, ICU admission and sedentary jobs.

LEVEL OF EVIDENCE

III.