Surgical Treatment of Pelvic Ring Injuries and Acetabular Fractures : Aspects on Patient-reported Outcome
Abstract: The overall aim of the present thesis was to study the patient perspective on outcome following surgical treatment of pelvic ring injuries and acetabular fractures. All studies were based on patients treated for such injuries at the Department of Orthopaedics, Uppsala University Hospital, Sweden.In Study I, a patient-reported outcome measure to provide condition-specific information regarding outcome after surgical treatment of pelvic ring injuries was developed. Seventy-three patients were asked to complete a questionnaire at three time points during follow-up. Evaluation of data resulted in the Pelvic Discomfort Index (PDI). This instrument is comprised of six questions regarding residual problems from the pelvic region with respect to pain, walking, hip motion, leg numbness, sexual life and the operation scar.The influence of the time-point post-surgery at which patients with surgically treated pelvic ring injuries or acetabular fractures estimate their pre-traumatic state was examined in study II. Seventy-three patients assessed their pre-traumatic status at three time-points post-surgery. It was found that pre-traumatic quality of life was high and comparable to a reference population. Pre-existing discomfort from the pelvic region was uncommon. A tendency for patients to estimate a better pre-traumatic status when assessments were delayed was observed.The objective of Study III was to compare outcome after surgical treatment of complex acetabular fractures in the elderly using either the combined hip procedure, consisting of open reduction and internal fixation (ORIF) in conjunction with an acute total hip arthroplasty, or ORIF alone with respect to mortality, need for secondary surgery and patient-reported outcome. Thirteen patients treated with the CHP were compared to 14 patients with similar fracture patterns treated with ORIF alone. The CHP conferred a markedly reduced need for secondary surgical procedures while no differences in perioperative mortality or patient-reported outcome could be demonstrated.Patient-reported outcome at five years following surgical treatment of pelvic ring injury was evaluated in study IV. The consequences of these injuries were found to be substantial and long-standing. Females reported a worse outcome than males, while influence of variables age, injury type and presence of associated injuries was limited.In Study V, patient experiences of life following treatment for pelvic ring injury was explored. Semi-structured interviews were conducted with ten patients at a median of 11 years after injury and analyzed using inductive content analysis. Patients described a heterogenous outcome, with residual impairment ranging from virtually none to severe disability. A need for adequate patient information and individual assessments of patients was noted.
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