A pelvic fracture is a
break of the borny fracture of the pelvis this includes, only break of the
sacrum, hip bones or tail bones. Symptoms include; pain, particularly with
movement complications may include, bleeding, and injury to the bladder or
vaginal trauma. Common causes include, fall from height, motor vehicle
collisions or even direct blow. In young people less significant trauma is
typically required while older people less significant trauma can result in a
fracture they are divided into two types; stable and unstable fractures again
divided into anterior and posterior and lateral compression. Pelvic fractures
makes upto 3 of adult fractures. Stable fracures generally have a good outcome
[Rhodes nelson 2008].
The borny pelvis consists
of the ischium, illium and pubis which forms anatomic ring with the sacrum
disruption. Distribution of the ring requires significant energy. In addition
trauma to extra pelvic organs is common. The pelvic fractures are often
associated with sever hemorrhage, 85% of the bleeding is venous or open surface
of the bone. Pelvic fractures are most commonly described using one of two
classification, the difference forces on pelvis result in different fractures
or determine stability or instability. Tile classification which is based on
the integrity of the posterior sacroilliac complex is disrupted in. C injuries
are characterized by complex disruption of the posterior sacroilliac complex
and are both rotationally and vertically unstable this is due to great force
applied. In young and burgess classification the fractures are graded into (3).
Grade 1 is associated with sacroilliac compression on side of the impact, while
in grade 2 associated posterior illiac fractures on side of the impact, in
grade 3 there is associated contrateral
sacroilliac joint injury(ICD 2006
One specific fracture in
pelvic is known as the 'open book' fracture according to (Marianne 2008) this
is often the result from a heavy impact to the groin, a common motorcycle
injury (WHO 2008) this kind of injury the left and right halves of the pelvis
are separated at front and rare, depending on the severity this may require
surgical reconstruction before rehabilitation. About 10% of the people that
seek treatment at a level trauma have open book fractures or injury(mariane
2008)
Globally, an estimate of
1.2 million people die from road traffic accidents and for each death from
trauma, 3 victims suffer from permanent disability. Moreover, trauma is the
third major cause of ischemia cardiovascular disease and occurrence of
depression among victims and family members. In a recent study done in Taiwan,
epidemiological survey using the nationwide randomly sampled data base showed
that 26.4% of all emergency department (ED) visitors utilized ED services.
Using evidence based on Taiwan’s nationwide registered health data, the
incidence and mortality of hospitalized traumatic pelvic fractures were 6%
increase from the previous year (WHO 2009). However some authors have reported
mortality rate as low as 5% which was considerably higher than the rates
reported from closed fractures in the same period (Lingard jedan et al 2009)
Regionally, countries in
Africa still have high rates of pelvic injuries; this is due to the road
traffic accidents which is the leading cause of this problem. It has been
predicted that, by 2025 road traffic injuries will rank as the leading cause of
pelvic fractures. 1.4 million Cases recorded in 2017 in a research done in
Cameroon, showed that of these cases, about 1.2 million cases were due to RTI’s
while 200,000 were due to high energy trauma, violence and pathological diseases
recorded only 50,000 fatalities (ICD 2017). This figure may increase by 1.8
million by 2025 if proper measures will not be put in place. By contrast,
developing countries have experienced an increased trend since 2006 because of
lack of proper measures that will help reduce the figure (Emmanuel Jemson
2019).
In Kenya, fatalities that
are attributed to pelvic injuries have been seen to increase steadily over the
years, this is due to increase in RTI’s which lead to pelvic fracture. With
RTI’s incidences, increasing from 200,000-500,000 in 2017, high energy trauma.
Violence being the second most cause of pelvic injuries with the fatalities
increasing from 1500-2100 the same year. According to a research done in the
University of Nairobi, found that the number of persons with pelvic fractures
has increased consistently in the recent years, in 2017 alone, 1150 cases were
reported country wide showing an increase over the past four year. In 2016,
cases reported were 750 and in 2015 the cases were 475 (Matheka 2017).
The findings of these
research was to help the health management team at Nakuru level five hospital
understand ways of preventing occurrence of pelvic fracture and also be able to
educate the community in order to prevent future motility and morbidity in the
future injuries
It was also to help the
researchers to continue with research on pelvic injuries
It will also act as a
future reference for studies in the same field and it is also a requirement in
partial fulfillment of the award of diploma in orthopaedics and trauma
medicine.
1.4 Research questions
1.
What are the factors contributing to pelvic fractures?
2. What are the causes of
pelvic fractures?
3. What are the ways used
in management?
4. What are complications
arising from the injury?
To determine factors
contributing to pelvic fractures among patients attending Nakuru level 5
hospital.
1. To determine the
social demographic characteristics among patients with pelvic fractures
2. To determine the
causes of pelvic fractures
3. To establish the ways
used in management.
4. To identify
complications arising from the injury.
My study was carried out at Nakuru level 5 Hospital and it include all patients in accident and emergency
departments, clinic, Theater and orthopedic wards, duration of the study
was from September 2021 to December 2021
so as to come up with demographic characteristics, causes, management and
complications of pelvic injuries .
1. The study was limited
to all patients attending Nakuru level 5 hospitall and not any other hospital.
2. The respondent
were not operational to give accurate information
3. Limited time thus
inadequate results.
Pelvic fractures occurs
when significant trauma such as road traffic collisions, fall from height or
crash injury. Due to the location of injuries to other structures such as major
blood vessel, the bladder and/or the bowel may occur. Pelvic fractures are
common injuries of the hip, the incidence of the pelvic fractures are 162 per
10,000 individuals worldwide. Patients of all age groups may develop pelvic
injuries. Pelvic fractures usually affect individuals of Caucasian race more
than any other race. The ration of female to male is higher in the elderly
whereas there is a equal gender
prediction for young adults.
Pelvic fractures are very
common either in isolation or combination with other lower extremity fractures
and injuries eg in the united states there is an incidence of around 67 lower
extremity fracture per 10000 people annually. With the exception of 18-36 years
pelvic fractures is the second most common lower extremity fracture, the
overall incidence of pelvic fractures occurring each year is increasingly
worldwide for example a study by Richardson for Rochester Minesota in the
united states documented 17% increase in pelvic fractures 1998-1999 (Melton l j
3rd 1998).
Another 2017 study by
jerrhag from swiden showed 2.0 increases in pelvic fractures per annum in male.
3.4% increase in women aged between 30-52 years between 1999-2010. This study
has showed statistically significant increase in the age of 17-64 age group.
Most of the pelvic injuries are closed and are
most frequently posterior (sometimes posterolateral or posteromedial) although
anterior, medial, lateral and divergent injuries are also infrequently
encountered. In plain radiograph the fracture is usually obvious especially if
adequate anterior posterior (AP) and Lateral views are obtained (Xiang Yao et
al 2020)
When pelvic fracture is
simple (i.e. no associated fracture) then closed reduction and a brief period
(e.g. <2 weeks) of immobilization is done using canvas sling (Kinner Davda
et al; 2017). Complex fracture – fractures of the pelvic require operative management,
consisting of reduction of the dislocation, management of the fracture and the
repair of surrounding damaged tissues (ORIF). They are far more likely to have
a poor outcome including secondary osteoarthritis, limited range of motion,
instability (40%) and recurrent dislocation as well as pain (this is more
common in open fracture – dislocations (sung H.Lee et al; 2020)
Incidence of total
fracture was observed in 7 of 67 Children (10.45%). Pelvic injuries was typically
accompanied by single or multiple fractures in 39 (58.21%) and 21(31.34%) of67
children, respectively. In contrast lateral humeral condyle fracture and medial
humeral epicondyle fracture accounted for 35.90% and 30.77% of pediatric elbow
fracture (Louahery DM 2010)
Treatment for the open
book will be performed by closed reduction and proper immobilization. urgical
intervention will be applied to restore the correct alignment of this fracture
(Menale AG, 2015).All patients with fracture dislocation received surgical
intervention by ORIF (Open reduction Internal Fixation). During follow up 56%
to 92% of children displayed significant recovery of elbow function with
improving MEPS after the displayed elbow and fractured fragments were reduced
and held in place for weeks (Valerio G 2010)
Age
Most patients who get
pelvic fractures are young and active people between 17 to 45years old (Kozin
SH, 2006)
Gender
The pelvic fractures
incidence was found to be high in men compared to women (Akhtar A, et al 2021)major
pelvic fractures comprised 73/4% in males and females 70.1%. The age
standardized in pelvic fractures incidence among males is388 and among females
266 (per 600,000 inhabits per year)
Education
Regarding education level
a study done in Nigeria showed that high number that gets pelvic fracture is
lower classes in primary school (Siebenlist, 2017). Awori et al 2015 revealed
that the majority (89%) had primary education.
Pelvic injuries typically
results when the hip experiences an expected or unbalanced impact
Trauma is the lead cause of death of patients
between the ages of 15 and 24 accounting for approximately 30.4% of all ICU
admission annually. The seriousness of pelvic fractures comes from the association
of other injuries as well as the potential hematoma and hemorrhagic shock.
Pelvic fractures make up to 10% of patients with pelvic injuries have atleast
one associated injury (WHO 2016). In a study done in st clare health care in
2007 from January to December showed that 57% of all pelvic injuries is due to
trauma and the leading cause of fracture pelvic (Elsvewa bv 2009).
Motor vehicles and motor
bikes injuries are always high energy and often results to pelvic fractures.
The national traffic safety administration suggests that nearly 15% of all
collition results in pelvic damages and 25% of victims who die in traffic
accidents to have had broken pelvices (NTSA 11th june 2017). In a study carried out in 2009 in the area of
Hannovar Germany, out of 12,428 individuals injured did sustain pelvic
injuries. The injuries according to means of transport were 46% with 25% being
accidents caused by cars, 15% motorcycles and 16% were pedestrians hit (Romario
Mathias 2009).
According to (WHO 2009), fall from
heights are the second leading cause of pelvic injuries worldwide with more
than 80% of all falls occurring in low and middle income countries. Depending
on heights, life threatening injuries are more likely to be. Falls greater than
18m are usually fatal, studies thatnwere made in Italy san Raffael hospital in
Milan in the year 2010-2011showed that 37% of all pelvic fractures were due to
fall from heights. This study also shows that heights of 7m and below had 17%
injuries unlike heights above 7m which had more than 83% injuries (Mathew Mirandes et al 2012)
Fragility fracture of the
pelvic are widely recognized. These fractures typically result from low energy trauma
such as falls. Severely, osteoporotic bone can fall simply due to lack of
osseous architecture and these fractures may occur without or in the absence of
trauma. Fragility fractures of the pelvis mostly occur in patients above 65yrs
of age after low energy falls. In the United States, majority of pelvic
fractures today have an osteoporotic origin, 64% of all pelvic fractures are
osteoporotic fractures and in patients above 60yrs (Melton mayo clinic 2014).
The management of the
fracture is based on severity of the fracture, medical condition of the patient
and the lifestyle. The treatment mode is divided into two; surgical and
non-surgical depending on the type of fracture site and also injury of soft
tissue (Lodwag oberkercher 2005).
Realignment of broken
pelvis requires surgery and this is done as an open reduction, incision is done
directly to manipulate the bone or a closed reduction in which incision is not
necessarily done. Once the bones are aligned, internal or external fixation to
all the bone in proper position is used. Metallic devices including wires,
pins, screws and plates are used. The surgeon may begin with an external
fixation technic in which an open or closed reduction is performed and the
bones are then held in placed by threading pins into the bone or either site of
the fracture. These pins are then connected to rods outside the skin which
forms a frame. Patients with acetabula fracture require an open reduction with
internal fixation (ORIF) especially those patients who also have displacement
of the joints. (Mayo clinic orthopaedics surgery 2009).
Loss of terminal extension
is the most common complication closed treatment of simple elbow dislocation
(Clark EM 2014) early; active range of motion (ROM) can help prevent from
occurring.
The dislocated joint be at higher risk of
developing osteoarthritis in future (Zhang P 2018)
Rarely blood vessels
supply the arm and can become pinched or trapped between the dislocated bones
or within the realigned joint lack of blood supply can cause severe pain and
permanent tissue damage in the arm and the hand (LIM SM 2017).
Nakuru is the third
largest metro in kenya after Nairobi and Mombasa in that order However in terms
of city proper, it is the fourth largest after Nairobi, Mombasa and kisumu.It
is the capital of Nakuru County and former capital of the Rift Valley province
as well as home to flamingo Radio which is the largest neo-urban Radio in the
metropoli. Its urban and rural population is 570,670 inhabitants according to
the 2019 cencus. Nakuru lies about, 1,850m above sea level. Alternatively names
include Nax and Nax Vegas.
Nakuru town has good
infrastructure and town planning. It has a well-planned bus terminal at the
heart of the town popularly known as the `Nakuru Airport’. It’s a busy place
where buses Nakuru climate is 26 degree Celsius, its yearlong warm or hot. The
main food crops grown include maize, beans, millet, sorghum, cassava, peas,
sweet potatoes and English potatoes, coffee, cotton and horticultural crops are
grown as cash crops. It is made of a kikuyu, kalenjin and Swahili.
The Nakuru County borders
7 counties with Laikipia to the North east, Nyandarua to the east, Kajiado to
the south, Narok to the south west, Bomet and Kericho to the west.
Nakuru level 5 hospital
is located in Nakuru County (Nakuru town constituency). Hospital receives both
inpatient and outpatient.
The study design was descriptive crossectional study which was
carried out to determine Demographic factors, social economic factors and
mechanism of injury in pelvic fractures in the elderly at Nakuru Level 5
Hospital.
The study targeted both
in patients and out patients who attended Nakuru Level 5 Hospital with pelvic
fractures.
i. All patients with pelvic injuries who presented
to orthopaedic and Trauma department, Orthopaedic Clinic and Orthopaedic wards.
ii. All patients with
pelvic fractures who were willing to participate in the study.
iii. All patients with or without traumatic etiology who attended orthopaedic and Trauma Department.
i. All patients who were
unwilling to provide information to the study.
ii. All patients without
pelvic fractures
Factors contributing to
pelvic in the elderly attending Nakuru Level 5 Hospital
Demographic factors
contributing to pelvic fractures in the elderly. Gender social-economic factors
contributing to pelvic fractures in the elderly. Age mechanism of injury to
sustain pelvic fractures.
Simple random procedure
was carried out in selection of patients with pelvic fractures who are elderly.
Sample size determination
on slovins formular which produces a simple formula to calculate the sample
size. n=
N/1 + Ne2
n= 49/1 + 49(0.05)2
n= 49/1 +49(0.0025)
n= 49/1 + 0.1225
n= 49/1.1225
n= 44
No. of samples required
is 4
Thus sample size = 733.6
The researcher administered
open ended questionnaires to collect data. This was suitable because of the
ability to collect a large amount of data within a relatively short period of
time. The questionnaire was developed by coming up with typed research
questions which were clear, concise and direct.
The closed structured
questionnaire was administered to the study population to obtain the data
concerning factors contributing to pelvic fractures in the elderly.
First, consent was sought
from the respondent to participate in the study. Upon agreeing administration
of the questionnaire took place which included: - Demographic factors and
social economic facts contributing to pelvic fractures in the elderly and the
mechanism of injury to sustain pelvic fractures in the elderly. The response
given was then being recorded.
Development of
questionnaire which was distributed to respondents upon agreeing was done
Check for the missing
data and rectification done for which were not clear. MS Excel was used to
enter the data given by the respondent. This was done in KNH in Orthopedic
wards casualty and Orthopedic clinic
number 5. This was to find the effectiveness of the tool of data collection.
After piloting it, showed
the questionnaire was effective and valid.
The method was reliable
as it was simple and clear and could give corresponding data when repeated
trial was done.
After random selection,
the questionnaire was distributed upon the consent of the respondent.
The data was analyzed
manually by means of scientific calculator and the findings were put in clear
and understandable ways. The data was presented using pie charts, tables and
graphs.
Permission to carry out
the study was sought from KMTC through the Director through the Principal,
through the HOD Orthopedic and Trauma Medicine to the Medical Supertendent Nakuru
Level 5 Hospital.
Informed consent was
obtained from the patients who who were taking part in the study. The researcher
promised to keep the information gotten from the patient private and
confidential and use for research purposes only.
This
chapter deals with analysis and interpretation of data. The data was collected
using closed structured questionnaire to obtain the information. Data was
obtained from respondents in orthopedic clinic, orthopedic wards and casting room.
The data was then organized by sorting, grouping, tallying and arranging .The
data was collected from 44 respondents with pelvic fractures. The data was then
presented in form of tables and pie charts.
The
age of the patient was presented in table 4.1 and figure 4.1 below
Table 1:
Age of the patients
Age bracket
Frequency [f]
Percentage %
18-40
15
34.09
Above 40
29
65.91
TOTAL
44
100
From
the table and figure 4.1 above, it was noted that majority of the patients with
pelvic was above 40 years with a few 18-40 years.
The
gender of the patients was presented in the table 4.2 and figure 4.2 below
GENDER
FREQUENCY
PERCENTAGE (%)
MALE
18
40.91%
FEMALE
26
59.09%
TOTAL
44
100%
The
study shows that female are more prone than male in pelvic injuries. It shows
that females were 59.09% in the study and male were 40.91% as seen in the table
and figure 4.2 above.
4.2.3. RESIDENCE
The
residence of the studied patients was presented in the table below,
Residence
Frequency
Percentage (%)
Rural areas
35
79.55(%)
Urban areas
9
20.45(%)
Total
44
100(%)
.
The education background
of the patient was presented in the table 4.4 and figure 4.4 below,
Education
Frequency
Percentage(%)
College graduate
10
22.73(%)
Non college graduate
34
77.27(%)
Total
44
100(%)
Figure
4.4 Patient Educations.
The income of the
patients was presented in the table 4.5 and figure 4.5 below,
Income
Frequency
Percentage(%)
High income
20
45.45(%)
Low income
24
54.55(%)
Total
44
100(%)
Figure
4.5
below shows income level,
The table and figure 4.6
below shows presentation of pelvic fractures based on mechanism of injury.
Table
4.6
Mechanism of injury
Frequency
Percentage (%)
Road traffic accidents
34
77.27(%)
Fall from height
10
22.73(%)
Total
44
100
Figure
4.6
below shows mechanism of injury.
4.5 MANAGEMENT
The management of the
fractures were presented in the table
4.5 and figure 4.5 below,
Management
Frequency
Percentage(%)
Internal fixation
7
16(%)
Traction
37
84(%)
Total
44
100(%)
Figure
4.5 Patient management
From the figure 4.5 above, it is noted that majority of the patients
84.(%) are on traction while 16.(%) are taken for internal fixation..
.6 4COMPLICATIONS
Complications
were presented in table 4.6 and figure 4.6 below
Table 1: complications
Complications
Frequency [f]
Percentage %
Infection
10
22.72%
Internal organ
damage
13
29.55%
Severe bleeding
21
47.73%
Total
44
100%
From
the table and figure 4.6 above, it was noted that majority of the patients with
pelvic fractures had severe bleeding (47.73%) followed by internal organ damage
(29.53%) and infection as the last (22.72%).
This chapter presents a
discussion of the major research findings which was studied.
The findings shows that
patients who are involved in pelvic fractures are patients above 40 years of age .Those above
40years are the most affected group with a percentage of 65.91% which
represents 29 patients out of 44 patients while the age bracket between 18-40
is less affected with 34.09% representing 15 patients out of 44 patients
studied .The study established that 59.09% which represents 26 out of 44
studied subjects are female .This shows that female are more prone to pelvic
fractures than males .This represents female to male ratio 13:9 respectively .The
study also established that most of the patients who are involved with pelvic fractures
are from rural areas and others from urban areas .The percentage of the
patients from rural areas is 79.55% which represents 35 patients out of 44
patients studied while those from urban areas were 20.45% which represents 9
patients out of 44 studied patients .A great percentage of these patients came
with a history of fall.
Researchers in previous
researches have confirmed some of the findings that were also identified in
this research .According to( Nellans et al 2012) ,women have a higher risk for
pelvic fractures than males as menopause set in at age 50 and that risk
doubles every 10 years.For males ,the onset of age related risk is much later
at age 80 .The same results have been identified in this research whereby
59.09%which represents 26 females out of 44
studied subjects and 18 males which represents 40.91% of the total
studied .Another research by Jerrhang D et al 2017 shows that pelvic injuries affects
mostly adults and elderly past 50 years of age and this risk increases with
increase in age .This has been also identified in this research whereby the age
bracket 60-70 has a higher risk ,65.91%representig 29 patients out of 44
studied subjects while 50-60 got a few numbers ,34.09% which represents 15
patients out of 44 studied subjects .According to Wilson RT et al 2013 ,he
found that in patients aged 60 years and above , college graduates have
60%lower risk of pelvic fractures compared to those who had not completed
college .This has also been identified in this research whereby a higher number
of non-college graduates 77.27% representing 34 out of 44 studied subjects is
noted compared to 22.73% which represents 10 out of 44 studied subjects who are
college graduates.
Based on education the
study established that most of the patients involved with pelvic injuries
77.27% which represents 34 out of 44 studied patients are non-college graduates
while less number 22.73% which represents 10 patients out of 44 studied
patients were college graduates. Based on income level the study showed that
most of the patients 54.55% which represents 24 patients out of 44 studied
patients had low income level while 45.45% which represents 20 out of 44
studied patients had high income.
Based on mechanism of injury,
the fractures were classified into two types: Fall from height and Road traffic
accidents .The study showed that patients who from height were 34 patients
which represent 77.27% of the studied subjects while those patients who were
involved in road traffic accidents were 10 which represents 22.73% of the 44
studied subjects.
Pelvic fractures
management technique is important from diagnosis to treatment, bed rest was
done to stable fracture-dislocation ,with severe nature operation might be
needed these confirms a research done with
restoration of normal mobility is the core aim in management of pelvic
fractures .The locked plate screw mechanism
functions as a substitute for
the bone cortex thus
making it possible
to use monocortical
screws stable internal
fixation has advantages
including early mobilization
of the pelvis thus
facilitating postoperative rehabilitation and
diminishing the stiffness caused
by prolonged immobilization
study have shown fracture fixed using
locked plates have greater
stability the aim
of surgical management for unstable
fractures of pelvic is to achieve
anatomical reduction and enable the patient
to have a better functional
recovery (Rev Bras ortop
et al 2015).
5.7
Complications
It can be concluded that
pelvic injuries in the elderly is a rising problem as it accounts for 20% of
all pelvic fractures .The increase in age leads to increase in a risk of
sustaining pelvic injuries as seen in age bracket between 50-60 and 61-70
respectively .This is likely due to decrease in bone mineral density. The study
shows that females are more prone to pelvic fractures than males .This is
because when the women reach the menopause at around 50years their hormone
levels shifts and bone mineral density starts to decrease and this doubles
every 10years while in males the risk is much later at age 80years.It is noted
that the fractures are highly experienced in rural areas compared to urban
areas .College graduates have less risk of fractures than non-college graduates
with low income experiencing high risk of fractures compared to high income
level patients .The study reveals that pelvic fractures is caused by Rti’s compared to fall from height.
1. Sengab
A, Krijnen P, Schipper IB. Risk factors for fracture
2. redisplacement
after reduction of pelvic fractures in children: a meta-analysis. Eur J Trauma
Emerg Surg. 2020 Aug;46(4):789-800
3. de
Putter CE, van Beeck EF, Looman CW, Toet H, Hovius SE, Selles RW. Trends pelvic
fractures in children and adolescents, 1997-2009. J Hand Surg Am. 2011
Nov;36(11):1810-1815.e2.
4. MacIntyre
NJ, Dewan N. Epidemiology of pelvicfractures and factors predicting risk and
prognosis. J Hand Ther. 2016 Apr-Jun;29(2):136-45.
5. Ryan
LM, Teach SJ, Searcy K, Singer SA, Wood R, Wright JL, Chamberlain JM.
Epidemiology of pelvic fractures in Washington, DC. J Trauma. 2010 Oct;69(4
Suppl): S200-5.
6. Südow
H, Navarro CM. The incidence of pelvic fractures in a Swedish pediatric
population - an observational cohort study of 90 970 individual fractures. BMC
Musculoskelet Disord. 2021 Jun 19;22(1):564.
7. Mauck
BM, Swigler CW. Evidence-Based Review of pelvic fracture . Orthop Clin North
Am. 2018 Apr;49(2):211-222.
8. Rennie
L, Court-Brown CM, Mok JY, Beattie TF. The epidemiology of fractures in
children. Injury. 2007 Aug;38(8):913-22.
9. Khosla
S, Melton LJ 3rd, Dekutoski MB, Achenbach SJ, Oberg AL, Riggs BL. Incidence of
childhood pelvic fractures over 30 years: a population-based study. JAMA. 2003 Sep
17;290(11):1479-85.
10. Al-Ansari
K, Howard A, Seeto B, Yoo S, Zaki S, Boutis K. Minimally fractured pediatric
pelvic fractures: is immobilization without manipulation enough? CJEM. 2007
Jan;9(1):9-15
11. McQuinn
AG, Jaarsma RL. Risk factors for redisplacement of pediatric pelvic fractures.
J Pediatr Orthop. 2012 Oct-Nov;32(7):687-92.
12. Alemdaroğlu
KB, Iltar S, Cimen O, Uysal M, Alagöz E, Atlihan D. Risk factors in
redisplacement of pelvic fractures in children. J Bone Joint Surg Am. 2008
Jun;90(6):1224-30.
13. Kong
L, Lu J, Zhou Y, Tian D, Zhang B. Incidence and risk factors for redisplacement
after closed reduction and instant rigid cast immobilization for pediatric
pelvic fractures: a case control study. J Orthop Surg Res. 2020 Apr
9;15(1):140.
14. Zamzam
MM, Khoshhal KI. Displaced fracture of the pelvic radius in children: factors
responsible for immobilized after closed reduction. J Bone Joint Surg Br. 2005
Jun;87(6):841-3.
15. Asadollahi
S, Ooi KS, Hau RC.pelvic fractures in children: risk factors for redisplacement
following closed reduction. J Pediatr Orthop. 2015 Apr-May;35(3):224-8.
16. Marcheix
PS, Peyrou P, Longis B, Moulies D, Fourcade L.fractures in children: role of
plaster in redisplacement of these fractures. J Pediatr Orthop B. 2011
Nov;20(6):372-5.
17. Noonan
KJ, Price CT. Forearm and distal radius fractures in children. J Am Acad Orthop
Surg. 1998 May-Jun;6(3):146-56.
18. Agbley
DY, Holdbrook-Smith HA, Segbefia M, Ahonon Y, Marfo K. Factors affecting early
re-displacement of paediatric pelvic
fractures at Korle Bu Teaching Hospital. Ghana Med J. 2020 Sep;54(3):151-155.
19. D
Ojuka, J Ating'a, D Ojuka et al. Redisplacement rates after reduction and
immobilization of isolated pelvic fractures. AJOL VOL 5(2010).
20. Mani
GV, Hui PW, Cheng JC. Translation of radius as a predictor of outcome ink
pelvic fractures of children. JBone Joint Surg Br 1993; 75:808-811.
21. Muoki
JK. Redisplacement risk factors for skeletally immature pelvic metaphyseal fractures treated by immobilization in Kenyatta national hospital.
2012.
22. Caldwell
RA, Shorten PL, Morrell NT. Common Upper Extremity Fracture Eponyms: A Look
Into What They Really Mean. J Hand Surg Am. 2019 Apr;44(4):331-334.
23. Corsino
CB, Reeves RA, Sieg RN. Pelvic Fractures. [Updated 2021 Aug 11]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.
24. Meena
S, Sharma P, Sambharia AK, Dawar A. Fractures of pelvic : an overview. J Family
Med Prim Care. 2014 Oct-Dec;3(4):325-32.
25. Naranje
SM, Erali RA, Warner WC Jr, Sawyer JR, Kelly DM. Epidemiology of Pediatric Fractures
Presenting to Emergency Departments in the United States. J Pediatr Orthop.
2016 Jun;36(4): e45-8.
26. Pope
D, Tang P.knee and pelvic Fractures. Hand Clin. 2018 Feb;34(1):27-32.
27. Thelen
S, Grassmann JP, Jungbluth P, Windolf J. Di pelvic fr fraktur: Aktuelle
Behandlungskonzepte und Kontroversen pelvic fractures: Current treatment
concepts and controversies]. Chirurg. 2018 Oct;89(10):798-812. German.
Instructions:
1. This questionnaire is
made strictly for study purposes only
2. Privacy and
confidentiality of the information obtained is observed
3. Read and answer all
questions appropriately, tick where necessary
DEMOGRAPHIC QUESTIONS
1. What is your gender?
a. Male (
)
b. Female (
)
c. Intersex (
)
2. What is your age?
3. What is your
ethnicity?
a .Bantu (
)
b. Nilotic (
)
c .Cushitic(
)
4. What is your area of
residence?
a .Urban
b. Rural
SOCIAL ECONOMIC QUESTIONS
5. What is your marital
status?
a. Single (
)
b. Married (
)
c .widow (
)
d. Widower (
)
e. Divorced (
)
f. Separated ( )
6. What is your level of
education?
a. Never went to school ( )
b. Primary level ( )
c. Secondary level ( )
d. Tertiary level ( )
e. If any other, specify..............
7. What is your religion?
a. Christian ( )
b. Muslim (
)
c. Hinduism (
)
8. Do you have a job?
a. Yes
b. No
9. If yes, then what is
your occupation?
a. Self-employed/ Business ( )
b. Farmer (
)
c. civil servant( )
d. If any other, specify........
9. Do you have National
Hospital Insurance Fund ( NHIF)
a. Yes
b. No
10. What is your income
level?
a. Below 10,000( )
b.10, 000-50000( )
c .Above 50,000( )
11. Do you take food rich
in calcium?
a. Yes.
b. No
12. Do you take alcohol?
a. Yes
b. No
13. If yes, was the
accident under the influence of alcohol?
a. Yes
b. No
15. Do you smoke?
a. Yes
b. No
MECHANISM OF INJURY QUESTIONS
18. What caused your injury?
a. Fall
b .RTA
c. If any other, specify.............
19. If by fall, how did you fall?
A .Less than 10000
b .10,000-20000
c .More than 20,000
17. Do you perform
physical activities?
a. Yes
b .No
MECHANISM OF INJURY
QUESTIONS
18. What caused your
injury?
a. Fall
b. RTA
c. If any other,
specify...........
APPENDIX
II: WORK PLAN
Activity
April
May
June
July
August
Identification of
research topic
Setting objectives
and research introduction
Literature review writing
Methodology
designing and writing
Research proposal
presentation
Item
Quality
Price per unit
Total amount
Pens
4
25
150
Pencil
1
30
50
Files
1
70
100
Foolscaps
2 reams
1000
2000
Flash disk
16 Gb
1500
1500
Typing and printing
150
200 per page
4000
Printing papers
2 reams
1000
2000
Internet
10 GB
1000
1000
Accommodation
4 months
1500
8000
Living expenses
4 months
1000
4000
Food
4 months
1800
7200
Calculator
1
1500
1500
Transport
4 months
450
1800
Binding
3
50
150
Ruler
1
50
50
Exercise book
2
100
200
Total
33700
