Morbidity and mortality following pelvic rami fractures in an elderly Newfoundland population

Introduction: Pelvic rami fractures in the elderly are associated with significant morbidity and mortality. Despite our rapidly aging population there is a paucity of literature dealing with fractures of the pelvic rami in this age group. The purpose of this study is report mortality rates following these injuries in the Eastern region of Newfoundland. Additionally, we aim to describe and quantify the important resultant morbidity in this vulnerable elderly population . Methods: A retrospective chart review was performed of all the pelvic fractures in individuals over the age of 60 between 2000 and 2005 in the Eastern Health region of Newfoundland and Labrador. From these patients, only those with the radiographic parameters consistent with low energy pattern pelvic ring injuries were included. Excluded from the study were those with concurrent fractures of the femur. Survival data, comorbidities, injury characteristics, hospital stay, ambulatory status, and place of residence were recorded from the chart. A surrogate control group was formulated from Statistics Canada survival data for use as a survival comparison group. Results: There were 80 fractures of the pelvis identified in patients over 60 years old from 2000-2005. Of these, 43 met our inclusion/exclusion criteria and were used in our analysis. The one and five year mortalities of these patients were 16.3% (95% CI; 7.80% to 30.3%) and 58.1% (95% CI; 43.3% to 71.6%), respectively. These were both significantly different from the point estimates from our constructed age and gender matched control group from the Statistics Canada data of 6.58% (one year mortality) and 31.3% (five year mortality). Morbidity was quantified by change in ambulatory status (independent, walker/cane assisted, wheelchair) and change in residential independence (independent, assisted living, nursing home). Post fracture, 36% of patients permanently required increased ambulatory aids and 21% of patients required a permanent increase in everyday level of care. Conclusion: This study suggests that there may be significantly increased mortality and morbidity following low energy pattern pelvic rami fractures in an elderly population compared to age and gender matched controls. In contrast to previous studies describing these injuries, there is greater homogeneity in this population with respect to age and mechanism of injury. This study generates several important hypotheses for future research and in particular highlights the need for larger prospective studies to identify factors predicting the highest risk for poor outcomes in this population.

Five times daily: the dynamics of prayer worship among Muslim immigrants in St. John's, NL

This thesis explores the ritual of prayer among Muslim immigrants in the city of St. John's, NL. Immigration across national, cultural, religious, and ethnic borders is a moment in an individual's life marked by significant change. My premise is that in such contexts the relatively conservative nature of religious ritual can supply much-needed continuity, comfort, and consolation for individuals living through the immigrant experience. As well, ritual forms are often put under stress when transferred to a considerably different place and cultural context, where “facts on the ground” may be obstacles to traditional and familiar ritual forms. Changes to the understanding or practice of ritual are common in new cultural and geographic situations, and ritual itself often becomes not merely a means of social identification and cohesion, but a practical tool in processing change - in the context of immigration, in learning to live in a new community. St. John's is a lively and historic city and while Muslim immigrants may be a small group within it they nevertheless contribute to the city's energy and atmosphere. This thesis endeavours to better understand the life stories of ten of these newcomers to St. John's, focusing on their religious backgrounds and lives. In particular, this thesis seeks to better understand the place of prayer in the immigrant experience.