Background: The aim of the present study was to describe specific characteristics of patients suffering from pelvic fragility fractures and evaluate factors that might influence treatment decisions which may optimize treatment pathways and patient mobility in the future. Methods: A prospective study with patients suffering from fractures of the pelvis and aged 60 years or above was performed between 2012 and 2016. Data acquisition took place at admission, every day during hospitalization and at discharge. Results: One hundred thirty-four patients (mean age of 79.93 (± 7.67) years), predominantly female (84%), were included. Eighty-six patients were treated non-operatively. Forty-eight patients underwent a surgical procedure. The main fracture types were B2 fractures (52.24%) and FFP IIb fractures (39.55%). At the time of discharge, pain level (NRS) could be significantly reduced (p < 0.001). Patients who underwent a surgical procedure had a significantly higher pain level on day three and four compared to the non-operative group (p = 0.032 and p = 0.023, respectively). Significant differences were found in the mobility level: patients treated operatively on day four or later were not able to stand or walk on day three as compared to non-operatively treated patients. Regarding B2 fractures, a significantly higher mobility level difference between time of admission and discharge was found in patients treated with a surgical procedure compared to patients treated non-operatively (p = 0.035). Conclusions: Fracture type, mobility level and pain level influence the decision to proceed with surgical treatment. Especially patients suffering from B2 fractures benefitted in terms of mobility level at discharge when treated operatively. Level of evidence: II

The aim of this study was to compare the outcome of cemented sacroiliac screw fixation to that of conservative treatment in nondisplaced fragility fractures of the sacrum during a 12-month follow-up. Therefore, matched-pair analysis including 40 patients from a previously performed prospective observational study was conducted. Pain was assessed using the visual analogue scale (VAS), functional capabilities and mobility were assessed using the Barthel index, and health-related quality of life (HRQL) was assessed using the EQ-5D questionnaire at 6 weeks, 6 months, and 12 months after the fracture, respectively. No significant differences between the two groups were seen regarding pain. In the operative group, a significantly improved Barthel index was observed after 6 months. A significantly higher HRQL was identified after 6 weeks in the operative group. Their mobility was comparable between the two groups before the fracture; after 6 weeks, mobility was significantly improved in the operative group. After 12 months, no significant differences were found regarding the functional outcome, HRQL or mobility. The 1-year mortality rate was 25% in the conservative group versus 5% in the operative group (not statistically significant). The present study revealed favorable short-term outcomes concerning the functional outcome, HRQL and mobility after sacroiliac screw fixation. After 12 months, the outcomes were similar to those of the patients managed conservatively.

Purpose: Various surgical techniques for osteosynthesis in fragility fractures of the pelvis (FFP) are described. Since 2012, a submuscularly placed internal fixator has been used to stabilize the anterior pelvic ring. Indications for this procedure are a dislocation in the anterior pelvic ring and/or severe pain with associated immobility. This technique potentially has several advantages compared to subcutaneous procedures, including improved patient comfort, less irritation, and enhanced biomechanical stability due to the deeper rod placement. Methods: Digital files of patients aged ≥ 65 years, who were treated with an internal fixator at a Level I trauma center in Germany between 2012 and 2021, were retrospectively analyzed. Results: Thirty-four patients (median age 79 years, 77% female, 61.8% ASA III) were treated. Most fractures were caused by ground-level falls (64.7%), followed by road traffic accidents (11.8%). In patients with low impact trauma, the most common fracture types were FFP IIb (37.04%) and FFP IIIc (18.52%). Complications during surgery occurred in 4 patients (11.76%) and postoperative complications in 6 patients (17.6%), with hematoseroma being the most common. Non-surgical complications occurred in 20 patients (total: 58.8%; Clavien-Dindo type 2 in 70%). After 12 months, the majority of all patients had the same mobility level as before the fracture. Conclusion: The submuscularly placed internal fixator is an effective technique for stabilizing anterior pelvic ring fractures in geriatric patients, offering advantages in cases of high dorsoventral instability or persistent severe anterior pain.

Purpose: The incidence of geriatric fractures, particularly pelvic fragility fractures, is rising due to demographic changes. While fractures located at the proximal femur remain the most common fracture in older adults, the number of pelvic fractures has constantly increased, especially following low-impact trauma such as falls. This study aims to evaluate the 5-year survival rate and identify factors influencing survival in geriatric patients with fragility fractures of the pelvis. Methods: A prospective single-center observational study included 134 patients aged 60 and older with fragility fractures of the pelvis from June 2012 to December 2016. Patients were contacted 5 years post-fracture to assess survival. Barthel Index, Instrumental Activities of Daily Living (IADL), comorbidity scores, living situation and fracture related data were collected. Statistical analyses were performed using IBM SPSS. Results: Of the 134 patients, 103 were re-examined after 5 years, revealing a mortality rate of 62.1%. The mean age of participants was 79.67 years, with a higher prevalence of females (82.5%). Survivors exhibited significantly better pre-fracture Barthel Index (91.79 vs. 82.35, p = 0.003) and IADL scores (6.38 vs. 4.11, p < 0.001). The ASA score and age-adjusted Charlson Comorbidity Score were also lower among survivors, indicating a correlation between pre-fracture functional status and long-term survival. Conclusion: Our Results indicate that survival outcomes for patients with fragility fractures of the pelvic are poor, highlighting an urgent need for tailored treatment protocols, which are currently lacking for pelvic fractures. Despite a survival rate of 37.9%, the treatment of these fragile patients remains warranted. Key predictors of survival include the pre-fracture Barthel Index and IADL scores, alongside lower ASA and Charlson Comorbidity Scores. We recommend assessing these factors upon admission to enhance mortality risk prediction and ensure more focused care for at-risk patients.