Background: Fragility fractures of the pelvis (FFP) in elderly patients are an increasing concern due to their association with osteoporosis and the aging population. These fractures significantly affect patients' mobility and quality of life. This study evaluates different surgical techniques in patients suffering from FFP to provide standardized recommendations for treatment strategies. In addition, we compared therapeutic concepts and their outcome between two major trauma centers in Germany. Methods: We conducted a retrospective analysis of 882 patients aged over 65 years who suffered from FFP between 2003 and 2020 at a level I and level III trauma center in a german metropolis. Fractures were classified according to Rommens and Hofmann. Data collection included patient demographics, fracture type, treatment strategy, and length of hospital stay. Results: FFP I fractures were predominantly treated conservatively at both centers. Significant variability was noted in the treatment of type II and III fractures, with level III trauma center having a higher surgical intervention rate for FFP II in 27.6 % compared to the level I trauma center in 9.9 % of the cases. The most common procedure at both hospitals was the stabilization of the posterior pelvic ring. Patients who underwent less invasive posterior-only stabilization had shorter length of hospital stay than those who received combined anterior and posterior stabilization. Conclusions: The study reveals substantial differences in the treatment approaches for FFP between two major trauma centers. Less invasive surgical methods, particularly posterior-only stabilization, are associated with shorter hospital stays and potentially better outcomes for elderly patients with unstable FFP. Clinical Relevance: This study underscores the importance of minimally invasive surgical techniques in managing FFP in elderly patients, highlighting their potential to reduce the length of hospital stay and improve recovery.

Introduction: Periprosthetic distal femur fractures are often considered more complex and morbid than native distal femur fractures, yet few studies directly compare them. This study aimed to compare patient characteristics, treatment strategies, and early complications between native and periprosthetic distal femur fractures using the Lewis–Rorabeck classification. Methods: We retrospectively analyzed 152 patients treated surgically for distal femur fractures at a level I trauma center. Cases included native fractures ( n = 90) and periprosthetic distal femur fractures ( n = 62), further divided into Lewis–Rorabeck Type I/II ( n = 49) and Type III ( n = 13). Demographics, comorbidities, surgical details, and in-hospital complications were assessed. We conducted a multivariate analysis comparing native fractures with Lewis–Rorabeck Type I/II fractures, as well as comparing Type I/II with Type III fractures. Results: Patients with periprosthetic fractures were older and had higher BMI than those with native fractures ( p < 0.001). Multivariate analysis showed no significant differences in surgery duration, mortality, mobility at discharge, transfusion needs, or revision rates between native distal femur fractures (AO/OTA Type A) and Lewis–Rorabeck Type I/II. The complication rate was significantly lower in the periprosthetic group ( p = 0.029). Lewis–Rorabeck Type III fractures showed significantly longer time to surgery ( p = 0.015) and revision surgery was performed more frequently compared to Lewis–Rorabeck Type I/II fractures. However, no differences were observed in early postoperative complications, mobility at discharge, or length of hospital stay. Conclusion: This study directly compares periprosthetic distal femur fractures stratified by implant stability to native distal femur fractures. The findings challenge the perception that periprosthetic fractures are universally more difficult to treat. Periprosthetic fractures achieve results comparable to native fractures. The increased complexity of Lewis–Rorabeck Type III fractures is reflected in prolonged time to surgery and an increased need for revision surgery.

Background: Periprosthetic femoral fractures (PPF) following total hip arthroplasty (THA) are a growing clinical challenge, particularly in the elderly. Postoperative mobility is a key determinant of outcome, yet little is known about how surgical treatment and weight-bearing protocols influence functional recovery in this population. Methods: We conducted a retrospective cohort study of 186 patients aged ≥ 65 years treated surgically for Vancouver type B or C PPF between January 2017 and August 2023 at a level 1 trauma center. Patients underwent either open reduction and internal fixation (ORIF) or revision arthroplasty. Postoperative weight-bearing protocols were categorized as full weight bearing (FWB) or partial weight bearing (PWB). The primary outcome was mobility status at hospital discharge. Binary logistic regression was used to identify independent risk factors for immobility. Results: Of the 186 patients included (mean age 82.4 ± 7.4 years), 64.5% were mobilized with FWB. In the ORIF group, patients allowed FWB were significantly older (85.5 ± 7.4 vs. 80.2 ± 6.3 years, p < 0.001). No significant differences in mobility, complication rates, revision surgery, or in-hospital mortality were observed between weight-bearing regimens, regardless of the type of surgery. Logistic regression identified intraoperative blood transfusion (OR = 3.17) and higher ASA scores (ASA III: OR = 9.10; ASA IV: OR = 32.03) as independent predictors of postoperative immobility. Neither the postoperative weight-bearing protocol nor the surgical procedure had a significant impact on mobility outcomes. Conclusion: This study examines postoperative weight-bearing strategies on clinical outcomes in patients with periprosthetic hip fractures and simultaneously identifies independent risk factors associated with postoperative immobility. Our findings suggest that mobility outcomes are more influenced by patient-related factors than by surgical procedure. Our findings support the safe implementation of full weight-bearing protocols in elderly patients following periprosthetic femoral fractures, regardless of the type of surgical intervention.

Background: Early mobilization with permission for full weight bearing is a cornerstone of postoperative care after proximal femoral fractures (PFFs). However, its biomechanical implementation during gait remains unclear. Clinical scores such as the Charlson Comorbidity Index (CCI) and the American Society of Anesthesiologists (ASA) classification describe comorbidity burden, but their relationship with actual weight bearing and functional outcome regarding activities associated with daily living is insufficiently understood. Methods: In this prospective cohort study, patients aged > 65 years treated surgically for femoral neck fractures (FNFs) or trochanteric femoral fractures (TFFs) were included. Postoperative weight bearing was assessed after 4 to 7 days using sensor-based insoles. Average peak force of the operated limb, normalized to body weight, was the primary outcome. Associations with postoperative weight bearing and functional outcome were analyzed using multivariable linear regression models. Results: Early postoperative weight bearing remained below recommended levels, with lower limb loading in TFFs. Higher CCI values were associated with increased loading in TFF patients, and higher ASA classifications with reduced loading. Higher postoperative Barthel Index (BI) was independently associated with increased limb loading. Postoperative BI was influenced by age, preoperative BI, and fracture type. Conclusions: Despite permission for full weight bearing, early postoperative limb loading after PFF remains below recommended levels, particularly in TFFs. CCI and ASA show fracture type-specific associations with actual weight bearing, whereas BI is independent of ASA and CCI. The BI may serve as a surrogate parameter to identify patients at risk of insufficient limb loading who may benefit from targeted physiotherapeutic interventions.