Operative treatment of fragility fractures of the pelvis is connected with lower mortality. A single institution experience

Abstract

Background Fragility fractures of the pelvis (FFP) represent an increasing clinical entity. Until today, there are no guidelines for treatment of FFP. In our center, recommendation for operative treatment was given to all patients, who suffered an FFP type III and IV and to patients with an FFP type IIwith unsuccessful non-operative treatment. We performed a retrospective observational study and investigated differences between fracture classes and management alternatives. We hypothetized that operative treatment may reduce mortality. Materials and methods The medical charts and radiographs of 362 patients were analysed. Patient demographics, FFP-classification, length of hospital stay (LoS), type of treatment, general and surgery-related complications, mortality, Short Form-8 physical component score (SF-8 PCS) and mental component score (SF-8 MCS), Parker Mobility Score (PMS) and Numeric Rating Scale (NRS) were documented. Results 238 patients had FFP type II and 124 FFP type III and IV. 52 patients with FFP type II (21.8%) and 86 patients with FFP type III and IV (69.4%) were treated operatively (p<0.001). Overall mortality did not differ between the fracture classes (p = 0.127) but was significantly lower in the operative group (p<0.001). Median LoS was significantly higher in FFP type III and IV (p<0.001) and in operated patients (p<0.001). There were more in-hospital complications in patients with FFP type III and IV (p = 0.001) and in the operative group (p = 0.006). More patients of the non-operative group were mobile (p<0.001) and independent (p<0.001) at discharge. Half of the patients could not return in their living environment.203 of the 235 surviving patients (86%) answered the questionnaires after a mean follow-up time of 38 months. SF-8 PCS, SF-8 MCS and PMS did not differ between the fracture classes and treatment groups. Pain perception was higher in the operated group (p = 0.013). Conclusion In our study, we observed that operative treatment of FFP provides low mortality rates, although LoS and in-hospital complications were higher in the operative group. At discharge, the non-operative group was more mobile and independent. At follow up, quality of life and mobility were comparable between the groups. Further prospective studies are needed to clarify the impact of operative treatment of FFP on mortality and functional outcome.

A computed tomography based survey study investigating the agreement of the therapeutic strategy for fragility fractures of the pelvis

“…Besides, an incorrect classification of FFP II by the observer, the observer might decide to not follow the recommendations of Rommens and Hofmann 9 . This might be the result of current studies showing a decreased rate of mortality 51 , rate of general complications for percutaneous procedures 52 and an improved mobility following operative therapy 53 . This data underlines the need to introduce additional modifiers for treatment decision (e.g.…”

Comparative outcome of different treatment options for fragility fractures of the sacrum

“…Hoech et al [74] found a signi cantly higher survival rate for surgically treated patients of 21% compared to conservatively treated patients over a two-year period. With a comparable distribution of FFP types, Rommens et al [75] also found a lower mortality in surgically treated patients.…”

Fragility Fractures of the Pelvis and Sacrum: Current Trends in Literature

“…The study concluded that operative treatment of FFP resulted in lower mortality rates ( P <0.001), although longer length of stay ( P <0.001) and more in hospital complications ( P =0.006) were observed in the operative group 29) . Patients in the non-operative group had greater mobility and independence at discharge ( P <0.001); however, comparable quality of life was observed between the groups 29) .…”

“…Unfortunately, data for evaluation of the outcomes of conservative management is limited; however, new studies are emerging. In a recent study reported in 2021, Rommens et al 29) conducted a retrospective comparison of operative vs. conservative management for FFP types II, III, and IV in 238 patients; 100 of these patients received conservative treatment. The study concluded that operative treatment of FFP resulted in lower mortality rates ( P <0.001), although longer length of stay ( P <0.001) and more in hospital complications ( P =0.006) were observed in the operative group 29) .…”

“…In a recent study reported in 2021, Rommens et al 29) conducted a retrospective comparison of operative vs. conservative management for FFP types II, III, and IV in 238 patients; 100 of these patients received conservative treatment. The study concluded that operative treatment of FFP resulted in lower mortality rates ( P <0.001), although longer length of stay ( P <0.001) and more in hospital complications ( P =0.006) were observed in the operative group 29) . Patients in the non-operative group had greater mobility and independence at discharge ( P <0.001); however, comparable quality of life was observed between the groups 29) .…”