Comparison of Operative and Non-Operative Management of Elderly Fragility Pelvic Ring Fractures

Abstract

To compare outcomes of nonoperative and percutaneous fixation of geriatric fragility lateral compression I (LC1) pelvic ring fractures. Design: Retrospective Two level one trauma centers Included were patients 60 years of age or older with an isolated LC1 pelvic ring fracture managed nonoperatively or those who failed mobilization and were managed operatively with percutaneous sacral fixation after failing to mobilize. Patients with high energy mechanisms of injury or polytrauma were excluded. Outcome Measures and Comparisons: The primary outcome was pain as measured by Visual Analog Scale (VAS) after treatment. Secondary outcomes included length of stay (LOS), discharge disposition, mortality, readmission rates, and complications. In total, 231 patients were included with a mean age of 79.5 years (range 60-100). One hundred eighty-five(80.0%) patients were female. Sixty-two (26.8%) patients received percutaneous sacral fixation after failed mobilization, and 169 (73.2%) were managed nonoperatively. In the operative group, the median time to surgery was hospital day four. Nonoperative patients were older (81.5 ± 10.0 years vs. 74.2 ± 9.4 years, p<0.01), and had a shorter hospital LOS (4.8 ± 6.2 days) than the operative group (10.6 ± 9.5 days, p<0.01). Patients in the operative group had more pain (VAS 7.9 ± 3.0) than the nonoperative group (VAS 6.6 ± 3.0) (p=0.01) on admission, but had similar pain control post-operatively (VAS 4.4 ± 3.0) compared to the nonoperative group (VAS 4.5 ± 3.6) on the equivalent hospital day (p=0.91). Thus, patients in the operative group experienced more improvement in pain (VAS 3.3 ± 2.7) compared to the nonoperative group (VAS 1.9 ± 3.9) after treatment (p=0.02). Ninety-day mortality (p=0.21) and readmission rates (p=0.27) were similar for both groups. Two patients in the operative cohort sustained nerve injuries, while one patient in the nonoperative group had a nonunion and underwent surgery. Patients who undergo percutaneous surgical fixation for low energy LC1 injuries have similar discharge disposition, mortality, complication rates, and readmission rates compared to patients treated nonoperatively. Percutaneous surgical fixation may provide significant pain relief for patients who failed conservative management. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.