Classifications and treatment management of fragility fracture of the pelvis: A scoping review

Background

Fragility fractures of the pelvis (FFP) present a growing challenge in aging populations. However, standardized classifications and treatment guidelines remain scarce.

Objective

This scoping review examines the application of fracture classifications, treatment strategies, and outcome evaluations for FFP, identifying gaps in the literature, and suggesting directions for future research.

Methods

A systematic search of multiple electronic databases yielded 117 studies discussing FFP names, classifications, treatment approaches, and outcomes. Data extraction focused on study characteristics, classification systems, treatment details, outcomes, and follow-up periods. Residual analysis using the Chi-square test assessed statistical associations and underrepresentation.

Results

The FFP classification was the most common (51.3%), with additional treatment indicators focused on immobility (44.4%) and pain assessment (using the Visual Analog Scale [VAS] or Numeric Rating Scale [NRS], 37.6%), consistent with existing guidelines. In contrast, the sacral insufficient fractures were statistically associated with pain indications but lacked corresponding classification application. Initial management typically involved conservative or observation period. Regarding the management indications and outcomes, surgical interventions were categorized into osteosynthesis and sacroplasty. Outcome evaluations often incorporated mobility and functional status (59.0%), hospitalization length (49.6%), mortality rates (41.0%), and post-treatment living conditions (41.0%). Patient recovery was assessed through VAS scores (59.0%) and Activities of Daily Living Patient-Reported Outcomes (ADL-PROs, 34.2%). However, inconsistencies in standardized outcomes, particularly in sacroplasty studies, hinder comparative analysis.

Conclusion

FFP classifications, along with pain and mobility assessments, were frequently applied as management indicators for FFP. Standardizing treatment indications and establishing consistent outcome measures, including the evidenced gap treatments (sacral insufficient fracture and cement augmentation), could significantly improve comparability across studies.