Surgical Fixation Enhances Discharge Independence in Elderly Patients With Fragility Fractures of the Pelvis.

Abstract

Objectives: To evaluate outcomes following surgical and nonsurgical management of fragility fractures of the pelvis (FFP) in elderly patients, focusing on pain relief, hospital course, complications, and discharge disposition.

Methods: Design: Retrospective cohort study.

Setting: Single Level I trauma center.

Patient selection criteria: All patients aged 60 years and older treated for low-energy FFP (OTA/AO 61-A/B/C) between 2018 and 2022 by one fellowship-trained orthopaedic trauma surgeon were included. Patients with high-energy mechanisms, polytrauma, and non-osteoporotic pathologic fractures were excluded.

Outcome measures and comparisons: Visual analog scale (VAS) pain scores at admission and discharge, hospital length of stay (LOS), in-hospital and 90-day complications, and discharge destination were compared among nonoperative, acute fixation, and delayed fixation cohorts. Acute fixation was defined as fixation during the index hospitalization, regardless of whether surgery was planned at admission or performed after failed inpatient mobilization. Delayed fixation was defined as fixation after discharge following initial nonoperative management.

Results: 132 patients were included, including 56 managed nonoperatively and 76 treated operatively (55 acutely, 21 delayed). Patients treated nonoperatively were older than those treated operatively (84.1±8.28 vs 77.1±9.48 years, P<0.005), while the proportion of female patients was similar between groups (91.1% vs 84.2%, P=0.300). Admission VAS pain scores were 6.4, 6.3, and 5.9 for the acute fixation, delayed fixation, and nonoperative groups, respectively, and discharge VAS scores were 3.0, 3.6, and 3.4, with no significant differences between groups (P>0.05). Postoperative LOS, defined as the hospital stay associated with definitive treatment and excluding any prior index admission for delayed fixation patients, was longest after acute fixation (9.7 days) compared with delayed fixation (2.8 days) and nonoperative treatment (5.2 days, P<0.05). Discharge disposition differed, with home discharge occurring in 27.3% of acutely fixed patients, 76.2% of delayed fixation patients, and 14.3% managed nonoperatively (P<0.05), with disposition defined at discharge from the hospitalization associated with definitive treatment. Discharge home was approximately threefold higher in the operative cohort than nonoperative cohort (40.8% versus 14.3%, P<0.05).

Conclusions: Percutaneous fixation of FFP was associated with greater likelihood of discharge home without increased complications. Acute fixation was associated with longer LOS.

Level of evidence: Level III, retrospective comparative study.