¹Orthopädie und Unfallchirurgie, Luzerner Kantonsspital Luzern, Luzern, Schweiz

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Objectives and questions: Fragility fractures of the pelvis (FFP) represent an increasingly challenging condition in the aging population, with significant impact on mobility, independence, and mortality. While early surgical intervention has become the gold standard in hip fractures, demonstrating reduced mortality and improved functional outcomes, the optimal treatment strategy for FFP type II remains controversial. Traditionally, these fractures have been treated conservatively. However, early surgical stabilization gained popularity to reduce pain and promote early mobilization in frail patients. This study aimed to compare early surgical stabilization to conservative treatment for FFP type II, addressing this critical gap in geriatric fracture care.

Material and methods: For the preliminary analysis 34 patients were included in this randomized controlled trial. Inclusion criteria were FFP type II, able to walk 4 meters before trauma and trauma <72 hours. Exclusion criteria were inoperable patients, open fractures, revision surgeries, concomitant fractures of the upper or lower extremities. The patients were randomly allocated to either early percutaneous screw fixation within 72 hours after trauma or conservative treatment. The primary outcome is mobility assessed using the DEMMI. Secondary outcomes included other mobility parameters, pain, independence, quality of life, radiological outcome, complications and mortality. P-values <0.05 are statistically relevant.

Results: 34 patients have been included until now. Most of the patients were female, 79.4%. The mean age was 85 8 years. 19 patients were randomized for conservative treatment and 15 patients for operative treatment. The first measurements were 3–5 days after inclusion. The DEMMI was 43 points for conservative and 50 points for operative (p=0.165). The 2 minutes walking distance was 22 meters for conservative and 43 meters for operative (p=0.047). The average amount of steps per day during the admission were 106 steps for conservative and 396 steps for operative (p=0.005). Four patients (21%) of the conservative group needed operative treatment due to persistent pain-related immobilization. In the conservative group there were four versus two deaths in the operative group(p=0.672). Furthermore, in the conservative group there were 4 systemic infections (p=0.113). In the operative group one re-osteosynthesis was performed. No other complications occurred.

Discussion and conclusions: Preliminary results show no significant difference of the DEMMI score between the two groups. However, it appeared that patients were more mobile based on the average amount of steps per day and 2 minutes walking distance. Definitive results, including a 1-year follow-up, are needed to draw final conclusions.