To compare early operative treatment with non-operative treatment of fragility fractures of the pelvis regarding mortality and functional outcome.
Retrospective SETTING:: Two trauma centers PATIENTS AND METHODS:: 230 consecutive patients 60 years of age or older with an isolated low-energy fracture of the pelvis and with a follow-up of at least 24 months. In center 1, treatment consisted of a non-operative attempt and early operative fixation if mobilization was not possible. In center 2, all patients were treated non-operatively.
MAIN OUTCOME MEASUREMENTS
Primary outcome was mortality. Secondary outcomes were in-hospital complications. Patients that survived were contacted by phone and a modified Majeed Score was obtained to assess functional outcome at final follow-up RESULTS:: At final follow-up (mean 61 months, SD 24), 105/230 (45.7 %) patients had died. One year after the initial hospitalization 34/148 patients (23%, 95% CI: 17% to 31%) of the ear1y operative group and 14/82 patients (17%, 95% CI 10% to 27%) of the non-operative group had died (p=0.294). Non-operative treatment had a protective effect on survival during the first two years (hazard ratio of the non-linear effect: 2.86, 95% CI 1.38 to 5.94, p<0.001). Patients in the early operative treatment group who survived the first two years, had a better long-term survival. The functional outcome at the end of follow-up as measured by a modified Majeed score was not different between the two groups (early operative: 66.1, SD 12.6 vs. non-operative: 65.7, SD 12.5, p=0.910).
Early operative fixation of patients who cannot be mobilized within three to five days was associated a higher mortality rate and complication rate at 1 year but with a better long-term survival after more than two years. Hence, patients with a life expectancy of less than 2 years may not benefit from surgery with regard to survival.
LEVEL OF EVIDENCE