Pelvis/acetabulum: management of geriatric injuries

Geriatric pelvic and acetabular fractures pose significant challenges due to patient frailty, comorbidities, and the complexity of fracture patterns. This review examines current evidence and evolving strategies for managing these injuries. Treatment approaches range from nonoperative management to surgical interventions, including percutaneous fixation, open reduction and internal fixation (ORIF), and total hip arthroplasty, either as a standalone procedure or combined with ORIF. Decision making is guided by fracture morphology, patient functionality, and physiological reserve to optimize clinical outcomes. Minimally invasive techniques, particularly for fragility fractures of the pelvis, have gained traction because of their ability to provide stable fixation while minimizing surgical morbidity. The importance of early mobilization and a multidisciplinary perioperative approach is highlighted as essential in reducing complications and improving recovery. Despite advancements, controversy remains regarding the optimal treatment of complex acetabular fractures in elderly patients. This review synthesizes the latest evidence and expert perspectives to aid clinicians in selecting the most appropriate management strategies, with the goal of restoring mobility, minimizing complications, and enhancing the quality of life in this vulnerable population.