Retrospective comparative study between conservative management and surgical fixation of pelvic insufficiency...

Pelvic insufficiency fractures (PIFs) are commonly underdiagnosed and delays in treatment can lead to complications including impaired mobility. This study compared outcomes between conservative treatment and surgical fixation in patients with PIFs.

A retrospective study of 19 patients with pelvic fractures between July 2023 and February 2024 was performed. Patients with isolated sacral and pelvic insufficiency fractures with no concomitant fracture that requires rehabilitation were included. Xray and Magnetic Resonance Imaging (MRI) images, and patient demographic data was collected. Primary study endpoints included the relative change in patient ambulation status from pre-injury to discharge. Patients were followed up outpatient 6 weeks and 3 months after discharge.

Surgical fixation was performed in 7 patients at an average of 10.1 days after injury (range 4-18 days). Mean duration of diagnosis was 2.74 days. Mean duration of diagnosis among patients requiring an MRI was 4.75 days. Length of inpatient stay in the non-operative and operative groups was 32.1 and 39.8 days respectively. Non-operative patients ambulated 3.5 days after admission with minimal pain. In the operative group, patients underwent a trial of conservative therapy for an average of 6 days (range 3-9 days) before deciding for surgical fixation. Patients were ambulatory 1 day post-fixation on average. There was no significant difference in ambulatory status between both groups at discharge.

Awareness of the sequelae of PIFs is required among clinicians and patients. Surgical intervention is a potentially effective treatment option for patients with unstable PIF and severe pain, as it can provide more rapid relief of symptoms and faster recovery. More robust protocols should be developed for PIF treatment to improve patient outcomes. More studies are required to determine the best framework for the management of PIFs to guide optimal care and outcomes.