Quantification of mobilization and pain level in fragility fracture of the pelvis

Fragility fractures of the pelvis (FFP) are increasing with the aging population and differ from high-energy pelvic trauma. The Rommens classification and the more recent OF classification guide treatment decisions. The OF pelvis score aims to objectify therapy choice by integrating fracture type, mobility, and pain among other variables. However, the rationale behind key thresholds, such as the VAS cut-off of 5 and the emphasis on mobilization remains unclear. This study seeks to define evidence-based thresholds to improve treatment decision-making.

This retrospective single-center study includes all patients ≥65 years with an FFP treated as inpatients between 2018 and 2023. Demographics, comorbidities, diagnostics, treatment type, pain level (VAS), mobility, and length of stay are demonstrated. A custom Likert-based mobility score is calculated for each patient. Statistical analysis is performed on pain level and mobilization between conservatively and operatively treated patients.

Totally 428 patients were included in the study. The median age was 85 (80-90) years. While 60.0% (n=257) were treated conservatively, 40.0% (n=171) underwent surgical treatment. The median time to decision for surgical treatment was 3 (2-7) days. At the third day of inpatient stay conservatively treated patients had a significantly better mobilization level (p<0.01) and lower pain level (p=0.015) than patient treated surgically. The suggested Likert Score for mobilization showed a cut-off value of <4 for operative treatment. Patients with a VAS >4 at the third day of the inpatient stay were more likely to be treated surgically. There was no significant difference in proportions of analgesics. Classification, mobilization and pain level had significant influence on the choice of treatment, with classification having the most impact.

This study presents comprehensive demographic data and inpatient information on pain level, analgesia, and mobility in FFP patients. A novel Likert-based mobility score is introduced to objectively quantify mobilization. For the first time, the typical timing of surgical decision-making is determined and used to compare pain level and mobility levels between treatment groups. Multivariable analysis identifies and weighs key factors influencing treatment decisions.