Current consensus and clinical approach to fragility fractures of the pelvis: an international survey of expert opinion

Laura Jill Kleeblad; Sverre A I Loggers; Wietse P Zuidema; Daphne van Embden; Theodore Miclau; Kees-Jan Ponsen

doi:10.1097/OI9.0000000000000293

Current consensus and clinical approach to fragility fractures of the pelvis: an international survey of expert opinion

OTA Int. 2023 Dec 22;6(5 Suppl):e293. doi: 10.1097/OI9.0000000000000293. eCollection 2023 Dec.

Authors

Laura Jill Kleeblad¹, Sverre A I Loggers¹, Wietse P Zuidema², Daphne van Embden², Theodore Miclau³, Kees-Jan Ponsen¹

Affiliations

¹ Department of Trauma Surgery, Northwest Clinics, Alkmaar, the Netherlands.
² Department of Trauma Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands.
³ Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, Department of Orthopaedic Surgery, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA.

Abstract

Introduction: Fragility fractures of the pelvis (FFP) in elderly patients are an underappreciated injury with a significant impact on mobility, independency, and mortality of affected patients and is a growing burden for society/health care. Given the lack of clinical practice guidelines for these injuries, the authors postulate there is heterogeneity in the current use of diagnostic modalities, treatment strategies (both operative and nonoperative), and follow-up of patients with FFP. The goal of this study was to assess international variation in the management of FFP.

Methods: All International Orthopaedic Trauma Association (IOTA) steering committee members were asked to select 15 to 20 experts in the field of pelvic surgery to complete a case-driven international survey. The survey addresses the definition of FFP, use of diagnostic modalities, timing of imaging, mobilization protocols, and indications for surgical management.

Results: In total, 143 experts within 16 IOTA societies responded to the survey. Among the experts, 86% have >10 years of experience and 80% works in a referral center for pelvic fractures. However, only 44% of experts reported having an institutional protocol for the management of FFP. More than 89% of experts feel the need for a (inter)national evidence-based guideline. Of all experts, 73% use both radiographs and computed tomography (CT) to diagnose FFP, of which 63% routinely use CT and 35% used CT imaging selectively. Treatment strategies of anterior ring fractures were compared with combined (anterior and posterior ring) fractures. Thirty-seven percent of patients with anterior ring fractures get admitted to the hospital compared with 75% of patients with combined fractures. Experts allow pain-guided mobilization in 72% after anterior ring fracture but propose restricted weight-bearing in case of a combined fracture in 44% of patients. Surgical indications are primarily based on the inability to mobilize during hospital admission (33%) or persistent pain after 2 weeks (25%). Over 92% plan outpatient follow-up independent of the type of fracture or treatment.

Conclusion: This study shows that there is a great worldwide heterogeneity in the current use of diagnostic modalities and both nonoperative and surgical management of FFP, emphasizing the need for a consensus meeting or guideline.

Keywords: (non)operative treatment; diagnostics; follow-up strategies; fragility fractures of the pelvis; osteoporosis.