Scientific Reports (Sep 2023)

Conservative versus operative treatment of FFP II fractures in a geriatric cohort: a prospective randomized pilot trial

  • Darius M. Thiesen,
  • Gerrit Althoff,
  • André Strahl,
  • Tim Rolvien,
  • Karl-Heinz Frosch,
  • Leon-Gordian Koepke,
  • Christian Arras,
  • Tobias M. Ballhause,
  • Dimitris Dalos,
  • Maximilian J. Hartel

DOI
https://doi.org/10.1038/s41598-023-43249-w
Journal volume & issue
Vol. 13, no. 1
pp. 1 – 9

Abstract

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Abstract A clear recommendation regarding treatment strategy of fragility fractures of the pelvic ring is missing. The most typical fracture pattern is a lateral compression type injury with non-displaced fractures of the anterior pubic rami and a unilateral os sacrum fracture (FFP II). We hypothesized that operative treatment would be superior to conservative treatment. From October 2017 to April 2020, a randomized prospective non-blinded trial with n = 39 patients was carried out. Two arms with 17 operative versus 22 conservative cases were created. Inclusion criteria were a posterior pelvic ring fracture FFP type II, age over 60 years and acute fracture (< 3 weeks). Barthel index, pain level (VAS), quality of life (EQ-5D-3L), and Tinetti–Gait Test were determined on admission, at discharge, and after 3, 6, 12 and 24 months. Median follow-up was 12.9 months. The Barthel index (= 0.325), VAS (p = 0.711), quality of life (p = 0.824), and Tinetti–Gait Test (p = 0.913) showed no significant differences between the two groups after 12 months. Two patients switched from the conservative to the operative arm due to persistent immobilization and pain. The one-year mortality rate showed no significant difference (p = 0.175). Our hypothesis that surgical treatment is superior was refuted. No significant benefit was shown in terms of quality of life, mortality and pain levels. The results suggest a more differentiated treatment approach in the future, with initial conservative treatment preferred. A larger multi-center trial is required to confirm these findings. Trial registration: The study was retrospectively registered with the German Clinical Trials Registry (DRKS00013703) on 10/12/2018.