BMC Geriatrics · Nov 3, 2026
Anterior subcutaneous pelvic internal fixation versus conservative treatment for type iib and iic fragility fractures of the pelvis in older adults: a multicentre retrospective study
By Wang F, Yang S, Lai J et al.
Objective: To compare anterior subcutaneous pelvic internal fixation with conservative treatment in older adults with type IIb and IIc fragility fractures of the pelvis (FFP). Methods: We included 217 patients with type IIb or IIc FFP treated at five trauma centres between January 2020 and December 2022 (operative, n = 86; conservative, n = 131). Demographics, comorbidities, length of stay, complications, costs, visual analogue scale (VAS) pain scores, mortality, Barthel Index (BI), instrumental activities of daily living (IADL) score and walking ability were analysed. Follow-up was ≥ 1 year. Multivariable regression and Kaplan–Meier analyses were performed. Results: Follow-up duration did not differ between groups (28.3 ± 13.2 vs. 29.0 ± 17.7 months; P = 0.733). The conservative group was older, with more comorbidities and complications but shorter stays and lower costs. Full weight-bearing occurred earlier in the operative group, whereas fracture-healing time did not differ. After adjustment, surgery was associated with lower odds of poorer walking ability (OR = 0.081, P = 0.001), higher BI (B = 3.318, P = 0.018) and lower VAS pain scores (B = − 1.219, P < 0.001), but not with IADL score (B = 0.844, P = 0.109). Mortality did not differ significantly (log-rank P = 0.074). Conclusion: Patients who underwent surgery were younger, had better pre-injury function and showed more favourable outcomes. Causality remains uncertain because of the retrospective design, baseline imbalances and strong correlation between pre- and post-injury walking ability. Surgical indications should balance potential benefits against higher costs and procedure-related complications.