AI Article Synopsis
- The incidence of fragility fractures of the pelvis is increasing, with unclear treatment options for type II fractures, traditionally managed conservatively, but a new trend is towards early surgical stabilization.
- A randomized clinical trial is underway to compare conservative management with early percutaneous screw fixation, focusing on mobility and pain relief in frail patients.
- The study aims to clarify the effectiveness of surgical treatment, with a target enrollment of 68 patients over a 2-year period, and the primary measure of mobility will be assessed using the DEMMI score.
Article Abstract
Background: The incidence of fragility fractures of the pelvis is rising. Whereas the treatment for FFP type I, III, and IV is clear, the optimal treatment for FFP type II remains a topic of discussion. Traditionally these fractures have been treated conservatively. However, there is a shift toward early surgical stabilization with percutaneous screw fixation to reduce pain and promote mobility in an already frail patient population. High-quality evidence, however, is lacking. Therefore, a randomized clinical trial was designed to compare conservative management to early percutaneous screw fixation in patients with type II fragility fractures.
Methods: This is a monocenter randomized controlled trial. All patients with a FFP type II are screened for inclusion. After obtaining informed consent, patients are randomized between conservative management and surgical stabilization. Conservative management consists of early mobilization under guidance of physiotherapy and analgesics. Patients randomized for surgical treatment are operated on within 72 h using percutaneous screw fixation. The primary endpoint is mobility measured by the DEMMI score. Secondary endpoints are other dimensions of mobility, pain levels, quality of life, mortality, and morbidity. The total follow-up is 1 year. The required sample size is 68.
Discussion: The present study aims to give certainty on the potential benefit of surgical treatment. Current literature on this topic remains unclear. According to the volume of FFP at the study hospital, we assume that the number of patients needed for this study is gathered within 2 years.
Trial Registration: ClinicalTrials.gov NCT04744350. Registered on February 8, 2021.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11287941 | PMC |
| http://dx.doi.org/10.1186/s13063-024-08350-z | DOI Listing |
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- Fragility and insufficiency fractures of the pelvis and sacrum are on the rise among the elderly due to weakened bones, leading to persistent pain, reduced mobility, and a risk of loss of independence.
- While conservative treatments are an option, surgery is often preferred for unstable fractures, especially since many patients do not receive adequate preventative care for osteoporosis-related fractures.
- Diagnostic imaging is crucial for identifying these fractures, with CT scans being the gold standard, but MRI offers the highest sensitivity for detecting complex fractures, guiding treatment based on fracture type and stability.
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