Management of a three-column unstable injury in nonagenarian patients: illustrative case

Management of three-column unstable fractures in nonagenarians requires individualized decision-making that balances surgical indications with patient-specific factors including cognitive status, compliance potential, family dynamics, and overall functional goals. The lack of standardized protocols necessitates a multidisciplinary approach integrating medical, surgical, psychosocial, and family considerations to optimize outcomes in this vulnerable population. https://thejns.org/doi/abs/10.3171/CASE25406.