SARCOPAENIA PREDICTS DELAYED AMBULATION IN GERIATRIC FRAGILITY FRACTURES OF THE PELVIC RING TREATED NONOPERATIVELY

Geriatric fragility fractures of the pelvic ring are associated with significant patient morbidity and mortality. While there is ongoing debate regarding the role of operative treatment in this patient population, the development of percutaneous operative techniques has resulted in an increase in surgical stabilization for fragility fractures of the pelvic ring. There remains a lack of consensus on which patients would benefit from operative treatment for fragility fractures of the pelvic ring. Failure to mobilize has been used as an indication for surgery. However, this results in delayed treatment decision making. The aim of this study is to determine which patient and injury factors are associated with failure of early mobilization in geriatric patients with a fragility fracture of the pelvic ring. We performed a retrospective cohort study assessing patients over the age of 60 years with a fragility fracture of the pelvic ring between July 2022 – June 2024. Patients with a fall from standing height who received nonoperative treatment were included. Patient and injury factors were collected including age, sex, pre-injury ambulatory status, fracture severity and sarcopenia. Sarcopenia was measured using a validated technique calculating the ‘Total Psoas Area’ to L3 vertebral body ratio (TPA/L3) (Figure 1) on CT. The primary outcome was failure to stand, with or without assistive devices, by post-injury day three. Multivariable logistic regression was performed to assess the association between patient and injury variables with failure to stand. The diagnostic accuracy of predictive variables was assessed using Receiver Operating Characteristics (ROC) analysis. Fifty-eight patients with a fragility fracture of a pelvic ring were included for analysis. The median age was 86 (IQR 78–90) and 78% (n=45) were female sex. Fifty-two percent (n=30) of patients failed to stand by day three post-injury. Multivariable logistic regression modelling was performed evaluating age, sex, Beckman pelvic ring fracture classification, sarcopenia and pre-injury ambulatory status. Sarcopenia was the only variable that was significantly associated with failure to stand (p = 0.001). Assessing the diagnostic accuracy of sarcopenia in predicting failure to stand, the area under the area under the ROC curve was 0.738, indicating moderate accuracy (Figure 2). The results from this study demonstrate sarcopenia, measured using the TPA/L3 method, is strongly associated with failure to stand at post injury day three following a fragility fracture of the pelvic ring. This measure can be used as part of a risk stratification tool and allow for identification of patients who would potentially benefit from operative treatment. Further research is required to identify a threshold value for sarcopenia at which surgical intervention should be considered. For any figures or tables, please contact authors directly.