Concomitant upper extremity fractures do not worsen outcomes in conservatively managed pelvic fractures: a cohort study of 1840 geriatric patients

INTRODUCTION: Pelvic fractures in elderly patients are associated with significant pain, functional decline, and prolonged rehabilitation, with the majority managed non-operatively. In the conservative management paradigm, intact upper extremity function is critical for mobilization with assistive devices; concurrent upper extremity (UE) fractures may therefore complicate recovery. The aim of this study was to evaluate the clinical outcomes associated with this injury combination in patients with conservatively managed pelvic fractures. METHODS: A retrospective cohort study was conducted at a Level 1 trauma center, including all patients aged ≥ 65 years admitted with pelvic ring or acetabular fractures managed non-operatively between January 2010 and January 2024. Patients were stratified by the presence of a concomitant UE fracture sustained during the same traumatic event. Primary outcomes were hospital length of stay (LOS) and all-cause mortality at multiple time points. Secondary outcomes included readmission rates and systemic infection rates. RESULTS: Of 1840 patients, 1693 (92.0%) sustained isolated pelvic fractures and 147 (8.0%) had concomitant UE fractures. Groups were comparable at baseline across all measured covariates. LOS did not differ significantly between groups (11.0 ± 14.2 vs. 11.8 ± 16.9 days; p = 0.796). Mortality was similar at all evaluated time points, including 30-day (3.3% vs. 3.6%; p = 0.752) and 1-year mortality (10.9% vs. 14.3%; p = 0.452). Readmission rates and systemic infection rates were comparable. Subgroup analyses by UE fracture location, treatment approach, and pelvic fracture type demonstrated no significant differences. CONCLUSIONS: Concomitant upper extremity fractures do not adversely affect clinical outcomes in geriatric patients with conservatively managed pelvic fractures. The contrast between these findings and published data in surgically managed proximal femur fracture patients supports the hypothesis that surgical complexity, rather than rehabilitative impairment alone, is the primary driver of adverse outcomes in elderly patients with concurrent fractures.