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

Abstract 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.