Augmented Surgical Fixation of Pelvic Fractures in Elderly Patients. A prospective case series study from level one trauma centre in Upper Egypt

Abstract Purpose The purpose of this study was to evaluate functional outcomes after augmenting surgical fixation of pelvic fractures in elderly patients and to identify clinical and surgical factors influencing recovery, particularly the role of early mobilization. Methods This prospective case series was conducted at Assiut University Trauma Hospital, which is level 1 trauma center, between May 2023 and July 2024. This study included 15 patients aged ≥ 65 years with pelvic fractures treated surgically using minimally invasive augmented surgical fixation techniques. Preoperative evaluation included clinical assessment, pelvic radiographs, and CT scans, with fractures classified according to the Rommens classification and AO/OTA systems. Posterior stabilization was performed using transsacral screws, with additional anterior fixation using INFIX or locked symphyseal plating when indicated. The primary outcome was post surgery weightbearing pain assessed by the Visual Analog Scale (VAS), while secondary outcomes included functional evaluation using the Majeed's score and Merle d’Aubigné score, radiological union and implant loosening. Follow-up was performed up to one year. Results Fifteen patients were included (mean age 67.7 ± 3.2 years), with a predominance of males (86.7%). Most injuries resulted from low-energy trauma (60%). According to Rommens classifications, types II–III fractures were most common fractures to be included, while AO/OTA type B fractures predominated. Transsacral screw fixation was the most frequently used technique (60%), often combined with anterior stabilization methods. Median intraoperative blood loss was 30 ml and mean radiation exposure was 2.76 ± 0.87 mSv. Significant improvement was observed in clinical outcomes during follow-up, with VAS scores decreasing from 3.47 ± 1.25 at 3 weeks to 0.85 ± 0.90 at 1 year (p < 0.001) and Majeed scores improving from 58 ± 12 at 1.5 months to 89 ± 10 at 1 year (p < 0.001). Delayed weight bearing and higher early pain scores were strongly associated with poorer functional outcomes. Early postoperative pain was the only independent predictor of the 1-year Majeed score. One-year mortality was 13.3%, radiological union occurred in 92.3% of patients, and implant loosening occurred in 23% without requiring reoperation. Conclusion Augmented fixation techniques provide stable management of pelvic fractures in elderly patients, facilitating early mobilization and significant functional improvement. Early pain control and timely weight bearing appear to be key determinants of recovery.