Predictors of long- term survival after pelvic ring fractures in geriatric patients - five-year results of a prospective observational study of 134 patients.

PURPOSE: The incidence of geriatric fractures, particularly pelvic fragility fractures, is rising due to demographic changes. While fractures located at the proximal femur remain the most common fracture in older adults, the number of pelvic fractures has constantly increased, especially following low-impact trauma such as falls. This study aims to evaluate the 5-year survival rate and identify factors influencing survival in geriatric patients with fragility fractures of the pelvis. METHODS: A prospective single-center observational study included 134 patients aged 60 and older with fragility fractures of the pelvis from June 2012 to December 2016. Patients were contacted 5 years post-fracture to assess survival. Barthel Index, Instrumental Activities of Daily Living (IADL), comorbidity scores, living situation and fracture related data were collected. Statistical analyses were performed using IBM SPSS. RESULTS: Of the 134 patients, 103 were re-examined after 5 years, revealing a mortality rate of 62.1%. The mean age of participants was 79.67 years, with a higher prevalence of females (82.5%). Survivors exhibited significantly better pre-fracture Barthel Index (91.79 vs. 82.35, p = 0.003) and IADL scores (6.38 vs. 4.11, p < 0.001). The ASA score and age-adjusted Charlson Comorbidity Score were also lower among survivors, indicating a correlation between pre-fracture functional status and long-term survival. CONCLUSION: Our Results indicate that survival outcomes for patients with fragility fractures of the pelvic are poor, highlighting an urgent need for tailored treatment protocols, which are currently lacking for pelvic fractures. Despite a survival rate of 37.9%, the treatment of these fragile patients remains warranted. Key predictors of survival include the pre-fracture Barthel Index and IADL scores, alongside lower ASA and Charlson Comorbidity Scores. We recommend assessing these factors upon admission to enhance mortality risk prediction and ensure more focused care for at-risk patients.