What are the treatment options for pelvic fractures in older adults?

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A pelvic fracture is any type of break in one or more bones of the pelvic ring, which consists of three bones:

• the sacrum, which is a triangular-shaped bone at the base of the spine
• the two hip bones, each consisting of an ischium, ilium, and pubic bone connected by three joints:
  • two sacroiliac (SI) joints between the sacral bone and the iliac wings
  • the pubic symphysis, which connects the two pubic rami

The pelvis is a very stable structure, as it has to support the weight of the upper body. Because of this, pelvic fractures are uncommon, affecting around 37 out of every 100,000 people in the United States each year. The incidence rate rises to 92 per 100,000 for people over age 65 years.

The American Association of Orthopedic Surgeons (AAOS) notes that medical professionals classify pelvic fractures as either “stable” or “unstable.”

Stable fractures are those that often result from low impact trauma. They are more common in older adults. These injuries involve damage to only one bone of the pelvic ring, and the two broken sections of the bone line up adequately.

By contrast, unstable fractures are often the result of high impact trauma. They are more common in younger adults. These injuries involve multiple breaks to the pelvic ring, and the broken ends of the bones do not line up adequately.

Older people with weaker bones can develop a pelvic fracture from low impact trauma, such as a fall.

Most pelvic fractures are the result of high impact trauma, such as automobile accidents.

Around 94% of pelvic fractures in people over age 60 years are due to the bone disease “osteoporosis.” This disease weakens the bones and increases the risk of bone fractures. According to the National Institutes of Health (NIH), osteoporosis is more common in women who have passed the age of menopause and in men over 70 years old.

The treatment options for a pelvic fracture depend partly on whether the fracture is due to high impact or low impact trauma.

Treating fractures from high impact trauma

Most pelvic fractures result from high impact trauma and typically occur alongside other life threatening injuries. In such instances, doctors will first focus on treating the most serious injuries.

The AAOS notes that the pelvic ring is close in proximity to major blood vessels and organs, and a fracture here has the potential to cause excessive bleeding.

According to a 2022 review, doctors will work to stabilize the fracture using one of the following methods:

• An external compression device: This device fits over the pelvic area to keep the bones in alignment and prevent internal bleeding.
• A skeletal traction device: This device consists of an external system of pulleys, weights, and counterweights that are attached to pins inside the pelvis. The system helps position the bones for optimal healing.
• An external skeletal fixation device: This device screws into the bones above and below the fracture and attaches to a device outside the skin. The device allows surgeons to adjust the tightness of the screws in order to realign the bones as they heal.

Treating fractures from low impact trauma

Pelvic fractures from low impact trauma primarily affect older adults.

Some older individuals may require surgery to treat a pelvic fracture. However, the risks of surgery increase with age. As such, doctors will usually only perform surgery if nonsurgical treatments are not viable.

There are three main nonsurgical treatment methods for pelvic fractures in older adults. These are outlined below:

Mobilization

Older adults must begin moving again as soon as they are able, as a lack of mobility causes the most severe side effects. These may include:

• Osteopenia: a reduction in the protein and mineral content of the bones
• Pulmonary infection: an infection in one or both lungs
• Blood clots: blockages that can occur in the veins or arteries

Mobilization methods involve physical therapy and mobility aids, such as crutches or a walking frame. Doctors may recommend that a person undergo a CT scan 10–12 days after mobilization to check for further dislocations.

Pain relief

The goal of analgesia is to alleviate pain to the extent that the person can bear some weight.

Doctors may recommend prescription analgesics, such as a narcotic or tramadol.

Osteoporosis medication

Osteoporosis is a common cause of pelvic fracture and other types of bone fracture in older adults.

The purpose of medication for osteoporosis is to help heal the existing fracture and reduce the risk of subsequent fractures. These medications work by slowing down cells that break down bone and stimulating cells that produce new bone.

When considering the best course of treatment, a doctor will assess the type of fracture, its cause, and any underlying physiological features that may influence recovery.

If the injury is unstable, with impact toward the back of the pelvic ring, a person may require surgical stabilization. However, surgery may not be appropriate, depending on the person’s condition.

When considering treatment options for pelvic fractures in older adults, doctors will take into account the following factors:

• whether the person has any preexisting health conditions
• whether the person is taking any medications
• whether the person can safely undergo anesthesia
• the person’s level of mobility before the accident
• the person’s cognitive and nutritional status

Compared with younger adults with pelvic fractures, older adults with this injury are at increased risk of long-term physical impairment and mortality.

People may find that their quality of life decreases after a pelvic fracture. This is particularly true when other bone injuries develop due to pelvic fracture. This can cause disability and can affect mental and social well-being.

Certain severe complications are also more likely to affect older adults during recovery. These include:

• bony fragments of the pelvis piercing the bladder
• injury to the obturator nerve, which innervates the thigh
• infection

Although severe, most of the complications listed above are uncommon.

Pelvic fractures are uncommon, as the pelvic ring is a very stable structure. Nonetheless, this type of injury can occur at any age.

Most pelvic fractures in younger people are due to high impact trauma, while most of these injuries in older people are due to low impact trauma. This is because older people tend to have weaker bones that are more susceptible to fracture.

The treatment for pelvic fractures can differ for older adults, usually because of differences in the type of fracture and its cause. When considering treatment approaches, doctors will also take into consideration the person’s overall health and mobility status prior to the injury.