The grade of instability in fragility fractures of the pelvis correlates with impaired early mobilization

Abstract

Purpose This study aimed to investigate whether gait patterns of patients with fragility fractures of the pelvis (FFP) comply with the grade of fracture instability, defined by radiological patterns. Patients and methods This prospective, single-center, observational study included 39 patients with an FFP. Gait analysis was performed with a wearable insole force sensor (Loadsol® by Novel, Munich, Germany) 4–7 days after admission. Patients were divided in two groups: Group A included FFP type 1 fractures, which affect the anterior pelvic ring only, Group B contained FFP type 2–4 fractures with an involvement of the posterior pelvic ring. Primary outcome parameter was the FTI ratio (force–time integral (N*s)). Results The mean age was 85.08 years (SD ± 6.45), 94.9% (37/39) of the patients were female. The most common fracture type was an FFP 2b (64.1%, 25/39). Group A showed a significantly higher FTI ratio (45.12%, SD ± 4.19%) than Group B (38.45%, SD ± 5.97%, p = 0.002). Further, a significant correlation of the FTI ratio and the average (r = 0.570, p < 0.001) and maximum (r = 0.394, p = 0.013) peak force was observed. Conclusion The gait pattern of patients with an FFP type 2–4 was more imbalanced than of patients with an FFP type 1 fracture. These findings match with the radiological classification of FFP, which indicates higher instability, when the posterior pelvis is affected. Gait analysis might offer earlier functional diagnostics and may accelerate the treatment decision with shorter periods of immobility in future. Especially in cross-border cases, early gait analysis could be beneficial to clarify the indication for or against surgery.

Evaluation of a New Treatment Strategy for Geriatric Fragility Fractures of the Posterior Pelvic Ring Using Sensor-Supported Insoles: A Proof-of-Concept Study

“…Also, the largest number of patients suffered from an FFP type II (50%), while patients with an FFP type III (0%) were not present. This distribution was, however, also noted in other studies [ 16 ].…”

“…Consequently, the aim of this study was to compare pre- and postoperative mobilization after surgical treatment of FFP types II, III and IV with the iFuse using sensor-supported insoles (Loadsols ® , Novel, Munich, Germany). Previous studies have already demonstrated the effectiveness of sensor-supported insoles for the detection of compromised mobility [ 15 , 16 ].…”