The Impact of CT Imaging on the Diagnosis of Fragility Fractures of the Pelvis: An Observational Prospective Multicenter Study

TL;DR

This study shows that CT scans are better than X-rays for diagnosing complex pelvic fractures in the elderly, which can help improve patient outcomes.

Contribution

The study demonstrates the critical role of CT imaging in detecting posterior ring fractures missed by X-rays in fragility pelvic fractures.

Findings

CT scans detected posterior ring fractures in 60.6% of cases, which X-rays failed to identify.

Patients with Nakatani II and III fractures had the most significant drops in hemoglobin levels.

The overall mortality rate was 13.13%, with higher rates in more complex fracture types.

Abstract

Background/Objectives: Fragility fractures of the pelvis (FFPs) are a significant concern in the elderly population, often leading to severe morbidity and mortality. This study aims to evaluate the diagnostic challenges, clinical outcomes, and mortality rates associated with FFPs in patients referred to multiple hospitals. Methods: A total of 99 patients with suspected pelvic fragility fractures were enrolled between January 2023 and June 2025. Initial diagnoses were made using plain X-rays, with computed tomography (CT) utilized to assess posterior ring fractures. Data on demographics, fracture types according to the Fragility Fracture of the Pelvis (FFP) Classification, hemoglobin levels, and mortality rates were collected and analyzed. Results: The findings revealed that while plain X-rays identified only anterior pelvic ring fractures, CT scans detected posterior ring fractures in 60.6% of cases. Patients with Nakatani II and III pelvic ramus fractures exhibited the most significant decreases in hemoglobin levels. The overall mortality rate was found to be 13.13%, with the highest rates observed in FFP I (13.5%) and FFP II (11.9%) groups. Conclusions: The findings of this study underscore the importance of CT imaging in the diagnosis of FFPs and highlight the need for close monitoring of hemoglobin levels in affected patients. This study also emphasizes the increased mortality risk associated with more complex fracture types. Future research should focus on evaluating functional independence and treatment outcomes to guide clinical decision-making in managing fragility fractures of the pelvis.

Figures