JBJS - 2026-09-18 - Journal Article
The Management of Pelvic and Vertebral Fragility Fractures: An Unmet Care Need.
Anderson PA, Giangregorio LM, Routt MLC
Topics
Key Takeaway
Vertebral and pelvic fragility fractures carry significant mortality and morbidity, yet remain underdiagnosed and undertreated, with surgical intervention reserved for intractable pain, functional decline, neurologic deficit, or radiographic deterioration.
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Summary
This narrative review addresses the diagnostic and management gaps in vertebral compression fractures and pelvic insufficiency fractures in the elderly. Nonoperative management—pain control, mobility optimization, nutritional support—is appropriate for most patients, with surgical indications limited to intractable pain, functional failure, neurologic deficit, or radiographic progression. Secondary fracture prevention is emphasized as essential to reduce refracture risk and accelerate recovery.
Key Limitation
The absence of a systematic search methodology and pooled outcome data means surgical indications and nonoperative protocols are presented without quantitative evidence thresholds, limiting actionable guidance for clinical decision-making.
Original Abstract
➢ Vertebral compression fractures and pelvic insufficiency fractures are common and result in increased mortality and morbidity.➢ These fractures can be difficult to diagnose because many patients are asymptomatic or have symptoms ascribed to other causes. Additionally, pelvic and sacral fractures are difficult to visualize radiographically.➢ Nonoperative treatment is appropriate for most patients and focuses on pain management, the improvement of mobility and activities of daily living, and nutritional support.➢ The surgical indications are intractable pain, poor functional ability, radiographic evidence of deterioration, and neurologic deficits.➢ Secondary fracture prevention is critical to prevent further fractures and may speed up recovery.