Keywords
Published : 2026-08-14
Abstract
Objective: The 1-year mortality rate of elderly pelvic fractures reaches 23%, and minimally invasive and effective fixation has become a research hotspot. Traditional plate and screw fixation carries risks of complications. This study compared the clinical efficacy of novel pelvic intramedullary nails combined with sacroiliac screws (IMN group) versus traditional plate-screw fixation combined with sacroiliac screws (plate group) in treating unstable pelvic fractures in elderly patients.
Methods: A retrospective analysis was performed on 32 elderly patients (over 60 years old) diagnosed with unstable pelvic fractures admitted to our hospital from 2020 to 2024. The IMN group (n=13) received anterior ring fixation with intramedullary nails and posterior ring fixation with sacroiliac screws; the plate group (n=19) underwent anterior ring reconstruction plate fixation combined with posterior sacroiliac screw fixation. All patients were followed up for at least 1 year (average follow-up duration: 21 months). Observation indicators included 1-year survival rate, Majeed functional score, operation time, intraoperative blood loss, fluoroscopy frequency, fracture healing time (Matta criteria), and postoperative complications. Results: Three patients died within 1 year after surgery (1 in the IMN group, 2 in the plate group), all due to pulmonary infection. Compared with the plate group, the IMN group showed significantly shorter operation time (73.2±13.4 min vs 106.2±22.5 min, P<0.05), drastically reduced intraoperative blood loss (52.4±32.2 ml vs 381.6±322.7 ml, P<0.05), and higher Majeed functional scores (83.5±8.6 vs 78.6±9.2). No statistically significant intergroup differences were observed in fracture healing time (average 2.8–2.9 months), fracture reduction quality (18 cases with anatomical/satisfactory reduction in each group), or 1-year survival rate. No complications occurred in the IMN group, while 2 patients in the plate group developed subcutaneous effusion that resolved after debridement. The IMN group required more intraoperative fluoroscopy (63.6±28.9 vs 35.7±12.2). Conclusion: For elderly unstable pelvic fractures, pelvic intramedullary nailing combined with sacroiliac screws achieves equivalent fracture reduction quality, bone healing and 1-year survival rates compared with traditional plate-screw fixation. Meanwhile, this minimally invasive technique significantly shortens operation duration, cuts intraoperative blood loss and lowers complication rates, delivering satisfactory clinical outcomes.
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