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Introduction: Non-operative management of pelvic ring injuries in the elderly is associated with a high risk of one-year mortality. The majority of these injuries are the result of a low-energy mechanism, however, due to the multiple medical comorbidities in this patient population the injuries are associated with a high degree of morbidity. The purpose of this study was to determine the one-year mortality risk after operative treatment of pelvic ring injuries in a geriatric patient population and the effect of patient and injury characteristics on the risk of mortality., Patients and Methods: We performed a retrospective review of patients over the age of 70 who underwent operative fixation of a pelvic ring injury at two Level 1 trauma centers between January 2016 and June 2019. Medical records were reviewed for patient and injury characteristics including: Charlson Comorbidity Index (CCI), American Society of Anesthesiologists (ASA) physical status score or Injury Severity Score (ISS), hospital and intensive care unit (ICU) length of stay (LOS). The primary outcome of interest was the one-year mortality risk following operative treatment. Secondary outcomes included the effect of patient and injury characteristics on the one-year mortality risk and the hospital LOS., Results: Ninety patients were included with an average age of 79.8  ±  6.5 years. The overall mortality was 8.9% (n = 8) and was significantly associated with the CCI. There was no significant effect related to the ASA physical status score or ISS. The average hospital LOS was 9.2 ± 7.3 days and was associated with the CCI, ASA physical status score, and ISS., Discussion: Non-operative management of pelvic ring injuries in geriatric patients is associated with a high risk of one-year mortality. Our findings suggest operative treatment of these fractures is associated with an acceptable risk of one-year mortality that falls below the commonly reported range for non-operatively managed injuries. Furthermore, the risk of mortality was significantly associated with the patient's pre-injury state as determined by the CCI., Competing Interests: Declaration of Competing Interest The authors have no disclosures to declare., (Copyright © 2021. Published by Elsevier Ltd.)

Objectives: Posterior iliac crescent fracture with associated sacroiliac joint disruption (PICFSID) is a type of traumatic posterior pelvic injury associated with instability. Posterior iliac fracture location and obliquity along with other details determine the treatment. Open reduction and internal fixation has been previously recommended for the majority of crescent fractures. Our objectives were to determine whether all crescents can be categorised according to the previously described Day crescent classification scheme, and to see which crescent types are amenable to percutaneous fixation., Patients and Methods: We identified 129 crescents in 128 patients during a 7-year time period. Of these, 100 patients met the inclusion criteria of at least 3 months of clinical and radiographic follow-up. There were 57 males and 43 females, with a mean age of 42 years and a mean injury severity score of 25.5. Treatment selection was based on fracture type and overall patient factors and consisted of non-operative management, pelvic external fixation, open reduction and internal fixation, and closed reduction and percutaneous iliosacral screw fixation., Results: There were 16 Type I, 47 Type II and 37 Type III crescent fractures. Twelve injuries could not be classified according to the Day scheme. Percutaneous iliosacral screw fixation was utilised in 60% of all crescents after either closed or open reduction of the PICFSID., Conclusions: The majority of PICFSIDs are amenable to closed reduction and percutaneous iliosacral screw fixation. The Day classification for PCIFSID should be expanded to include variant injury patterns., (Copyright © 2012 Elsevier Ltd. All rights reserved.)