Journal Article

Lateral compression type 1 fracture fixation in the elderly fragility fractures

Mcdaid, Catriona, Doherty, Laura, Maturana, Camila, Torgerson, David, Roche, Jenny, Acharya, Mehool, Hull, Peter, Hewitt, Catherine, Laycock, Joanne, Kassam, Jamila, Cook, Elizabeth, Hilton, Catherine, Bates, Peter, Corbacho, Belen, Sivapathasuntharam, Dhanupriya, Backhouse, Michael Ross, Forward, Daren

2023

Overview

Background Lateral compression type1 (LC-1) fragility fractures are a common, painful injury in older adults resulting in reduced mobility. The incidence of these fractures is increasing with the growing older adult population. The current standard of care is non-surgical management; however, patients with this injury are at risk of long-term immobility and related complications. INFIX is a pelvic fixation device used in younger patients with high-energy fractures. The device is fitted via a percutaneous technique with no external pin sites and has good purchase even in osteoporotic bone. It therefore has the potential to be well tolerated in patients with LC-1 fragility fractures. INFIX could improve patients' ability to mobilise and reduce the risk of immobility-related complications. However, there is a risk of complications related to surgery, and robust evidence is required on patient outcomes. This study will investigate the clinical and cost-effectiveness of surgical fixation with INFIX compared to non-surgical management of LC-1 fragility fractures in older adults. Methods A multi-centre randomised controlled trial of 600 patients allocated 1:1 to non-surgical management or INFIX surgery. The study will have a 12-month internal pilot to assess recruitment and trial feasibility. The primary outcome will be the patient quality of life over 6 months, measured by the patient-reported EQ-5D-5L. The secondary outcomes will include physical function, mental health, pain, delirium, imaging assessment, resource use, and complications. Discussion The L1FE study aims to compare the clinical and cost-effectiveness of surgical and non-surgical management of people aged 60 years and older with LC-1 fragility fractures. The trial is sufficiently powered and rigorously designed to inform future clinical and patient decision-making and allocation of NHS resources. Trial registration International Standard Randomised Controlled Trial Number Registry ISRCTN16478561. Registered on 8 April 2019 Keywords: INFIX surgery, Lateral compression type 1, LC-1, Pelvic fracture fixation, Elderly patients, Older adults, Fragility fracture, Osteoporotic bone, Pubic ramus fracture, Immobility-related complications

• Publisher: BioMed Central Ltd
• Subject: Care and treatment / Demographic aspects / Fractures / Frail elderly / Identification and classification / Injuries / Orthopedic surgery / Testing