INTRODUCTION: This study compared robot-assisted fracture reduction (RAFR) with manual closed reduction followed by navigation-assisted fixation in surgically treated patients with fragility fractures of the pelvis (FFP) type III or IV. Outcomes after operative versus initial non-operative management were also examined.
PATIENTS AND METHODS: This retrospective cohort study included 115 patients aged ≥ 60 years treated between March 2021 and June 2025: 39 underwent RAFR, 34 manual closed reduction with navigation-assisted fixation, and 42 initial non-operative treatment. The primary outcome was postoperative reduction quality according to the Matta criteria. Secondary outcomes included 1-year functional scores, mortality, and surgery-related complications.
RESULTS: RAFR was associated with lower odds of a worse postoperative Matta grade than manual closed reduction with navigation-assisted fixation (adjusted common OR=0.139, 95% CI 0.039-0.440; P = 0.001). Among 58 operated survivors with complete 1-year assessments, RAFR was associated with a higher Parker Mobility Score (β=2.030, 95% CI 1.093-2.966; P < 0.001), whereas adjusted differences in Barthel Index, EQ-5D-5L, and NRS were not statistically significant. In the operative versus initial non-operative comparison, 6-month mortality was 4.3% versus 15.8% (P = 0.064) and 1-year mortality was 8.6% versus 21.1% (P = 0.078), with no significant difference in overall survival (P = 0.536). Operative treatment was associated with better 1-year functional and pain outcomes after adjustment.
CONCLUSION: RAFR was associated with better postoperative reduction quality and a higher 1-year Parker Mobility Score than manual reduction/navigation, whereas adjusted differences in Barthel Index, EQ-5D-5L, and NRS were not statistically significant. Operative treatment was associated with better 1-year functional and pain outcomes in exploratory analyses, but a survival advantage was not demonstrated.
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