Occult Insufficiency Fractures in Older Adults: Imaging Diagnosis, Functional Decline, and Mobility-Preserving Management
DOI:
https://doi.org/10.64784/342Palabras clave:
insufficiency fractures, fragility fractures, older adults, osteoporosis, pelvic fractures, sacral fractures, magnetic resonance imaging, computed tomography, diagnostic delay, mobility, rehabilitation, functional independenceResumen
Insufficiency fractures in older adults represent an important manifestation of skeletal fragility and are frequently associated with osteoporosis, minimal trauma, diagnostic delay, and progressive loss of functional independence. This study analyzed insufficiency fractures from an integrated traumatological, radiological, and geriatric perspective, focusing on radiological patterns, occult posterior pelvic injuries, diagnostic limitations, functional outcomes, and strategies aimed at preserving mobility. A structured review based on the scientific method was performed using clinical studies, imaging research, observational cohorts, and relevant reviews addressing adults aged 65 years and older. The evidence showed that conventional radiography may underestimate the extent of pelvic and sacral injuries, while computed tomography improves characterization of fracture morphology and posterior pelvic involvement. Magnetic resonance imaging demonstrated greater sensitivity for occult insufficiency fractures, particularly when radiographs or CT findings were inconclusive. Posterior pelvic injuries were frequently identified in patients initially diagnosed with isolated pubic ramus fractures, indicating that apparent anterior-ring lesions may represent only part of a more complex injury. Functional deterioration was also relevant, with reported loss of independent mobility, incomplete recovery, institutionalization, and mortality following pelvic fragility fractures. Conservative management most frequently included pain control, rehabilitation, and progressive mobilization, although substantial variability remained among treatment protocols. Overall, the findings support a multidisciplinary approach combining early recognition, appropriate advanced imaging, assessment of mechanical stability, rehabilitation, osteoporosis management, and mobility-centered care. Diagnostic accuracy and preservation of functional independence should be considered complementary objectives in the management of insufficiency fractures in older adults.
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