Osteoporotic Pelvic Fractures

Abstract

Background: The estimated incidence of osteoporotic pelvic fractures among persons over age 60 in Germany is 224 per 100 000 persons per year, and rising. A number of surgical treatment options are available, but clinical long-term data are lacking.

Methods: This review is based on pertinent publications and guidelines retrieved by a selective literature search, and on the authors' clinical experience.

Results: Patients often report one or more relatively trivial traumatic incidents leading up to the fracture. They complain of pain in the hip, groin, or lower lumbar region, or of low back pain and sciatica. A new classification scheme entitled Fragility Fractures of the Pelvis (FFP) takes the morphology of the fracture into account and can be used as an aid to therapeutic decision-making (evidence level IV). The goal of treatment is early mobilization with adequate pain relief. Isolated anterior pelvic ring fractures (FFP I) and nondisplaced posterior pelvic ring fractures (FFP II) are usually stable and can be treated conservatively. Type III and IV injuries are unstable and should generally be treated surgically.

Conclusion: Retrospective analyses have shown that osteoporotic pelvic fractures are associated with decreased mobility and independence and with a one-year mortality ranging from 9.5% to 27%. Prospective therapeutic trials are urgently needed.

Figure 1

The sex and age distribution of pelvic ring fractures in the elderly, according to an analysis of curent data from the pelvis registry of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU) by Rollmann et al. 2017 (9)

Figure 2

An FFP type I fracture is an isolated fracture of the anterior pelvic ring in the Fragility Fractures of the Pelvis classification, according to Rommens and Hofmann (2, 16). The four different types of fracture are shown in this figure and in Figures 3–5. The letters a, b, and c correspond to the subtypes described in the text

Figure 3

An FFP type II fracture is a nondisplaced fracture of the posterior pelvic ring

Figure 4

An FFP type III fracture is a displaced unilateral posterior pelvic ring fracture

Figure 5

An FFP type IV fracture is a displaced bilateral posterior pelvic ring fracture

Figure 6

Treatment algorithm in the authors’ institution (Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH [Universitätsklinikum Giessen und Marburg GmbH (UKGM)], Marburg, Germany) for the treatment of fragility fractures of the pelvic ring in the elderly. CT, computed tomography; DEXA, double x-rax energy absorptiometry; FFP, Fragility Fractures of the Pelvis; Fx,fracture; PT, physiotherapy; MRI, magnetic resonance imaging; SI, sacroiliac; VAS, Visual Analog Scale

Figure 7

The surgical methods mentioned in the text for stabilization of the anterior and posterior pelvic ring are shown here. a) Cemented sacroiliac screw osteosynthesis for a bilateral fracture of the lateral mass of the sacrum. b) Sacroiliac screw osteosynthesis, transsacral bar osteosynthesis, and a retrograde transpubic screw in the pubic bone inserted percutaneously. c) Ventral plate osteosynthesis for a fracture lateral to the sacroiliac joint. d) Unilateral lumbopelvic fixation combined with a cemented sacroiliac screw (triangular fixation). e) Ventral plate osteosynthesis of the anterior pelvic ring and transsacral bar osteosynthesis. f) Internal fixation with a screw-and-rod system to stabilize the anterior pelvic ring