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Review
. 2019 Jun 3;4(6):313-320.
doi: 10.1302/2058-5241.4.180062. eCollection 2019 Jun.

Pelvic ring fractures in the elderly

Markus A Küper  1 , Alexander Trulson  1 , Fabian M Stuby  2 , Ulrich Stöckle  1
Affiliations
Review

Pelvic ring fractures in the elderly

Markus A Küper et al. EFORT Open Rev. .

Abstract

Pelvic ring fractures are rare injuries in the elderly though the incidence is increasing due to the increasing age of the population.Main goal of treatment is the quickest possible re-mobilization to prevent side-effects of immobilization such as osteopenia, pulmonary infections or thromboembolic events.Isolated anterior pelvic ring fractures are stable injuries and therefore they usually can be treated conservatively, while pelvic ring injuries with involvement of the posterior ring are considered unstable and should undergo surgical stabilization if the patient's condition allows for it.Conservative treatment includes adequate analgesia, guided mobilization with partial weight bearing if possible and osteoanabolic medication.The appropriate surgical procedure should be discussed in an interdisciplinary round considering patient's pre-injury condition, anaesthetic and surgical risks. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180062.

Keywords: geriatrics; insufficiency fractures; osteoporosis; pelvic ring fractures.

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Conflict of interest statement

ICMJE Conflict of interest statement: US reports consultancy fees from Aesculap, KLS, Merete, OPED, outside the submitted work. All other authors have nothing to declare.

Figures

Fig. 1
Fig. 1
Classification of pelvic ring fractures according to AO/CCF (Comprehensive Classification of Fracture). a) Type A fracture with injury of the anterior ring or the iliac crest or the sacral bone beneath the SI joints. b) Type B fracture with injury of the anterior ring and partial lesion of the posterior ring. c) Type C fracture with complete interruption of the posterior ring and possibly injury of the anterior ring.
Fig. 2
Fig. 2
Epidemiology of 1024 pelvic fractures in 2012–2017. a) The vast majority of the pelvic fractures were pelvic ring fractures (74%), followed by acetabular fractures (20%) and combined pelvic ring/acetabular fractures (6%). b) 61% of the patients with pelvic ring fractures were older than 65 years. c) The most common fracture type was Type B (58%), followed by Type A fractures (25%) and Type C fractures (17%). So, 75% of the pelvic ring fractures were classified as unstable fractures.
Fig. 3
Fig. 3
Possibly missed unstable pelvic ring fracture without CT scan in a 91-year-old male patient. a) Plain pelvic radiography shows a dislocated fracture of the anterior pelvic ring. b) Additional CT scan reveals a ventral impression of the sacral bone on the same side. Classification must be changed from Type A to Type B fracture.
Fig. 4
Fig. 4
Treatment algorithm for patients with suspected pelvic ring fracture.
See this image and copyright information in PMC

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