Stabilization of Osteoporotic Pelvis and Acetabular Fractures

Abstract

Background: The surgical management of osteoporotic pelviacetabular fractures poses distinct challenges due to poor screw purchase, severe comminution of fractures, and the inability to perform prolonged surgeries in patients with significant comorbidities. These fractures necessitate tailored modifications in surgical approaches, implant selection, and techniques based on the patient's overall health, fracture complexity, and bone quality.

Methods: A comprehensive literature search was conducted using PubMed and Google Scholar databases to identify relevant articles on the management of osteoporotic pelvi-acetabular fractures.

Results: Implant selection plays a pivotal role in addressing the fragility of osteoporotic fractures. Specialized implants, such as locking plates with multidirectional screw holes, along with augmentation using polymethylmethacrylate (PMMA) or bone substitutes, enhance screw fixation in compromised bone. Sacral fractures, which are commonly involved, are often managed with percutaneous fixation using long cancellous screws. Minimally invasive long-screw fixation techniques are particularly effective for less displaced acetabular fractures. For displaced acetabular fractures with articular impaction, fracture elevation and stabilization using bone grafts or bone graft substitutes are crucial. When feasible, less invasive surgical techniques are preferred to minimize operative trauma. In some cases, the fixation of acetabular fractures in osteoporotic bone may fail over time, necessitating conversion to total hip arthroplasty (THA). For fractures with severe comminution, primary THA combined with column reduction and fixation is frequently a safer and more effective approach. Early postoperative mobilization is critical to reduce the risk of complications such as deep vein thrombosis and pressure ulcers.

Conclusion: The stabilization of osteoporotic pelvic and acetabular fractures requires a multifaceted approach incorporating advanced surgical techniques, specialized implants, and augmentation methods. Early mobilization and individualized postoperative management are essential for optimizing patient outcomes and minimizing complications.

Keywords: Acetabular impaction; Acetabular plates; Fragility fracture; Pelvis; Percutaneous fixation; Primary hip arthroplasty.