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Clinical pathways for fragility fractures of the pelvic ring: personal experience and review of the literature.

Rommens PM, Ossendorf C, Pairon P, Dietz SO, Wagner D, Hofmann A - J Orthop Sci (2014)

Bottom Line: Fragility fractures of the pelvic ring (FFP) are increasing in frequency and require challenging treatment.The classification system also provides recommendations for type and invasiveness of treatment.In this article, a literature review of treatment alternatives is presented and compared with our own experiences.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University, Langenbeckstrasse 1, 55131, Mainz, Germany, pol.rommens@unimedizin-mainz.de.

ABSTRACT
Fragility fractures of the pelvic ring (FFP) are increasing in frequency and require challenging treatment. A new comprehensive classification considers both fracture morphology and degree of instability. The classification system also provides recommendations for type and invasiveness of treatment. In this article, a literature review of treatment alternatives is presented and compared with our own experiences. Whereas FFP Type I lesions can be treated conservatively, FFP Types III and IV require surgical treatment. For FFP Type II lessions, percutaneous fixation techniques should be considered after a trial of conservative treatment. FFP Type III lesions need open reduction and internal fixation, whereas FFP Type IV lesions require bilateral fixation. The respective advantages and limitations of dorsal (sacroiliac screw fixation, sacroplasty, bridging plate fixation, transsacral positioning bar placement, angular stable plate) and anterior (external fixation, angular stable plate fixation, retrograde transpubic screw fixation) pelvic fixations are described.

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Transverse CT cut through dorsal pelvis of 83-year old female. Zones of low bone density in both sacral alae and a fracture of the left sacral ala are visible
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Fig3: Transverse CT cut through dorsal pelvis of 83-year old female. Zones of low bone density in both sacral alae and a fracture of the left sacral ala are visible

Mentions: FFP Type II lesions are non-displaced injuries of the dorsal pelvic ring. Distinct fracture patterns of the sacrum were identified [9]. Here, a vertical fracture line is consistently a part of sacral insufficiency fractures. The fracture is situated in the lateral mass, lateral to the neuroforamina and medial to the sacroiliac joint. In an osteoporotic anatomical specimen, an “alar void” was shown in the lateral mass of the sacrum [17] (Fig. 3). Patients with FFP Type II lesions present with pain in the dorsal pelvis and also experience pain in the groin in cases of pubic rami fractures. Due to acute and intense pain, the patients can hardly be mobilized within the first days after admission. If no pain relief is observed within days with adequate pain medication and mobilization remains impossible, surgical stabilization of the dorsal fracture should be considered. In FFP Type II lesions, the bony structures are not displaced. Therefore, a percutaneous procedure for internal fixation is possible [18]. Alternatives for invasive treatment are sacroiliac screw osteosynthesis, sacroplasty, bridging plate osteosynthesis or insertion of a transsacral positioning bar.Fig. 3


Clinical pathways for fragility fractures of the pelvic ring: personal experience and review of the literature.

Rommens PM, Ossendorf C, Pairon P, Dietz SO, Wagner D, Hofmann A - J Orthop Sci (2014)

Transverse CT cut through dorsal pelvis of 83-year old female. Zones of low bone density in both sacral alae and a fracture of the left sacral ala are visible
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4306730&req=5

Fig3: Transverse CT cut through dorsal pelvis of 83-year old female. Zones of low bone density in both sacral alae and a fracture of the left sacral ala are visible
Mentions: FFP Type II lesions are non-displaced injuries of the dorsal pelvic ring. Distinct fracture patterns of the sacrum were identified [9]. Here, a vertical fracture line is consistently a part of sacral insufficiency fractures. The fracture is situated in the lateral mass, lateral to the neuroforamina and medial to the sacroiliac joint. In an osteoporotic anatomical specimen, an “alar void” was shown in the lateral mass of the sacrum [17] (Fig. 3). Patients with FFP Type II lesions present with pain in the dorsal pelvis and also experience pain in the groin in cases of pubic rami fractures. Due to acute and intense pain, the patients can hardly be mobilized within the first days after admission. If no pain relief is observed within days with adequate pain medication and mobilization remains impossible, surgical stabilization of the dorsal fracture should be considered. In FFP Type II lesions, the bony structures are not displaced. Therefore, a percutaneous procedure for internal fixation is possible [18]. Alternatives for invasive treatment are sacroiliac screw osteosynthesis, sacroplasty, bridging plate osteosynthesis or insertion of a transsacral positioning bar.Fig. 3

Bottom Line: Fragility fractures of the pelvic ring (FFP) are increasing in frequency and require challenging treatment.The classification system also provides recommendations for type and invasiveness of treatment.In this article, a literature review of treatment alternatives is presented and compared with our own experiences.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University, Langenbeckstrasse 1, 55131, Mainz, Germany, pol.rommens@unimedizin-mainz.de.

ABSTRACT
Fragility fractures of the pelvic ring (FFP) are increasing in frequency and require challenging treatment. A new comprehensive classification considers both fracture morphology and degree of instability. The classification system also provides recommendations for type and invasiveness of treatment. In this article, a literature review of treatment alternatives is presented and compared with our own experiences. Whereas FFP Type I lesions can be treated conservatively, FFP Types III and IV require surgical treatment. For FFP Type II lessions, percutaneous fixation techniques should be considered after a trial of conservative treatment. FFP Type III lesions need open reduction and internal fixation, whereas FFP Type IV lesions require bilateral fixation. The respective advantages and limitations of dorsal (sacroiliac screw fixation, sacroplasty, bridging plate fixation, transsacral positioning bar placement, angular stable plate) and anterior (external fixation, angular stable plate fixation, retrograde transpubic screw fixation) pelvic fixations are described.

Show MeSH
Related in: MedlinePlus