Chronic pelvic insufficiency fractures and their treatment.

Arch Orthop Trauma Surg

Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Published: December 2024

AI Article Synopsis

  • Fragility and insufficiency fractures of the pelvis and sacrum are on the rise among the elderly due to weakened bones, leading to persistent pain, reduced mobility, and a risk of loss of independence.
  • While conservative treatments are an option, surgery is often preferred for unstable fractures, especially since many patients do not receive adequate preventative care for osteoporosis-related fractures.
  • Diagnostic imaging is crucial for identifying these fractures, with CT scans being the gold standard, but MRI offers the highest sensitivity for detecting complex fractures, guiding treatment based on fracture type and stability.

Article Abstract

Fragility and insufficiency fractures of the pelvis (FFP) and sacrum (SIF) are increasingly prevalent, particularly among the elderly, due to weakened bone structure and low-energy trauma. Chronic instability from these fractures causes persistent pain, limited mobility, and significant reductions in quality of life. Hospitalization is often required, with substantial risks of loss of independence (64-89%) and high mortality rates (13-27%). While conservative treatment is possible, surgical intervention is preferred for unstable or progressive fractures. FFP and SIF are primarily associated with osteoporosis, with 71% of patients not receiving adequate secondary fracture prevention. Imaging modalities play a crucial role in diagnosis. Conventional radiography often misses sacral fractures, while computed tomography (CT) is the gold standard for evaluating fracture morphology. Magnetic resonance imaging (MRI) offers the highest sensitivity (99%), essential for detecting complex fractures and assessing bone edema. Advanced techniques like dual-energy CT and SPECT/CT provide further diagnostic value. Rommens and Hofmann's classification system categorizes FFP based on anterior and posterior pelvic ring involvement, guiding treatment strategies. Progression from stable fractures (FFP I-II) to highly unstable patterns (FFP IV) is common and influenced by factors like pelvic morphology, bone density, and sarcopenia. Treatment varies based on fracture type and stability. Non-displaced posterior fractures can be managed with sacroplasty or screw fixation, while displaced or unstable patterns often require more invasive methods, such as triangular lumbopelvic fixation or transsacral bar osteosynthesis. Sacroplasty provides significant pain relief but has limited stabilizing capacity, while screw augmentation with polymethylmethacrylate improves fixation in osteoporotic bones. Anterior ring fractures may be treated with retrograde transpubic screws or symphyseal plating, with biomechanical stability and long-term outcomes depending on fixation techniques. FFP and SIF management requires a multidisciplinary approach to ensure stability, pain relief, and functional recovery, emphasizing early diagnosis, tailored surgical strategies, and secondary prevention of osteoporotic fractures.

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Source
http://dx.doi.org/10.1007/s00402-024-05717-4DOI Listing

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