The surgical treatment of unstable osteoporotic pelvic ring fractures with bilateral vertebropelvic stabilization using a less invasive technique

Abstract Background Fragility fractures without significant trauma of the pelvic ring in older patients were often treated conservatively. An alternative treatment is surgery involving percutaneous screw fixation to stabilize the posterior pelvic ring. This surgical treatment enables patients to be mobilized quickly and complications associated with bedrest and temporary immobility are reduced. However, the functional outcome following surgery and quality of life of the patients have not yet been investigated. Here, we present a comprehensive study addressing the long-term well-being and the quality of life of patients with fragility pelvic ring fractures after surgical treatment. Methods Between 2011–2019, 215 geriatric patients with pelvic ring fractures were surgically treated at the university hospital in Göttingen (Germany). Of these, 94 patients had fragility fractures for which complete sets of computer tomography (CT) and radiological images were available. Fractures were classified according to Tile and according to the FFP classification of Rommens and Hofmann. The functional outcome of surgical treatment was evaluated using the Majeed pelvic score and the Short Form Health Survey-36 (SF-36). Results Thirty five tile type C and 48 type B classified patients were included in the study. After surgery eighty-three patients scored in average 85.92 points (± 23.39) of a maximum of 100 points using the Majeed score questionnaire and a mean of 1.60 points on the numerical rating scale ranging between 0 and 10 points where 0 points refers to “no pain” and 10 means “strongest pain”. Also, the SF-36 survey shows that surgical treatment positively effects patients with respect to their general health status and by restoring vitality, reducing bodily pain and an increase of their general mental health. Conclusions Patients who received a percutaneous screw fixation of fragility fractures of the posterior pelvic ring reported an overall positive outcome concerning their long-term well-being. In particular, older patients appear to benefit from surgical treatment. Trial registration Functional outcome and quality of life after surgical treatment of fragility fractures of the posterior pelvic ring, DRKS00024768. Registered 8th March 2021 - Retrospectively registered. Trial registration number DRKS00024768.

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Less invasive lumbopelvic fixation technique using a percutaneous pedicle screw system for unstable pelvic ring fracture in a patient with severe multiple traumas

Journal of Neurosurgery Spine ◽

10.3171/2016.7.spine16323 ◽

2017 ◽

Vol 26 (2) ◽

pp. 203-207 ◽

Cited By ~ 6

Author(s):

Sei Yano ◽

Yasuchika Aoki ◽

Atsuya Watanabe ◽

Takayuki Nakajima ◽

Makoto Takazawa ◽

...

Keyword(s):

Pelvic Ring ◽

Spinous Process ◽

Pelvic Ring Fracture ◽

Fixation Technique ◽

Multiple Fractures ◽

Ring Fracture ◽

Less Invasive ◽

Pelvic Ring Fractures ◽

Iliac Screws ◽

Multiple Traumas

Pelvic ring fractures are defined as life-threatening injuries that can be treated surgically with external or internal fixation. The authors report on an 81-year-old woman with an unstable pelvic fracture accompanying multiple traumas that was successfully treated with a less invasive procedure. The patient was injured in a traffic accident and sustained a total of 20 fractures, including pelvic ring, bilateral rib, and lumbar transverse processes fractures, and multiple fractures of both upper and lower extremities. The pelvic ring fracture was unstable with fractures of the bilateral sacrum with right sacroiliac disruption, right superior and inferior pubic rami, left superior pubic ramus, and ischium. During emergency surgery, bilateral external fixation was applied to the iliac crest to stabilize the pelvic ring. Second and third surgeries were performed 11 and 18 days after the first emergency surgery, respectively, to treat the multiple fractures. At the third surgery, the pelvic ring fracture was stabilized surgically using a less invasive posterior fixation technique. In this technique, 2 iliac screws were inserted on each side following an 8-cm midline posterior incision from the S-1 to S-3 spinous process, with the subcutaneous tissue detached from the fascia of the paraspinal muscles. The S-2 spinous process was removed and 2 rods were connected to bilateral iliac screws to stabilize the bilateral ilium in a switchback fashion. A crosslink device was applied to connect the 2 rods at the base of the S-2 spinous process. Following pelvic fixation, percutaneous pedicle screws were inserted into L-4 and L-5 vertebral bodies on both sides, and connected to the cranial rod connecting the bilateral iliac screws, thus completing the lumbopelvic fixation. The postoperative course was favorable with no postoperative complications. At the 10-month follow-up, bone union had been achieved at the superior ramus of the pubis, the patient did not complain of pain, and her activities of daily life returned to preinjury status. Unstable pelvic ring fractures need to be sufficiently stabilized for good surgical outcome. However, to avoid postoperative complications, a less invasive treatment is preferred, particularly in cases with poor general condition. This procedure is less invasive and provides sufficient stabilization to the unstable pelvic ring fracture, and thus is the ideal surgical procedure for such cases.

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Surgical treatment of unstable pelvic ring fractures

Vojnosanitetski pregled ◽

10.2298/vsp170401064k ◽

2019 ◽

Vol 76 (1) ◽

pp. 36-41

Author(s):

Miroslav Kezunovic ◽

Nikola Bulatovic

Keyword(s):

Surgical Treatment ◽

Femoral Head ◽

Internal Fixation ◽

External Fixation ◽

Pelvic Ring ◽

Early Mobilization ◽

Skeletal Traction ◽

Pelvic Ring Injuries ◽

Pelvic Ring Fractures ◽

Stable Osteosynthesis

Background/Aim. Pelvic ring fractures are complex injuries and are often associated with internal organs injuries. These injuries require rapid and accurate diagnosis and in some cases one or more surgical interventions. The aim of this retrospective study is to describe the indications and outcomes of surgical treatment of pelvic ring injuries with the emphasis on anatomical reconstruction and stable osteosynthesis as a prerequisite for early mobilization and more favorable functional outcomes. Methods. In the period from 2006 to 2012, fifty-five patients with pelvic ring injuries with or without acetabular fractures were analyzed. The average age of all patients was 36 years. Forty-one patients were treated with operational open reduction and internal fixation (ORIF) while nine of them were treated nonoperatively (bed rest, skeletal traction and external fixation). Results. All operated patients were treated within 3- 24 days with ORIF, stable osteosynthesis and early mobilization which resulted in avascular necrosis (AVN) of the femoral head in two cases. AVN of the femoral head was noted in five cases in combined and isolated pelvic ring injuries and acetabulum which were treated with skeletal traction. Neurological deficit was recorded in three patients treated with conservative methods while two patients underwent ORIF. Deep vein thrombosis (DVT) was noted in two patients and pulmonary thromboembolism appeared in one patient 23 days after surgical intervention. Two infections occurred around Steinman pins in the patients who had the definitive treatment performed with external fixator. In one patient treated with ORIF a superficial infection occurred and was treated with antibiotics. The functional results were evaluated based on Merle d'Aubign? score. The results of the radiography treatment were analyzed according to Slatis. Conclusion. Strict application of rational criteria and surgical technique with stable internal fixation with early mobilization provide significantly better outcomes of these injuries in relation to non surgical treatment or treatment with definitive external fixation.

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J.W.R. Young and A.R. Burgess, Radiologic Management of Pelvic Ring Fractures, Systematic Radiographic Diagnosis, Urban & Schwarzenberg, Baltimore, Munich (1987) 94 pp., 82 figs.

Clinical Radiology ◽

10.1016/s0009-9260(88)80383-0 ◽

1988 ◽

Vol 39 (2) ◽

pp. 256-256

Author(s):

P RENTON

Keyword(s):

Pelvic Ring ◽

Radiographic Diagnosis ◽

Pelvic Ring Fractures

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CHOICE OF TERMS FOR SURGICAL TREATMENT OF UNSTABLE PELVIC RING IN VICTIMS WITH POLYTRAUMA BASED ON ANATOMY-FUNCTIONAL ASSESSMENT OF THE TRAUMA SEVERITY

World of Medicine and Biology ◽

10.26724/2079-8334-2020-3-73-21-26 ◽

2020 ◽

Vol 16 (73) ◽

pp. 021

Author(s):

V.V. Burluka ◽

N.L. Ankin ◽

V.N. Denisenko ◽

M.A. Maksymenko ◽

K.V. Shepitko

Keyword(s):

Surgical Treatment ◽

Functional Assessment ◽

Pelvic Ring ◽

Trauma Severity

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Insufficiency Fractures vs. Low-Energy Pelvic Ring Fractures – Epidemiological, Diagnostic and Therapeutic Characteristics of Fragility Fractures of the Pelvic Ring

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1394-6502 ◽

2021 ◽

Author(s):

Manuel Sterneder ◽

Patricia Lang ◽

Hans-Joachim Riesner ◽

Carsten Hackenbroch ◽

Benedikt Friemert ◽

...

Keyword(s):

Pelvic Ring ◽

Diagnostic Testing ◽

Insufficiency Fracture ◽

Fragility Fractures ◽

Relative Increase ◽

Trauma Centre ◽

Low Energy ◽

Insufficiency Fractures ◽

Type Iv ◽

Pelvic Ring Fractures

Abstract Background Fragility fractures of the pelvis (FFP) encompass two fracture entities: fracture after low-energy trauma and insufficiency fracture without trauma. It is unclear whether the two subgroups differ in terms of diagnosis and therapy. The aim of this retrospective study was to evaluate insufficiency fractures with regard to defined parameters and to compare specific parameters with the fractures after low-energy trauma. Patients and Methods In the period from 2008 to 2017, 203 patients with FFP were recorded at our clinic (Level 1 Trauma Centre DGU, SAV approval). Of these, 25 had an insufficiency fracture and 178 had a pelvic ring fracture after low-energy trauma. Epidemiological, diagnostic and therapeutic parameters were examined. Results There was a relative increase in the insufficiency fracture within the FFP (2008 – 2009: 5.0% vs. 2015 – 2017: 17.8%). In these patients, osteoporosis tended to be more pronounced than in patients after low-energy trauma (t-value: − 3.66 vs. − 3.13). The diagnosis of insufficiency fractures showed increased use of MRI and DECT (60.9% vs. 26.0%) and a high proportion of type IV fractures after FFP (40.0% vs. 7.9%). In terms of therapy, surgical treatment of the insufficiency fracture was sought more often (68,2% vs. 52,1%), with a tendency towards increased use of combined osteosynthesis procedures (14.3% vs. 7.6%). Conclusion We were able to show that as the number of cases increases, the insufficiency fracture becomes more important within FFP. If these patients tend to have more pronounced osteoporosis, particular attention should be paid to the diagnosis and adequate therapy of the osteoporosis, especially in the case of an insufficiency fracture. In addition to the increased diagnostic testing using MRI and DECT to detect oedema and the increased surgical therapy for this type of fracture, it is also noteworthy that the insufficiency fracture can cause higher-grade fractures after FFP.

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Low-Energy Pelvic Ring Fractures: A Care Conundrum

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320985406 ◽

2021 ◽

Vol 12 ◽

pp. 215145932098540

Author(s):

Bailey R. Abernathy ◽

Lisa K. Schroder ◽

Deborah C. Bohn ◽

Julie A. Switzer

Keyword(s):

Acute Care ◽

Patient Population ◽

Pelvic Ring ◽

Fracture Prevention ◽

Low Energy ◽

Care Pathways ◽

Secondary Fracture ◽

Secondary Fracture Prevention ◽

Pelvic Ring Fractures ◽

Rehabilitative Care

Introduction: A need exists for improved care pathways for patients experiencing low-energy pelvic ring fractures. A review of the current literature was performed to understand the typical patient care and post-acute rehabilitation pathway within the US healthcare system. We also sought to summarize reported clinical outcomes worldwide. Significance: Low-energy pelvic ring fracture patients usually do not qualify for inpatient admission, yet they often require post-acute rehabilitative care. The Center for Medicare and Medicaid Services’ (CMS) 3-day rule is a barrier to obtaining financial coverage of this rehabilitative care. Results: Direct admission of some patients to post-acute care facilities has shown promise with decreased cost, improved patient outcomes, and increased patient satisfaction. Secondary fracture prevention programs may also improve outcomes for this patient population. Conclusions: Post-acute care innovation and secondary fracture prevention should be prioritized in the low-energy pelvic fragility fracture patient population. To demonstrate the effect and feasibility of these improved care pathways, further studies are necessary.

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