Fragility Fractures of the Pelvic Ring – Does the Evidence of Oedema Lead us to More Surgeries?

2020 ◽  
Author(s):  
Patricia Lang ◽  
Manuel Sterneder ◽  
Hans-Joachim Riesner ◽  
Carsten Hackenbroch ◽  
Benedikt Friemert ◽  
...  
Keyword(s):  
Pelvic Ring ◽  
Fragility Fractures ◽  
Diagnostic Procedures ◽  
Fracture Morphology ◽  
Therapy Regimen ◽  
Therapeutic Consequences ◽  
Pelvic Ring Fractures ◽  
Clear Change ◽  
Choice Of Therapy

Abstract Introduction The choice of therapy for fragility fractures of the pelvis (FFP) is largely determined by the diagnosed fracture morphology. It is now unclear whether the change in diagnostic options – sensitive detection of fracture oedema in the sacrum using MRI and dual-energy computed tomography (DECT) – has an impact on the therapeutic consequences. The aim of this retrospective study was therefore to evaluate the change in the diagnostics used and the resulting therapy regimen in our patient population. Materials and Methods We performed a monocentric-retrospective analysis of 196 patients with a fragility fracture of the pelvis in our clinic (national TraumaZentrum® DGU and SAV approval) in the period from 2008 to 2017. We examined changes in epidemiology, diagnostics/classification and therapy of the pelvic ring fractures treated by us. Results The diagnostic procedures used are subject to a clear change towards oedema detection using MRI and DECT. The graduation has changed towards more severe forms of fracture after FFP. There is now also an increasing proportion of patients treated by surgery (2008 – 2009: 5.3% vs. 2015 – 2017: 60.3%). Conclusion We were able to show that the introduction of sensitive diagnostic procedures coincided with a higher classification of the fractures. It is also noteworthy that the increase in operations is not only due to a higher degree of classification; also in relative terms, more patients are operated on within type FFP II.

scholarly journals Modified Therapy Concepts for Fragility Fractures of the Pelvis after additional MRI

2019 ◽  
Author(s):  
Isabel Graul ◽  
Ivan Marintschev ◽  
Carsten Hackenbroch ◽  
Hans-Georg Palm ◽  
Benedikt Friemert ◽  
...  
Keyword(s):  
Bone Density ◽  
Pelvic Ring ◽  
Fragility Fractures ◽  
Diagnostic Procedures ◽  
High Morbidity ◽  
Mri Imaging ◽  
Horizontal Fracture ◽  
Therapy Decision ◽  
Therapeutic Consequences ◽  
Ct And Mri

Abstract Background Fractures of the pelvic ring in elderly patients have increased in frequency over time. These injuries are associated with a high morbidity and have a socio-economic impact. The diagnostic procedures and their influence of therapy decisions are still controversial.Methods In a retrospective study, we investigate the value of additional MRI examination on therapy decision of fragility fractures of the pelvis. The evaluation of all patients with pelvic fractures without adequate trauma and with performed CT and MRI from 2010 to 2017 was conducted at three large German hospitals. The imaging procedure took place within a maximum interval of 4 weeks. After evaluation of the imaging, the resulting therapeutic consequences either based on CT alone or on CT and MRI were reviewed by experienced pelvic surgeons. Furthermore, a measurement of Hounsfield units as an indicator of reduced bone density was recorded in the L5 vertebra.Results Of 754 patients with pelvic injuries, 67 (age 80 +/- 9.7 years, f: m 54:13) could be included in the study. The detection of vertical fractures in CT (n = 40 unilateral, n = 11 bilateral) could be increased by the additional MRI (n = 44 unilateral, n = 23 bilateral). A horizontal fracture component was identified in CT in 9.0% (n = 6) vs. MRI in 25.4% (n = 17) of the cases. An anterior pelvic ring injury was detected in 71.6% (n = 44; 4x bilateral) in CT, in 80.6% in MRI (n = 50, 4 bilateral). Additive MRI imaging increased the decision rate for surgical therapy from 20.9% (n = 14) to 31.3% (n = 21). In 90.0% of the patients (n = 60) a reduced bone density in the L5 vertebra was measured.Conclusions The results of this study further support the value of bone marrow detection by MRI diagnostics (or dual source CT which showed promising initial results) for the detection of pelvic ring fractures. For the first time, the study identifies an additional therapeutic consequence by an increased rate of surgical procedures.

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

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.

Pelvic Fractures

1994 ◽  
Vol 35 (5) ◽  
pp. 420-425 ◽  
Author(s):  
J. Albrechtsen ◽  
J. Hede ◽  
A. G. Jurik
Keyword(s):  
Femoral Head ◽  
Pelvic Ring ◽  
Posterior Part ◽  
Conventional Radiography ◽  
Pelvic Fractures ◽  
Acetabular Fractures ◽  
Pelvic Ring Fractures

Sixty-two patients with pelvic fractures were evaluated by conventional radiography and CT. A correct pathoanatomic classification of the fractures was most often obtained by conventional radiography, but CT added information regarding acetabular fractures and involvement of the posterior part of the pelvic ring. Besides, CT was essential in the detection of intraarticular fragments and lesions of the femoral head. Classification of pelvic ring fractures by the pattern of traumatic forces was easily obtainable by conventional radiography, but often difficult to achieve by CT.

Classification of Pelvic Ring Fractures in Skeletonized Human Remains

2014 ◽  
Vol 60 ◽  
pp. S171-S176 ◽  
Author(s):  
Socorro Báez-Molgado ◽  
Eric J. Bartelink ◽  
Lyman M. Jellema ◽  
Linda Spurlock ◽  
Sabrina B. Sholts
Keyword(s):  
Pelvic Ring ◽  
Human Remains ◽  
Pelvic Ring Fractures

scholarly journals ‘Within Ring’ Concept Treatment for Displaced H-Shaped Type IVb Fragility Fractures of the Pelvis

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Yohei Yanagisawa ◽  
Yusuke Eda ◽  
Shotaro Teruya ◽  
Hisanori Gamada ◽  
Masashi Yamazaki
Keyword(s):  
Pelvic Ring ◽  
Pedicle Screws ◽  
Fragility Fractures ◽  
Clinical Results ◽  
High Energy ◽  
Fixation Method ◽  
Case Presentation ◽  
Pelvic Fixation ◽  
Pelvic Ring Fractures ◽  
Sacroiliac Rod Fixation

Introduction. Sacroiliac rod fixation (SIRF) preserves the mobility of L5/S1 (lumber in the pelvis), as a surgical procedure for high-energy pelvic ring fractures. The concept of SIRF method without pedicle screws into L4 and L5 is called ‘within ring’ concept. Case Presentation. We report here the clinical results of ‘within ring’ concept treatment with sacroiliac rod fixation for a case of displaced H-shaped Rommens and Hofmann classification type IVb fragility fractures of the pelvis (FFP), which A 79-year-old woman had been difficult to walk due to pain that had been prolonged for more than one month since her injury. The patient was successfully treated with SIRF, no pain waking with a walking stick and returned to most social activities including living independently within 6 months of the operation. Conclusion. SIRF is useful because it can preserve the mobility in the lumbar pelvis; not including the lumbar spine in the fixation range like spino pelvic fixation is a simple, safe, and low-invasive internal fixation method for displaced H-shaped type IVb fragility fractures of the pelvis.

scholarly journals Biomechanical Comparison of Five Fixation Techniques for Unstable Fragility Fractures of the Pelvic Ring

2021 ◽  
Vol 10 (11) ◽  
pp. 2326
Author(s):  
Moritz F. Lodde ◽  
J. Christoph Katthagen ◽  
Clemens O. Schopper ◽  
Ivan Zderic ◽  
Geoff Richards ◽  
...  
Keyword(s):  
External Fixator ◽  
Motion Tracking ◽  
Pelvic Ring ◽  
Plate Fixation ◽  
Treatment Options ◽  
Fragility Fractures ◽  
Study Groups ◽  
Axial Stiffness ◽  
Pelvic Ring Fractures ◽  
Fixation Techniques

Background: Incidence of pelvic ring fractures has increased over the past four decades, especially after low-impact trauma—classified as fragility fractures of the pelvis (FFP). To date, there is a lack of biomechanical evidence for the superiority of one existing fixation techniques over another. An FFP type IIc was simulated in 50 artificial pelvises, assigned to 5 study groups: Sacroiliac (SI) screw, SI screw plus supra-acetabular external fixator, SI screw plus plate, SI screw plus retrograde transpubic screw, or S1/S2 ala–ilium screws. The specimens were tested under progressively increasing cyclic loading. Axial stiffness and cycles to failure were analysed. Displacement at the fracture sites was evaluated, having been continuously captured via motion tracking. Results: Fixation with SI screw plus plate and SI screw plus retrograde transpubic screw led to higher stability than the other tested techniques. The S1/S2 ala–ilium screws were more stable than the SI screw or the SI screw plus external fixator. Conclusions: In cases with displaced fractures, open reduction and plate fixation provides the highest stability, whereas in cases where minimally invasive techniques are applicable, a retrograde transpubic screw or S1/S2 ala–ilium screws can be considered as successful alternative treatment options.

scholarly journals A retrospective study about functional outcome and quality of life after surgical fixation of insufficiency pelvic ring injuries

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Katharina Jäckle ◽  
Marc-Pascal Meier ◽  
Mark-Tilmann Seitz ◽  
Sebastian Höller ◽  
Christopher Spering ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Functional Outcome ◽  
Pelvic Ring ◽  
Fragility Fractures ◽  
Well Being ◽  
Posterior Pelvic Ring ◽  
Pelvic Ring Fractures ◽  
Sf 36

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.

The imaging and classification of severe pelvic ring fractures

2013 ◽  
Vol 95-B (10) ◽  
pp. 1396-1401 ◽  
Author(s):  
B. J. Gabbe ◽  
M. Esser ◽  
A. Bucknill ◽  
M. K. Russ ◽  
D-J. Hofstee ◽  
...  
Keyword(s):  
Pelvic Ring ◽  
Pelvic Ring Fractures
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