Fragility fractures of the pelvis: treatment and preliminary results

Arduini, Mario; Saturnino, Luca; Piperno, Alessandro; Iundusi, Riccardo; Tarantino, Umberto

doi:10.1007/s40520-015-0430-4

Cited by 33 publications

(43 citation statements)

References 14 publications

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“…Einige andere aber sprachen sich bez. der Diagnostik von Insuffizienz-/Stress-und okkulten Frakturen für die MRT vor der CT aus, bezeichneten sie sogar als "Goldstandard bei Fragilitätsfrakturen" [21,31]. Argument war hier die überlegene Sensitivität der MRT für genannte Frakturen.…”

Section: Frakturlokalisationunclassified

“…Die MRT wird in den meisten Fällen der CT nachgeschaltet, wenn diese kein eindeutiges Ergebnis liefert und die Beschwerden der Patienten aber weiterhin bestehen [16 -18]. Andere Autoren ziehen hingegen die MRT der CT aufgrund ihrer höheren Sensitivität (100 % MRT vs. 65-75 % CT; [17,19,20]) für okkulte und Insuffizienzfrakturen zur Diagnostik von Beckenfrakturen nach inadäquatem Trauma vor [15,21].…”

Section: Introductionunclassified

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Magnetic Resonance Imaging in Pelvic Fractures – Part 1: Which Criteria Lead Us to Supplementary MRI Diagnostics?

et al. 2019

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Introduction Isolated pelvic fractures are relatively rare with an incidence of 3 – 6% of all fractures, but their incidence in polytraumatized individuals increases to 25%. The S3 guideline Polytrauma gives a clear recommendation for diagnostics by means of pelvic radiography (X-ray) and computed tomography (CT). A recommendation for the diagnosis by means of magnetic resonance tomography (MRI) especially in patients with low energetic/missing trauma does not currently exist. It is unclear on the basis of which criteria the MRI can be indicated in pelvic fractures. The aim of our study was therefore to retrospectively record indications for the indication of MRI in pelvic fractures – with adequate as well as inadequate trauma. Material and Methods In a retrospective clinical study, a total of 140 patients (median 68 years, range 15 – 97, 75 female, and 66 male) with a pelvic fracture were included in the study over a period of three years. Overall, the trauma mechanism revealed 73 adequate and 67 inadequate fractures. 31/140 patients had undergone MRI of the pelvis in addition to a CT/X-ray scan. The two subgroups “with MRI” and “without MRI” were analyzed with regard to the parameters “sex”, “age”, “adequacy of the trauma”, “fracture localization”, “duration of admission to imaging”, “type of therapy” and “duration to surgery” compared. Results It was shown that the MRI diagnosis was performed especially in female, elderly patients (81 years, range 19 – 94 years). Patients with inappropriate trauma have received MRI more frequently (74%) than patients with adequate trauma (26%). With regard to fracture localization no differences could be shown. The MRI was performed on a median 4 days after the CT examination. Regarding the decision “conservative” vs. “operationally” our two groups without and with MRT tended to differ not. Patients with MRI were operated on median 2 days later than patients who did not receive MRI. Conclusions Pelvic fracture MRI should be performed primarily in elderly female patients without adequate trauma. In patients with adequate trauma, MRI is of low value, especially as MRI diagnostics are performed with delay, resulting in later surgery.

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Section: Frakturlokalisationunclassified

Section: Introductionunclassified

Magnetic Resonance Imaging in Pelvic Fractures – Part 1: Which Criteria Lead Us to Supplementary MRI Diagnostics?

et al. 2019

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“…The cause of an insufficiency fracture of the pelvis is usually a disturbed bone strength and biology in the sense of osteoporosis [4][5][6].Physiological bone resorption occurs in the course of aging. Main risk factors are age [1][2][3] and female gender [1][2][3], in addition to rheumatoid arthritis with corticosteroid therapy [7], condition after radiotherapy [8], bone metabolic diseases, long-term immobilization, vitamin D deficiency [9], nicotine abuse, organ transplantation and diabetes mellitus type 1 [9].…”

Section: Risk Factors For Insufficiency Fractures Of the Pelvic Ringmentioning

confidence: 99%

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

Graul

Marintschev

Hackenbroch

et al. 2019

Preprint

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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.

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“…According to Ferguson et al[3], associated acetabular fractures (Letournel classification) are the most common fractures in the elderly and also the most difficult to treat surgically with a high risk of poor outcomes [3]. In treating these lesions, the decrease of physiological reserve and healing abilities has indeed a negative effect on the possibility of a favorable clinical outcome [4]. Therefore, the acetabular fractures in the elderly may cause disability which could affect not only the life of the patients but also the life of their families.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, the acetabular fractures in the elderly may cause disability which could affect not only the life of the patients but also the life of their families. So, the surgical treatment of these fractures is challenging [1][2][3][4]. Hip surgeons are still debating between total hip arthroplasty (THA) in osteosynthesis [5] and open reduction internal fixation (ORIF) [6] for the proper management of complex acetabular fractures.…”

Section: Introductionmentioning

confidence: 99%

Total hip arthroplasty vs. osteosynthesis in acute complex acetabular fractures in the elderly: Evaluation of surgical management and outcomes

Carta

Falzarano

Rollo

et al. 2016

JAD

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Objective: To retrospectively evaluate the open reduction internal fixation and total hip arthroplasty directions, results and complications associated with internal fixation in managing these fractures. Methods: In 8 years at 4 centers, 61 patients with associated acetabular fractures (Letournel classification) were treated. The patients were divided into two groups. The total hip arthoplasty (THA) group consisted of 30 patients, while the open reduction internal fixation group had 31 patients. The average age of the patients was 74.7 years. The following parameters were compared: the duration of surgery and hospitalization, the international unit of red blood cell concentrate transfusion, the time for the verticalization of the patient, perioperative complications, Harris hip score, and the short form (12) health survey. The clinical and radiographic follow-up was performed at 1 month, 3 months, 6 months and 12 months and annually thereafter. Patients with post-traumatic osteoarthritis formed the third comparison group. P ≤ 0.05 was considered statistically significant according to the analytical Student's t-test. Results: The P < 0.05 in favor of the THA group was: surgical time, length of stay, number of the international unit of red blood cell concentrate transfusions, verticalization, quality of life and hip function, a reduction of perioperative complications and reinterventions. Conclusions: Our experience shows that the THA treatment for acetabular fractures in the elderly is to be preferred.

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Fragility fractures of the pelvis: treatment and preliminary results

Abstract: Our study shows encouraging results and demonstrates that minimally or less invasive osteosynthesis technique could lead to good outcome in these patients.

Cited by 33 publications

References 14 publications

Magnetic Resonance Imaging in Pelvic Fractures – Part 1: Which Criteria Lead Us to Supplementary MRI Diagnostics?

Magnetic Resonance Imaging in Pelvic Fractures – Part 1: Which Criteria Lead Us to Supplementary MRI Diagnostics?

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

Total hip arthroplasty vs. osteosynthesis in acute complex acetabular fractures in the elderly: Evaluation of surgical management and outcomes

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