Fragility Fractures of the Pelvis and Sacrum: Current Trends in Literature

Abstract

Fragility fractures of the pelvis (FFP) and fragility fractures of the sacrum (FFS), which are emerging in the geriatric population, exhibit characteristics that differ from those of pelvic ring disruptions occurring in the younger population. Treatment of FFP/FFS by a multidisciplinary team can be helpful in reducing morbidity and mortality with the goal of reducing pain, regaining early mobility, and restoring independence for activities of daily living. Conservative treatment, including bed rest, pain therapy, and mobilization as tolerated, is indicated for treatment of FFP type I and type II as loss of stability is limited with these fractures. Operative treatment is indicated for FFP type II when conservative treatment has failed and for FFP type III and type IV, which are displaced fractures associated with intense pain and increased instability. Minimally invasive stabilization techniques, such as percutaneous fixation, are favored over open reduction internal fixation. There is little evidence regarding outcomes of patients with FFP/FFS and more literature is needed for determination of optimal management. The aim of this article is to provide a concise review of the current literature and a discussion of the latest recommendations for orthopedic treatment and management of FFP/FFS.

Incidence of Suboptimal Fluoroscopic Outlet Imaging of the Sacrum and Pelvic Retroversion Necessary for Optimal Views

“…[1][2][3][4] Percutaneous fixation of fractures involving the posterior pelvic ring is increasing in popularity. [5][6][7] This technically challenging procedure involves the insertion of screws adjacent to critical neurovascular structures through osseous corridors across disruptions of the sacrum, sacroiliac joint(s), and/or iliac bone(s). A nuanced understanding of the osteologic variants and radiographic anatomy of the posterior pelvis is necessary to achieve accurate reduction and safe positioning of implants.…”