Progress of instability in fragility fractures of the pelvis: An observational study

Rommens, Pol Maria; Arand, Charlotte; Hopf, Johannes Christof; Mehling, Isabella; Dietz, Sven-Oliver; Wagner, Daniel

doi:10.1016/j.injury.2019.08.038

Cited by 72 publications

(83 citation statements)

References 23 publications

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“…Therefore, the usage of both classifications in our study are consistent. We found more complications and a longer stay in hospital in AO C patients compared to AO B. Interestingly, FFP II fractures showed a risk for complications comparable with AO B patients, whereas FFP III and IV revealed an increased risk for complications, even increased over AO C. Taking into account that there is a possibility of progression of fracture severity reported [ 42 , 43 ], further information seems to be mandatory which patients suffering FFP I or II fractures will heal conservatively, and which preferably should be offered early in the surgery to prevent progression. This is probably one of the most important questions in this field to be answered in the near future.…”

Section: Discussionmentioning

confidence: 73%

Safety, Effect and Feasibility of Percutaneous SI-Screw with and without Augmentation—A 15-Year Retrospective Analysis on over 640 Screws

Hartensuer

Lodde

Keller

et al. 2020

JCM

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Background: Minimally invasive sacroiliac-screw (SI-screw) fixation of the pelvis is used in energy trauma (Arbeitsgemeinschaft für Osteosynthesefragen (AO) classified) and fragility fractures (Fragility Fracture of the Pelvis (FFP) classified). However, available clinical data are based on small case series and biomechanical data seem to be contradictory. Methods: The present single center retrospective cohort study investigated percutaneous SI-screw fixation and augmentation over 15 years. Groups were compared concerning the general epidemiological data, mobilization, complication rates, duration of stay, and safety of SI-screw insertion. Multivariable analyses were performed using logistic regression. Results: Between 2005 and March 2020, 448 patients with 642 inserted SI-screws were identified. Iatrogenic neurological impairment was documented in 2.47% and correlated with screw misplacement. There was an increased complication risk in patients with AO type C over patients with AO type B and in FFP II over FFP III/IV patients. Cement-augmented FFP patients showed a 25% reduced stay in hospital and a reduced complication risk. Cement-associated complications were seen in 22% without correlation to neurologic impairment. Conclusions: The present study confirms the safety and usability of percutaneous SI-screw fixation, despite specific risks. Cement augmentation seems to reduce the complication risk in FFP patients and shorten hospital stay for some reasons, without increased specific complications or correlated neurological impairment.

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Section: Discussionmentioning

confidence: 73%

Safety, Effect and Feasibility of Percutaneous SI-Screw with and without Augmentation—A 15-Year Retrospective Analysis on over 640 Screws

Hartensuer

Lodde

Keller

et al. 2020

JCM

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“…It is likely that these fractures cause pain due to micro movements in the fracture zone, and therefore the patients try to reduce loading the fractured side. This goes along with the anatomical description of the FFP, where a higher FFP classification indicates a more unstable fracture type [24]. Referring to the fracture pattern and taking under consideration the degree of resulting instability, a conservative or operative treatment is generally recommended.…”

Section: Discussionmentioning

confidence: 99%

Load-Bearing Detection with Insole-Force Sensors Provides New Treatment Insights in Fragility Fractures of the Pelvis

Pfeufer

Becker

Faust

et al. 2020

JCM

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Background: Due to an aging society, more and more surgeons are confronted with fragility fractures of the pelvis (FFPs). The aim of treatment of such patients should be the quickest possible mobilization with full weight-bearing. Up to now however, there are no data on loading of the lower extremities in patients suffering FFPs. We hypothesized to find differences in loading of the lower limbs. Methods: 22 patients with a mean age of 84.1 years were included. During gait analysis with insole-force sensors, loading on the lower extremities was recorded during early mobilization after index fracture. Results: Especially the average peak force showed differences in loading, as the affected limb was loaded significantly less {59.78% (SD ± 16.15%) of the bodyweight vs. 73.22% (SD ± 14.84%) (p = <0.001, effect size r = 0.58)}. Furthermore, differences in loading in between the fracture patterns of FFPs were observed. Conclusion: This study shows that it is possible to reliably detect the extremity load, with the help of an insole device, in patients presenting with fragility fractures of the pelvis. There is great potential to improve the choice and time of treatment with insole-force sensors in FFPs in future.

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“…Rommens et al reported that fracture progression can occur in FFPs. They described a case of one patient who had an additional contralateral fracture after operative treatment of the fractured side 20 . Our technique involves the insertion of two screws into the ilium bilaterally and can be consider ILIS, which can prevent fracture progression in Type IIIA FFPs.…”

Section: Discussionmentioning

confidence: 99%

Iliac intramedullary stabilization for Type IIIA fragility fractures of the pelvis

Okazaki

Shirahama

Hashida

et al. 2020

Sci Rep

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There have been few reports on fixation of Rommens classification Type IIIA fragility fractures of the pelvis (FFPs). Here, we present our less invasive surgical technique, called iliac intramedullary stabilization (ILIS), for the internal fixation of Type IIIA FFPs. The technique involves a closed reduction, termed the femur internal rotation reduction method (FIRM), whereby the fracture fragments are repositioned using lateral rotators by internally rotating the femur while the patient is in the prone position. Two iliac screws are inserted on the ilium bilaterally via the supra-acetabular bone canal during FIRM and connected with two transverse rods and two cross connectors. We refer to this internal fixation procedure as ILIS. We retrospectively recruited patients with Type IIIA fractures, treated using this procedure, at our institute between October 2017 and October 2019. We evaluated operative and post-operative outcomes. We enrolled 10 patients (9 women and 1 man; mean age, 85.2 years) who were followed up for over 6 months. All patients suffered FFPs after falling from a standing position. The mean operative time was 145.1 (range, 94–217) minutes, and the mean blood loss was 258.5 (range, 100–684) ml. All patients were allowed full weight bearing from post-operative day 1. All patients achieved bone union and regained their pre-injury walking ability at 6 months after surgery without evident secondary displacement. In conclusion, our ILIS technique allows less invasive internal fixation of Type IIIA FFPs with adequate stability for full weight bearing from post-operative day 1.

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Progress of instability in fragility fractures of the pelvis: An observational study

Cited by 72 publications

References 23 publications

Safety, Effect and Feasibility of Percutaneous SI-Screw with and without Augmentation—A 15-Year Retrospective Analysis on over 640 Screws

Safety, Effect and Feasibility of Percutaneous SI-Screw with and without Augmentation—A 15-Year Retrospective Analysis on over 640 Screws

Load-Bearing Detection with Insole-Force Sensors Provides New Treatment Insights in Fragility Fractures of the Pelvis

Iliac intramedullary stabilization for Type IIIA fragility fractures of the pelvis

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