Prolonged pain in patients with fragility fractures of the pelvis may be due to fracture progression

Ueda, Yasuhisa; Inui, Takahiro; Kurata, Yoshiaki; Tsuji, Hideki; Saito, Jota; Shitan, Yui

doi:10.1007/s00068-019-01150-0

Cited by 31 publications

(27 citation statements)

References 15 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: 75%

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: 75%

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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“…Several studies of FFP have been reported internationally [5-7, 9, 10]; however, only a single study by Ueda [11] has reported a case series of FFP in Japan. Although the number of FFP patients is increasing in the past few years [12], many clinicians, even orthopedic surgeons, are not familiar with FFP, which may result in an opportunity loss for surgical treatment. Especially, diagnosing a fracture in the posterior pelvic ring is difficult when using conventional X-ray images due to the rarefication of the bone because of osteoporosis.…”

Section: Discussionmentioning

confidence: 99%

Mobility and mortality of 340 patients with fragility fracture of the pelvis

Yoshida

Tajima

Saito

et al. 2020

Eur J Trauma Emerg Surg

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Purpose To investigate prognosis of patients with fragility fracture of the pelvis (FFP) treated in a single trauma unit in Japan. Methods We retrospectively investigated 340 consecutive patients with FFP (40 men, 300 women; average age, 82.5 years) treated in our facility from April 2012 to April 2019. Fractures were categorized according to the Rommens classification. Patients' mechanism of injury, existence of hip implant, standing and walking abilities (using the Majeed score), and 1-year mortality rate were evaluated. Results According to the Rommens classification, there were 84 type Ia, 2 type Ib, 24 type IIa, 78 type IIb, 51 type IIc, 40 type IIIa, 1 type IIIb, 4 type IIIc, 1 type IVa, 51 type IVb, and 3 type IVc fractures. Sixteen patients (4.7%) received surgical treatments. Twenty-eight patients (8.2%) had no memory of a traumatic event, and 61 (18%) had implants from a previous hip surgery. A total of 176 patients (52%) were followed up for ≥ 1 year, and 70 (39.8%) and 67 (38.1%) patients had recovery of standing and walking abilities, similar to those before the injury. The operative group (7/9 = 77.8%) had a higher proportion of patients who regained their standing and walking abilities at the 1-year follow-up than the conservative group. The 1-year mortality rate of the patients who could be followed for ≥ 1 year was 6.7%. Conclusion According to our data, 4.7% of patients were indicated for surgery, and only < 40% of patients were able to regain their pre-injury standing and walking abilities at 1 year after the injury. FFP may greatly affect an elderly's activities of daily living and may lead to prognosis similar to patients with proximal hip fractures. To regain the walking ability of patients with FFP, more aggressive indication of surgical treatment may be considered depending on the patient's background. Further examinations are necessary to determine the surgical indications and treatment protocol for FFP.

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“…Hofmann [7]. Figure 1 is adapted from Ueda, Y. et al [9] with permission from Springer Nature, 2020. FFP type I: anterior injury only.…”

Section: Figure 2 Comprehensive Classification Of Fragility Fracturementioning

confidence: 99%

“… Comprehensive classification of fragility fractures of the pelvis according to Rommens and Hofmann [ 7 ]. Figure 1 is adapted from Ueda, Y. et al [ 9 ] with permission from Springer Nature, 2020. FFP type I: anterior injury only.…”

Section: Figurementioning

confidence: 99%

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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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Prolonged pain in patients with fragility fractures of the pelvis may be due to fracture progression

Cited by 31 publications

References 15 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

Mobility and mortality of 340 patients with fragility fracture of the pelvis

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

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