Fractures around the Pelvis, Pelvic Rim &amp;amp; Acetabulum in the Elderly: Report on 54 Cases

Peter Reynders-Frederix,Freddy Mboti,Dragos Schiopu,Cristina Reynders-Frederix,Tamas Illes

doi:10.4236/ojo.2020.103008

Abstract

The authors report on 34 patients with a pelvic rim disruption who were treated with percutaneous 7.3 mm screws. This technique is less invasive and gives immediate comfort. Screws were placed with conventional fluoroscopic assistance. In four cases, the screw tip was protruding out of the pelvic bone, two malposition screws were in the back, and two were in the front of the pelvic ring. A revision was needed in one case. We also report on 20 elderly patients with a fracture dislocation of the hip that ran into the pelvis. Eight of them were anteromedial dislocations, and the rest were central dislocations of the femoral head. In the group of anteromedial fracture dislocations, the results were excellent, with an open reduction and internal fixation (ORIF) achieved through a retroperitoneal approach. In the subgroup of central fracture dislocations, we performed the same type of osteosynthesis via the retroperitoneal approach. However, we obtained an excellent result for only two cases. We have a couple of results. First, a percutaneous screw fixation for pelvic fractures with fluoroscopic guidance gives excellent results in most cases. Second, central fracture dislocations of the hip perform poorly after osteosynthesis via the retroperitoneal approach. These fractures probably should be offered acute or delayed total hip arthroplasty (THA).

Highlights

From 1970-1997, the incidence of osteoporotic fractures of the pelvis increased by 460% [1]
We report on 20 elderly patients with a fracture dislocation of the hip that ran into the pelvis
The posterior fracture of the sacral wing is often not seen on plain radiographs, making CT evaluation necessary for a complete diagnosis

Summary

Introduction

From 1970-1997, the incidence of osteoporotic fractures of the pelvis increased by 460% [1]. In the protrusion type of acetabular fractures, the incapacity of the elderly patient is more pronounced In these frail patients, the combination of pain, blood loss, and oftentimes being bedridden can be fatal in the early onset of the illness. Recent reports favour early internal fixation as the preferred treatment for most of the displaced fractures of the pelvis and acetabulum. For fracture dislocations of the hip joint, be it central or anterior, there exists no treatment consensus. There was a clear tendency of good access to the anterior pelvic ring fracture by percutaneously screw fixation under image intensifier control. In central fracture dislocation of the acetabulum, we could not retain the hip joint after open reduction and plate osteosynthesis. Even the liberal use of the quadrilateral buttress plates could not prevent the gradual secondary displacement of the hip in this subgroup

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Discussion

Conclusion