Fragility fractures of the pelvic ring

Abstract

Improved diagnostics and ageing population have led to increasing rates of pelvic ring fragility fractures. This is a patient group that presents with significant co-morbidities, requiring wide range of resources, prolonged care, and significant financial burden. However, the literature lacks clear guidance on their diagnosis and management. Fragility fractures of the pelvis behave differently to the classical high-energy injuries in young adults, and hence, their management principles are also different. The management goal is to control pain and restore pre-injury mobility. Multidisciplinary input and early social care planning are vital. Most patients can be managed conservatively, but a selected group may require surgical fixation owing to failure to progress with conservative treatment. Early identification of those patients and unstable fracture patterns is the key to prevent progression to complex non-unions. Surgical fixation requires special considerations compared to young adult fractures. Stabilization of both anterior and posterior parts of the pelvic ring provides adequate biomechanical construct to allow full weight-bearing in this age group. This review aims to provide guidance on the assessment and management of those injuries.