Management of osteoporotic pelvic fractures

Abstract

Fragility fractures of the pelvis (FFPs) are an increasing entity among osteoporotic fractures. They are the result of a low-energy trauma and have specific fracture morphologies and different degrees of instability. A new classification system distinguishes between anterior and posterior, nondisplaced and displaced, and unilateral or bilateral fractures of the posterior pelvic ring. Treatment consists of adequate pain therapy and adapted physiotherapy. Anterior and nondisplaced posterior lesions are treated conservatively. In displaced lesions and in cases of unsuccessful conservative treatment, operative therapy is recommended. The surgery should be as minimally invasive as possible. Alternatives for posterior pelvic ring stabilization are iliosacral screw osteosynthesis, trans-sacral bar osteosynthesis, and internal transiliac and lumbopelvic fixation. When the posterior pelvic ring is stabilized surgically, fixation of the broken anterior pelvic ring should be considered as well. Alternatives are external fixation, retrograde transpubic fixation, plate osteosynthesis, and anterior subcutaneous internal fixation. Mobilization with full weight-bearing follows after a safety period of short transfers. Prospective studies are needed to shed light on the natural course and outcome of different treatment regimens for FFPs.