Abstract
BackgroundThe incidence of osteoporotic pelvic fractures in elderly patient is rising. This brings an increasing burden on health and social care systems as these injuries often lead to prolonged hospital admissions, loss of independence, morbidity and mortality. Some centres now advocate stabilisation of these injuries to reduce pain, facilitate early mobilisation, decrease hospital stay and restore independence. A systematic review of the literature was planned to establish the evidence for this intervention.MethodsA systematic review was performed according to PRISMA guidelines. A clinical librarian performed a search of the following databases: NHS Evidence, TRIP, the Cochrane Database of Systematic Reviews, MEDLINE and EMBASE. Seventeen eligible studies were identified with 766 patients.ResultsThe quality of evidence was poor with no good quality randomised trials. The majority of injuries were minimally displaced. Posterior ring injuries were most often stabilised with percutaneous screws which were sometimes augmented with void filler. A number of techniques were described for stabilisation of the anterior ring although fixation of the anterior ring was frequently not performed.There was consistent evidence from the included studies that operative intervention significantly improved pain. Complications were minimal but there were increased failure rates when a single unaugmented sacroiliac joint screw was used. The limited availability of non-operative comparators made it difficult to draw firm conclusions about the efficacy of surgical over non-surgical management in these patients.ConclusionsOperative management of fragility fractures of the pelvis should be considered for patients failing a brief period of non-operative management, however prospective randomised trials need to be performed to provide improved evidence for this intervention. Surgeons should consider which fixation techniques for fragility fractures of the pelvis are robust enough to allow immediate weightbearing, whilst minimising operative morbidity and post-operative complications.PROSPERO Systematic Review ID: CRD42020171237.
Highlights
The incidence of osteoporotic pelvic fractures in elderly patient is rising
High energy pelvic fractures associated with major trauma have predominated, the incidence of low energy fragility fractures of the pelvis (FFP) is increasing and predicted to continue rising in the future [1,2,3]
The management of FFP in the elderly has involved a brief period of bed rest and analgesia followed by return to mobilisation as pain allowed [5, 6]
Summary
The incidence of osteoporotic pelvic fractures in elderly patient is rising. This brings an increasing burden on health and social care systems as these injuries often lead to prolonged hospital admissions, loss of independence, morbidity and mortality. The rising incidence of osteoporosis has brought significant challenges regarding the management of associated low energy injuries. Low energy FFP are more commonly characterised by injuries affecting only the weaker osteoporotic bone. Significant pain caused by the injury [7, 8] often leads to prolonged immobility [9]. As with other debilitating osteoporotic fractures, this injury carries with it a significant financial burden [16] and results in a significant reduction in patient reported quality of life [17]
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