Top

European Journal of Trauma and Emergency Surgery

23-02-2024 | Computed Tomography | Original Article

Evaluation of a treatment protocol based on conservative therapy for fragility fractures of the pelvis

Authors: Takahiro Oda, Shimpei Kitada, Hitoshi Hirase, Yuma Takada, Kenjiro Iwasa, Takahiro Niikura

Published in: European Journal of Trauma and Emergency Surgery

Abstract

Purpose

In an aging society, fragility fractures of the pelvis (FFP) have increased significantly. However, there is no clear consensus on the timing and criteria for transitioning from conservative treatment to surgery for these fractures. Thus, we aimed to investigate the effects of our treatment protocol for FFP based on conservative treatment.

Methods

We conducted a retrospective study including 74 patients with FFP at our institution between 2015 and 2021. All patients were treated conservatively for the first two weeks. During this period, only wheelchair transfer was allowed. If the patient could not walk after this period, surgery was performed. Fracture type (Rommens classification), walking ability, presence of complications after admission, presence of fracture union, and surgical treatment was investigated. Patients were divided into two groups: a stable group (type I/II) and an unstable group (type III/IV).

Results

Fracture union was achieved in all patients. Thirteen patients developed complications after being admitted to our hospital; seven showed decreased walking ability, and six required surgeries. The stable and unstable groups comprised 47 and 27 patients, respectively. There were no statistically significant differences between the groups regarding the percentage of patients who developed complications or experienced decrease in walking ability. The percentage of patients who required surgery was significantly higher in the unstable group (p < 0.05).

Conclusion

Our FFP management protocol was effective regardless of fracture type. It is important to provide a period for careful assessment of instability, and to try to prevent fracture progression.

Banierink H, Duis KT, Prijs J, Wendt KW, Stirler VMA, Helden SH, Nijveldt RJ, Boomsma MF, Heineman E, Reininga IHF, IJpma FFA. What is the long-term clinical outcome after fragility fractures of the pelvis? - A CT-based cross-sectional study. Injury. 2022;53(2):506–13. https://doi.org/10.1016/j.injury.2021.09.056.CrossRefPubMed

Maier GS, Kolbow K, Lazovic D, Horas K, Roth KE, Seeger JB, Uwe Maus U. Risk factors for pelvic insufficiency fractures and outcome after conservative therapy. Arch Gerontol Geriatr. 2016;67:80–5. https://doi.org/10.1016/j.archger.2016.06.020.CrossRefPubMed

Kannus P, Parkkari J, Niemi S, Sievänen H. Low-trauma pelvic fractures in elderly Finns in 1970–2013. Calcif Tissue Int. 2015;97:577–80. https://doi.org/10.1007/s00223-015-0056-8.CrossRefPubMed

Benzinger P, Becker C, Kerse N, Bleibler F, Gisela Büchele G, Icks A, Rapp K. Pelvic fracture rates in community-living people with and without disability and in residents of nursing homes. J Am Med Dir Assoc. 2013;14:673–8. https://doi.org/10.1016/j.jamda.2013.03.012.CrossRefPubMed

Rommens PM, Ossendorf C, Philip Pairon P, Dietz SO, Wagner D, Hofmann A. Clinical pathways for fragility fractures of the pelvic ring: personal experience and review of the literature. J Orthop Sci. 2015;20(1):1–11. https://doi.org/10.1007/s00776-014-0653-9.CrossRefPubMed

Oberkircher L, Ruchholtz S, Rommens PM, Hofmann A, Bücking B, Krüger A. Osteoporotic pelvic fractures. Dtsch Arztebl Int. 2018;115(5):70–80. https://doi.org/10.3238/arztebl.2018.0070.CrossRefPubMedPubMedCentral

Rommens PM, Arand C, Hofmann A, Wagner D. When and how to operate fragility fractures of the pelvis? Indian J Orthop. 2019;53(1):128–37. https://doi.org/10.4103/ortho.IJOrtho_631_17.CrossRefPubMedPubMedCentral

Omichi T, Takegami Y, Tokutake K, Saito Y, Ito O, Ando T, Imagama S. Mortality and functional outcomes of fragility fractures of the pelvis by fracture type with conservative treatment: a retrospective, multicenter TRON study. Eur J Trauma Emerg Surg. 2021. https://doi.org/10.1007/s00068-021-01839-1.CrossRefPubMed

Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury. 2013;44:1733–44. https://doi.org/10.1016/j.injury.2013.06.023.CrossRefPubMed

10.

Ueda Y, Inui T, Kurata Y, Tsuji H, Saito J, Shitan Y. Prolonged pain in patients with fragility fractures of the pelvis may be due to fracture progression. Eur J Trauma Emerg Surg. 2021;47(2):507–13. https://doi.org/10.1007/s00068-019-01150-0.CrossRefPubMed

11.

Yoshida M, Tajima K, Saito Y, Koji Sato K, Uenishi N, Iwata M, et al. Mobility and mortality of 340 patients with fragility fracture of the pelvis. Eur J Trauma Emerg Surg. 2021;47(1):29–36. https://doi.org/10.1007/s00068-020-01481-3.CrossRefPubMed

12.

Hotta K, Kobayashi T. Functional treatment strategy for fragility fractures of the pelvis in geriatric patients. Eur J Trauma Emerg Surg. 2021;47(1):21–7. https://doi.org/10.1007/s00068-020-01484-0.CrossRefPubMed

13.

Rommens PM, Hofmann A, Kraemer S, Kisilak M, Boudissa M, Wagner D. Operative treatment of fragility fractures of the pelvis: a critical analysis of 140 patients. Eur J Trauma Emerg Surg. 2022;48(4):2881–96. https://doi.org/10.1007/s00068-021-01799-6.CrossRefPubMed

14.

Rommens PM, Boudissa M, Krämer S, Kisilak M, Hofmann A, Wagner D. Operative treatment of fragility fractures of the pelvis is connected with lower mortality. A single institution experience. PLoS One. 2021;16(7):e0253408. https://doi.org/10.1371/journal.pone.0253408.CrossRefPubMedPubMedCentral

15.

Pieroh P, Höch A, Hohmann T, Gras F, Märdian S, Pflug A, Wittenberg S, Ihle C, Blankenburg N, Dallacker-Losensky K, Schröder T, Herath SC, Wagner D, Palm HG, Josten C, Stuby FM. Fragility fractures of the pelvis classification: a multicenter assessment of the intra-rater and inter-rater reliabilities and percentage of agreement. J Bone Joint Surg Am. 2019;101(11):987–94. https://doi.org/10.2106/JBJS.18.00930.CrossRefPubMed

16.

Rommens PM, Hopf JC, Arand C, Handrich K, Mehdi Boudissa M, Daniel WD. Prospective assessment of key factors influencing treatment strategy and outcome of fragility fractures of the pelvis (FFP). Eur J Trauma Emerg Surg. 2022;48(4):3243–56. https://doi.org/10.1007/s00068-022-01887-1.CrossRefPubMedPubMedCentral

17.

Dietz SO, Hofmann A, Rommens PM. Haemorrhage in fragility fractures of the pelvis. Eur J Trauma Emerg Surg. 2015;41(4):363–7. https://doi.org/10.1007/s00068-014-0452-1.CrossRefPubMed

18.

Ten Broek RP, Bezemer J, Timmer FA, Mollen RM, Boekhoudt FD. Massive haemorrhage following minimally displaced pubic ramus fractures. Eur J Trauma Emerg Surg. 2014;40(3):323–30. https://doi.org/10.1007/s00068-013-0361-8.CrossRefPubMed

19.

Lyders EM, Whitlow CT, Baker MD, Morris PP. Imaging and treatment of sacral insufficiency fractures. AJNR Am J Neuroradiol. 2010;31(2):201–10. https://doi.org/10.3174/ajnr.A1666.CrossRefPubMedPubMedCentral

20.

Nakayama Y, Suzuki T, Honda A, Shinnosuke Yamashita S, Matsui K, Ishii K, Kurozumi T, Watanabe Y, Kawano H. Interdigitating percutaneous screw fixation for Rommens type IIIa fragility fractures of the pelvis: technical notes and preliminary clinical results. Int Orthop. 2020;44(11):2431–6. https://doi.org/10.1007/s00264-020-04664-0.CrossRefPubMed

21.

Okazaki S, Shirahama M, Hashida R, Matsuura M, Yoshida S, Nakama K, Matsuse H, Shiba N. Iliac intramedullary stabilization for Type IIIA fragility fractures of the pelvis. Sci Rep. 2020;10(1):20380.CrossRefPubMedPubMedCentral

22.

Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology. 1986;160(2):445–51. https://doi.org/10.1148/radiology.160.2.3726125.CrossRefPubMed

23.

Ritchie H, Roser M. Obesity. Our world in data. https://ourworldindata.org/obesity. Accessed 15 June 2023

24.

Hajek A, König HH. The curvilinear effect of BMI on functional health – evidence of the long-running German ageing survey. Obes Facts. 2017;10(3):252–60. https://doi.org/10.1159/000471486.CrossRefPubMedPubMedCentral

25.

DeKeyser GJ, Kellam PJ, Haller JM, Higgins TF, Marchand LS, Rothberg DL. Emergency department stress radiographs of lateral compression type-1 pelvic ring injuries are safe effective, and reliable. J Bone Joint Surg Am. 2022;04(4):336–44. https://doi.org/10.2106/JBJS.21.00737.CrossRef

26.

Nuber S, Ritter B, Fenwick A, Förch S, Wanzl M, Nuber M, Mayr E. Midterm follow-up of elderly patients with fragility fractures of the pelvis: A prospective cohort-study comparing operative and non-operative treatment according to a therapeutic algorithm. Injury. 2022;53(2):496–505. https://doi.org/10.1016/j.injury.2021.09.044.CrossRefPubMed

27.

Jäckle K, Meier MP, Seitz MT, Höller S, Spering C, Acharya MR, Lehmann W. A retrospective study about functional outcome and quality of life after surgical fixation of insufficiency pelvic ring injuries. BMC Musculoskelet Disord. 2021;22(1):1035. https://doi.org/10.1186/s12891-021-04925-y.CrossRefPubMedPubMedCentral

28.

Kortebein P, Ferrando A, Lombeida J, Wolfe R, Evans WJ. Effect of 10 days of bed rest on skeletal muscle in healthy older adults. JAMA. 2007;297(16):1772–4. https://doi.org/10.1001/jama.297.16.1772-b.CrossRefPubMed

29.

Peichl P, Holzer LA, Maier R, Holzer G. Parathyroid hormone 1–84 accelerates fracture-healing in pubic bones of elderly osteoporotic women. J Bone Joint Surg Am. 2011;93(17):1583–7. https://doi.org/10.2106/JBJS.J.01379.CrossRefPubMed

30.

Scheyerer MJ, Osterhoff G, Wehrle S, Wanner GA, Simmen HP, Werner CML. Detection of posterior pelvic injuries in fractures of the pubic rami. Injury. 2012;43(8):1326–9. https://doi.org/10.1016/j.injury.2012.05.016.CrossRefPubMed

31.

Cabarrus MC, Ambekar A, Ying LuY, Link TM. MRI and CT of insufficiency fractures of the pelvis and the proximal femur. AJR Am J Roentgenol. 2008;191(4):995–1001. https://doi.org/10.2214/AJR.07.3714.CrossRefPubMed

32.

Palm HG, Lang P, Hackenbroch C, Sailer L, Friemert B. Dual-energy CT as an innovative method for diagnosing fragility fractures of the pelvic ring: a retrospective comparison with MRI as the gold standard. Arch Orthop Trauma Surg. 2020;140(4):473–80. https://doi.org/10.1007/s00402-019-03283-8.CrossRefPubMed

Title: Evaluation of a treatment protocol based on conservative therapy for fragility fractures of the pelvis
Authors: Takahiro Oda
Shimpei Kitada
Hitoshi Hirase
Yuma Takada
Kenjiro Iwasa
Takahiro Niikura
Publication date: 23-02-2024
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Computed Tomography
Published in: European Journal of Trauma and Emergency Surgery
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-024-02469-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Evaluation of a treatment protocol based on conservative therapy for fragility fractures of the pelvis

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content