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European Journal of Trauma and Emergency Surgery

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Open Access 03-04-2021 | Original Article

Percutaneous operative treatment of fragility fractures of the pelvis may not increase the general rate of complications compared to non-operative treatment

Authors: Laura Gericke, Annemarie Fritz, Georg Osterhoff, Christoph Josten, Philipp Pieroh, Andreas Höch

Published in: European Journal of Trauma and Emergency Surgery | Issue 5/2022

Abstract

Purpose

Despite an increasing number of fragility fractures of the pelvis (FFP) over the last 2 decades, controversy persists on their therapy with special regard to potential complications. Therefore, the present study compared the complication rates and in-hospital mortality of non-operative therapy, percutaneous treatment and open reduction and internal fixation (ORIF) of pelvic fractures in elderly patients.

Methods

All consecutive patients treated for FFP between January 2013 and December 2017 aged 65 years or older were retrospectively identified from an institutional database. Demographic data and specific patient data were collected with a special focus on pre-existing comorbidities. General and surgical complications, hospital length of stay (LOS) and mortality rates were compared.

Results

379 patients (81.3 ± 7.5 years; 81% female) were identified, 211 (55.7%) were treated non-operatively, 74 (19.5%) percutaneously and 94 (24.8%) with ORIF. The rate of general complications did not differ between treatment groups (non-operative: 21.8%; percutaneous: 28.4%; ORIF: 33.0%; p = 0.103). Surgery-related complications were twofold more frequent in the ORIF group as than in the percutaneously treated group (18.1% vs. 9.5%). The LOS differed significantly (non-operatively: 8.9 ± 7.1 days; percutaneous: 16.6 ± 8.2 days; ORIF: 19.3 ± 12.8 days; p < 0.001). Hospital mortality rate was higher in patients with ORIF (5.3%) than percutaneous treatment (0%) (p = 0.044).

Conclusions

Complication rates and hospital mortality in elderly patients with FFPs are high and associated with long LOS. For surgical treatment of FFPs, the complication rate and mortality can be significantly reduced using percutaneous procedures compared to ORIF. Therefore, percutaneous surgery should be preferred where possible.

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Buller LT, Best MJ, Quinnan SM. A nationwide analysis of pelvic ring fractures: incidence and trends in treatment, length of stay, and mortality. Geriatr Orthop Surg Rehabil. 2016;7:9–17. https://doi.org/10.1177/2151458515616250.CrossRefPubMedPubMedCentral

Andrich S, Haastert B, Neuhaus E, et al. Epidemiology of pelvic fractures in germany: considerably high incidence rates among older people. PLoS ONE. 2015;10:e0139078. https://doi.org/10.1371/journal.pone.0139078.CrossRefPubMedPubMedCentral

Clement ND, Court-Brown CM. Elderly pelvic fractures: the incidence is increasing and patient demographics can be used to predict the outcome. Eur J Orthop Surg Traumatol. 2014;24:1431–7. https://doi.org/10.1007/s00590-014-1439-7.CrossRefPubMed

Oberkircher L, Ruchholtz S, Rommens PM, et al. Osteoporotic pelvic fractures. Dtsch Arztebl Int. 2018;115:70–80. https://doi.org/10.3238/arztebl.2018.0070.CrossRefPubMedPubMedCentral

Rommens PM, Wagner D, Hofmann A. Fragility fractures of the pelvis. JBJS Rev. 2017. https://doi.org/10.2106/JBJS.RVW.16.00057.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

Kanakaris NK, Greven T, West RM, et al. Implementation of a standardized protocol to manage elderly patients with low energy pelvic fractures: can service improvement be expected? Int Orthop. 2017;41:1813–24. https://doi.org/10.1007/s00264-017-3567-2.CrossRefPubMed

Maier GS, Kolbow K, Lazovic D, et al. 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

Rollmann MF, Herath SC, Holstein JH, et al. Surgical treatment of pelvic ring fractures in the elderly now and then: a pelvic registry study. Aging Clin Exp Res. 2017;29:639–46. https://doi.org/10.1007/s40520-016-0612-8.CrossRefPubMed

10.

Schmitz P, Baumann F, Grechenig S, et al. The cement-augmented transiliacal internal fixator (caTIFI): an innovative surgical technique for stabilization of fragility fractures of the pelvis. Injury. 2015;46(Suppl 4):S114–20. https://doi.org/10.1016/S0020-1383(15)30029-2.CrossRefPubMed

11.

König A, Oberkircher L, Beeres FJP, et al. Cement augmentation of sacroiliac screws in fragility fractures of the pelvic ring-A synopsis and systematic review of the current literature. Injury. 2019;50:1411–7. https://doi.org/10.1016/j.injury.2019.06.025.CrossRefPubMed

12.

Kim W-Y, Lee S-W, Kim K-W, et al. Minimally invasive surgical treatment using “iliac pillar” screw for isolated iliac wing fractures in geriatric patients: a new challenge. Eur J Trauma Emerg Surg. 2019;45:213–9. https://doi.org/10.1007/s00068-018-1046-0.CrossRefPubMed

13.

Höch A, Pieroh P, Henkelmann R, et al. In-screw polymethylmethacrylate-augmented sacroiliac screw for the treatment of fragility fractures of the pelvis: a prospective, observational study with 1-year follow-up. BMC Surg. 2017;17:132. https://doi.org/10.1186/s12893-017-0330-y.CrossRefPubMedPubMedCentral

14.

Rommens PM. Paradigm shift in geriatric fracture treatment. Eur J Trauma Emerg Surg. 2019;45:181–9. https://doi.org/10.1007/s00068-019-01080-x.CrossRefPubMed

15.

Breuil V, Roux CH, Testa J, et al. Outcome of osteoporotic pelvic fractures: an underestimated severity. Survey of 60 cases. Jt Bone Spine. 2008;75:585–8. https://doi.org/10.1016/j.jbspin.2008.01.024.CrossRef

16.

Noser J, Dietrich M, Tiziani S, et al. Mid-term follow-up after surgical treatment of fragility fractures of the pelvis. Injury. 2018;49:2032–5. https://doi.org/10.1016/j.injury.2018.09.017.CrossRefPubMed

17.

Höch A, Özkurtul O, Pieroh P, et al. Outcome and 2-year survival rate in elderly patients with lateral compression fractures of the pelvis. Geriatr Orthop Surg Rehabil. 2017;8:3–9. https://doi.org/10.1177/2151458516681142.CrossRefPubMed

18.

Mears SC, Berry DJ. Outcomes of displaced and nondisplaced pelvic and sacral fractures in elderly adults. J Am Geriatr Soc. 2011;59:1309–12. https://doi.org/10.1111/j.1532-5415.2011.03455.x.CrossRefPubMed

19.

van Dijk WA, Poeze M, van Helden SH, et al. Ten-year mortality among hospitalised patients with fractures of the pubic rami. Injury. 2010;41:411–4. https://doi.org/10.1016/j.injury.2009.12.014.CrossRefPubMed

20.

Loggers SAI, Joosse P, Jan Ponsen K. Outcome of pubic rami fractures with or without concomitant involvement of the posterior ring in elderly patients. Eur J Trauma Emerg Surg. 2018. https://doi.org/10.1007/s00068-018-0971-2.CrossRefPubMed

21.

Ochenjele G, Reid KR, Castillo RC, et al. Predictors of unplanned reoperation after operative treatment of pelvic ring injuries. J Orthop Trauma. 2018;32:e245–50. https://doi.org/10.1097/BOT.0000000000001170.CrossRefPubMed

22.

Eckardt H, Egger A, Hasler RM, et al. Good functional outcome in patients suffering fragility fractures of the pelvis treated with percutaneous screw stabilisation: assessment of complications and factors influencing failure. Injury. 2017;48:2717–23. https://doi.org/10.1016/j.injury.2017.11.002.CrossRefPubMed

23.

Taillandier J, Langue F, Alemanni M, et al. Mortality and functional outcomes of pelvic insufficiency fractures in older patients. Joint Bone Spine. 2003;70:287–9.CrossRef

24.

Morris RO, Sonibare A, Green DJ, et al. Closed pelvic fractures: characteristics and outcomes in older patients admitted to medical and geriatric wards. Postgrad Med J. 2000;76:646–50. https://doi.org/10.1136/pmj.76.900.646.CrossRefPubMedPubMedCentral

25.

Höch A, Pieroh P, Gras F, et al. Age and “general health”-beside fracture classification-affect the therapeutic decision for geriatric pelvic ring fractures: a German pelvic injury register study. Int Orthop. 2019. https://doi.org/10.1007/s00264-019-04326-w.CrossRefPubMed

26.

Hu F, Jiang C, Shen J, et al. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury. 2012;43:676–85. https://doi.org/10.1016/j.injury.2011.05.017.CrossRefPubMed

27.

Morrison RS, Siu AL. Survival in end-stage dementia following acute illness. JAMA. 2000;284:47–52. https://doi.org/10.1001/jama.284.1.47.CrossRefPubMed

28.

Fritz A, Gericke L, Höch A, et al. Time-to-treatment is a risk factor for the development of pressure ulcers in elderly patients with fractures of the pelvis and acetabulum. Injury. 2020;51:352–6. https://doi.org/10.1016/j.injury.2019.12.007.CrossRefPubMed

29.

Teasell R, Dittmer DK. Complications of immobilization and bed rest. Part 2: Other complications. Can Fam Physician. 1993;39:1440–2.PubMedPubMedCentral

30.

Dittmer DK, Teasell R. Complications of immobilization and bed rest. Part 1: musculoskeletal and cardiovascular complications. Can Fam Physician. 1993;39:1428–32.PubMedPubMedCentral

31.

Caviglia H, Mejail A, Landro ME, et al. Percutaneous fixation of acetabular fractures. EFORT Open Rev. 2018;3:326–34. https://doi.org/10.1302/2058-5241.3.170054.CrossRefPubMedPubMedCentral

32.

Rommens PM, Arand C, Hopf JC, et al. Progress of instability in fragility fractures of the pelvis: an observational study. Injury. 2019. https://doi.org/10.1016/j.injury.2019.08.038.CrossRefPubMed

Title: Percutaneous operative treatment of fragility fractures of the pelvis may not increase the general rate of complications compared to non-operative treatment
Authors: Laura Gericke
Annemarie Fritz
Georg Osterhoff
Christoph Josten
Philipp Pieroh
Andreas Höch
Publication date: 03-04-2021
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 5/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-021-01660-w

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Percutaneous operative treatment of fragility fractures of the pelvis may not increase the general rate of complications compared to non-operative treatment

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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