[Surgical stabilization of fragility fractures of the pelvis shows a good age-appropriate result regardless of the surgical procedure].

BACKGROUND

The treatment of fragility fractures of the pelvis (FFP) is becoming increasingly more important due to the demographic changes. Older age and the associated multimorbidity pose a challenge for the optimal treatment of pelvic fractures.

METHOD: A total of 36 patients were included. They were categorized according to the FFP classification with the following distribution: 44.4% FFP II, 16.7% FFP III and 38.9% FFP IV. Transiliosacral screws used unilaterally/bilaterally (cannulated 7.3 mm titanium screws with 32 mm thread, MedTech J&J, Umkirch, Germany) were compared to a continuous transiliosacral sacral rod (cannulated 7.5 mm rod, Marquardt, Spachingen, Germany) for stabilization of the posterior pelvic ring (screw vs. rod) and in combination with or without a ventral supra-acetabular external fixator (steel Schanz screws with cross-connectors classified as ⌀Fix vs. Fix). The parameters measured were the duration of surgery, complication and revision rates and functional outcomes. The quality of life on the visual analogue scale (EQ-VAS), EQ-5D-5L index and Elderly Mobility Scale (EMS) were compared 1 day, 6 weeks and 6 months postoperatively.

RESULTS

The mean age of the overall cohort was 81.5 ± 7.7 years and the overall mortality rate was 5.6%. The higher complication (29.4% vs. 17.6%, p = 0.419) and revision rates (5.9% vs. 0.0%, p = 0.310) of the screw group were not statistically significant. The EQ-VAS, EQ-5D-5L and EMS showed no significant differences between screw vs. rod. The fix group had a longer operation time (47.2 ± 9.2 min vs. 35.2 ± 20.2 min, p = 0.005) but a lower complication rate (11.1% vs. 28.0%, p = 0.306); however, their mobility was significantly reduced postoperatively and after 6 weeks (EMS day 1: 6 ± 4 vs. 11 ± 4, p = 0.003; week 6: 12 ± 2 vs. 16 ± 3, p = 0.010).

DISCUSSION: Osteoporosis treatment had not been performed prior to the injury in 64.7% of the injured patients, 29.4% received a basic treatment for osteoporosis and 5.9% received specific treatment for osteoporosis. Surgical treatment of FFP II-IV showed a good clinical outcome with age-appropriate values after 6 months. The clinical outcome was the same after 6 months regardless of the surgical procedure.