Fragilitätsfrakturen des Beckens

Rommens, Pol Maria; Arand, Charlotte; Thomczyk, S.; Handrich, Kristin; Wagner, Daniel; Hofmann, A.

doi:10.1007/s00113-019-0643-7

Cited by 22 publications

(17 citation statements)

References 27 publications

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“…Surgical treatment, including anatomical reduction and adequate fixation, of the anterior pelvic ring contributing approximately 30% to the stability of the entire pelvic ring [4] is necessary to restore biomechanical stability and to ensure an adequate healing of the symphysis and an early mobilisation of the patient [1,5].…”

mentioning

confidence: 99%

Novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study

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Kistler³

et al. 2021

Arch Orthop Trauma Surg

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Introduction Open book fractures are challenging injuries oftentimes requiring surgical treatment. The current treatment of choice is symphyseal plating, which requires extensive surgery and entirely limits physiological movement of the symphyseal joint, frequently resulting in implant failure. Therefore, we investigated the biomechanical properties of a semi-rigid implant (modified SpeedBridge™) as a minimally invasive tape suture construct for the treatment of open book fractures and evaluated the superiority of two techniques of implementation: criss-cross vs. triangle technique. Materials and methods Nine synthetic symphyseal joints were dissected creating an open book fracture. The different osteosynthesis methods (plating, modified SpeedBridge™ in criss-cross/triangle technique) were then applied. All constructs underwent horizontal and vertical loading, simulating biomechanical forces while sitting, standing and walking. For statistical analysis, dislocation (mm) and stiffness (N/mm) were calculated. Results Symphyseal plating for the treatment of open book fractures proved to be a rigid osteosynthesis significantly limiting the physiological mobility of the symphyseal joint (dislocation: 0.08 ± 0.01 mm) compared to the tape sutures (dislocation: triangle technique 0.27 ± 0.07 mm, criss-cross technique 0.23 ± 0.05 mm) regarding horizontal tension (p < 0.01). Both modified SpeedBridge™ techniques showed sufficient biomechanical stability without one being superior to the other (p > 0.05 in all directions). Considering vertical loading, no statistical difference was found between all osteosynthesis methods (caudal: p = 0.41; cranial: p = 0.61). Conclusions Symphyseal plating proved to be the osteosynthesis method with the highest rigidity. The modified SpeedBridge™ as a semi-rigid suture construct provided statistically sufficient biomechanical stability while maintaining a minimum of symphyseal movement, consequently allowing ligamental healing of the injured joint without iatrogenic arthrodesis. Furthermore, both the criss-cross and the triangle technique displayed significant biomechanical stability without one method being superior.

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mentioning

confidence: 99%

Novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study

Kußmaul

Schwaabe

Kistler³

et al. 2021

Arch Orthop Trauma Surg

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“…Type III FFP is characterised by a displaced unilateral posterior pelvic ring injury, usually associated with instability of the anterior pelvic ring, although this is not obligatory. Type IV FFP is a displaced, bilateral fracture of the posterior pelvic ring [13]. There are also subclassifications for an even more exact grading of the fracture [4].…”

Section: Classification Of Fragility Fracturesmentioning

confidence: 99%

“…Type II fractures are regarded as moderately stable and can also be initially treated conservatively [4]. Should conservative treatment fail, then surgical management is an option [13]. FFP types III and IV are considered unstable.…”

Section: Management Of Fragility Fractures Of the Pelvismentioning

confidence: 99%

“…The FFP type II fracture is the most common fracture pattern of the FFP classification [4, 6, 13, 15] and lies, with regard to treat- ment recommendation, between the clear-cut recommendation for a conservative approach for type I fractures and the clear-cut recommendation for surgical management for type III and IV fractures [4,13]. With type II fractures, Rommens and Hofmann see the potential problem of prolonged, unsuccessful conservative therapy [4].…”

Section: Increased Rate Of Surgical Management Of Ffp Type II Fracturmentioning

confidence: 99%

“…If we assume that the average distribution pattern of sustained fragility fracture types has basically remained the same, then this in comparison with earlierhigher classification level of the fractures using oedema-sensitive imaging modalities (MRI/DECT) has presumably led to the increase in surgical management of fragility fractures of the pelvis evident in our study. This is due to the fact that, based on the degree of instability, surgical management should be pursued in FFP type III and IV fractures [4,13]. Ultimately, however, it is probably not only the oedema-sensitive imaging alone that is responsible for the increase in surgical management, but rather also the experience of FFP fractures often undergoing prolonged, unsuccessful conservative treatment [4].…”

Section: The Impact Of Oedema-sensitive Diagnostic Investigations On Therapeutic Decision-makingmentioning

confidence: 99%

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Fragility Fractures of the Pelvic Ring – Does the Evidence of Oedema Lead us to More Surgeries?

et al. 2020

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Introduction The choice of therapy for fragility fractures of the pelvis (FFP) is largely determined by the diagnosed fracture morphology. It is now unclear whether the change in diagnostic options – sensitive detection of fracture oedema in the sacrum using MRI and dual-energy computed tomography (DECT) – has an impact on the therapeutic consequences. The aim of this retrospective study was therefore to evaluate the change in the diagnostics used and the resulting therapy regimen in our patient population. Materials and Methods We performed a monocentric-retrospective analysis of 196 patients with a fragility fracture of the pelvis in our clinic (national TraumaZentrum® DGU and SAV approval) in the period from 2008 to 2017. We examined changes in epidemiology, diagnostics/classification and therapy of the pelvic ring fractures treated by us. Results The diagnostic procedures used are subject to a clear change towards oedema detection using MRI and DECT. The graduation has changed towards more severe forms of fracture after FFP. There is now also an increasing proportion of patients treated by surgery (2008 – 2009: 5.3% vs. 2015 – 2017: 60.3%). Conclusion We were able to show that the introduction of sensitive diagnostic procedures coincided with a higher classification of the fractures. It is also noteworthy that the increase in operations is not only due to a higher degree of classification; also in relative terms, more patients are operated on within type FFP II.

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