Fragility Fractures of the Pelvis Classification

Pieroh, Philipp; Höch, Andreas; Hohmann, Tim; Gras, Florian; Märdian, Sven; Pflug, A.; Wittenberg, Silvan; Ihle, Christoph; Blankenburg, Notker; Dallacker-Losensky, Kevin; Schröder, Tanja; Herath, Steven C.; Wagner, Daniel; Palm, Hans‐Georg; Josten, Christoph; Stuby, Fabian

doi:10.2106/jbjs.18.00930

Cited by 27 publications

(14 citation statements)

References 23 publications

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“…FFP often do not fit well into the OTA, Tile or Young and Burgess classifications as elderly patients tend to have bony injuries rather than ligamentous involvement [ 4 , 8 ]. Recognising this, the Rommen’s classification was developed specifically for these injuries and may be more useful in classifying these injuries in the future [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Operative management of fragility fractures of the pelvis – a systematic review

Wilson

Kelly

Rickman

2021

BMC Musculoskelet Disord

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Background 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. 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. Methods A 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. Results The 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. Conclusions Operative 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.

show abstract

Section: Discussionmentioning

confidence: 99%

Operative management of fragility fractures of the pelvis – a systematic review

Wilson

Kelly

Rickman

2021

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…FFP often do not t well into the OTA, Tile or Young and Burgess classi cations as elderly patients tend to have bony injuries rather than ligamentous involvement [4,8]. Recognising this, the Rommen's classi cation was developed speci cally for these injuries and may be more useful in classifying these injuries in the future [47].…”

Section: Discussionmentioning

confidence: 99%

Operative Management of Fragility Fractures of the Pelvis – A Systematic Review

Wilson

Kelly

Rickman

2021

Preprint

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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. 17 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 variety 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

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Section: Ffp-klassifikationunclassified

“…Die Reliabilität der FFP Klassifikation wurde durch zwei Studien bestimmt [15,16] . Während Pieroh et al [16] eine moderate Intraobserver-Reliabilität und eine substantielle Interob-server-Reliabilität bzgl. Gruppenunterscheidung sowie eine moderate Interrater-Reliabilität der gesamten Klassifikation nachwiesen, berichteten Krappinger et al [15] über eine moderate Interobserver-Reliabilität und eine substantielle Intraobserver-Reliabilität.…”

Section: Ffp-klassifikationunclassified