Fragility Fractures of the Pelvis: Current Practices and Future Directions

Hutchings, Lynn; Roffey, Darren M.; Lefaivre, Kelly A.

doi:10.1007/s11914-022-00760-9

Cited by 7 publications

(3 citation statements)

References 82 publications

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“…This leads to vertically oriented sacral fractures through the ala, not involving the neuroforamina, but in case of bilateral injury often joined by a horizontal fracture creating a H-type pattern. 19 , 20 Owing to the difference in injury patterns after low-energy trauma, fracture classification is challenging according to the experts. However, full assessment of the fracture pattern is necessary to establish the best treatment plan.…”

Section: Discussionmentioning

confidence: 99%

Current consensus and clinical approach to fragility fractures of the pelvis: an international survey of expert opinion

Kleeblad,

Loggers,

Zuidema

et al. 2024

OTA International: The Open Access Journal of Orthopaedic Trauma

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Introduction: Fragility fractures of the pelvis (FFP) in elderly patients are an underappreciated injury with a significant impact on mobility, independency, and mortality of affected patients and is a growing burden for society/health care. Given the lack of clinical practice guidelines for these injuries, the authors postulate there is heterogeneity in the current use of diagnostic modalities, treatment strategies (both operative and nonoperative), and follow-up of patients with FFP. The goal of this study was to assess international variation in the management of FFP. Methods: All International Orthopaedic Trauma Association (IOTA) steering committee members were asked to select 15 to 20 experts in the field of pelvic surgery to complete a case-driven international survey. The survey addresses the definition of FFP, use of diagnostic modalities, timing of imaging, mobilization protocols, and indications for surgical management. Results: In total, 143 experts within 16 IOTA societies responded to the survey. Among the experts, 86% have >10 years of experience and 80% works in a referral center for pelvic fractures. However, only 44% of experts reported having an institutional protocol for the management of FFP. More than 89% of experts feel the need for a (inter)national evidence-based guideline. Of all experts, 73% use both radiographs and computed tomography (CT) to diagnose FFP, of which 63% routinely use CT and 35% used CT imaging selectively. Treatment strategies of anterior ring fractures were compared with combined (anterior and posterior ring) fractures. Thirty-seven percent of patients with anterior ring fractures get admitted to the hospital compared with 75% of patients with combined fractures. Experts allow pain-guided mobilization in 72% after anterior ring fracture but propose restricted weight-bearing in case of a combined fracture in 44% of patients. Surgical indications are primarily based on the inability to mobilize during hospital admission (33%) or persistent pain after 2 weeks (25%). Over 92% plan outpatient follow-up independent of the type of fracture or treatment. Conclusion: This study shows that there is a great worldwide heterogeneity in the current use of diagnostic modalities and both nonoperative and surgical management of FFP, emphasizing the need for a consensus meeting or guideline.

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Section: Discussionmentioning

confidence: 99%

Current consensus and clinical approach to fragility fractures of the pelvis: an international survey of expert opinion

Kleeblad,

Loggers,

Zuidema

et al. 2024

OTA International: The Open Access Journal of Orthopaedic Trauma

View full text Add to dashboard Cite

show abstract

“…The intricate nature of the injuries, possibility of accompanying trauma, and urgency for prompt and thorough treatment pose considerable obstacles in contemporary trauma care. [10,11] Administering anesthesia during pelvic fracture surgery is a distinct and complex difficulty. Traditional GA is frequently employed, providing transient suppression of the central nervous system and alleviation of pain.…”

Section: Discussionmentioning

confidence: 99%

“…The intricate nature of the injuries, possibility of accompanying trauma, and urgency for prompt and thorough treatment pose considerable obstacles in contemporary trauma care. [10,11]…”

Section: Discussionmentioning

confidence: 99%

Perioperative impact of ultrasound-guided ilioinguinal and iliohypogastric nerve blocks in patients undergoing pelvic fracture surgery

Shen,

Ma,

Yang

et al. 2024

Medicine

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Pelvic fractures present a severe and complex clinical challenge. This study aimed to compare ultrasound-guided ilioinguinal (IIN) and iliohypogastric nerve (IHN) blocks with conventional general anesthesia (GA) in patients undergoing internal fixation surgery for pelvic fractures. A retrospective analysis was conducted on 100 patients equally divided into ultrasound-guided and control groups. The study monitored hemodynamics, intraoperative anesthesia drug usage, postoperative pain levels, and the incidence of adverse reactions between the 2 groups. The ultrasound-guided group underwent ultrasound-guided IHN and IIN blocks combined with GA. The ultrasound-guided group exhibited significant advantages for hemodynamic measurements at specific time points, lower consumption of Propofol and Remifentanil, and reduced pain intensity across all evaluated time intervals (P < .05). The incidence rate of adverse reactions was significantly lower in the ultrasound group (P = .016). Ultrasound-guided anesthesia is a superior alternative to conventional GA for managing pelvic fractures through internal fixation surgery. It offers advantages in terms of hemodynamic stability, drug consumption, postoperative pain management, and adverse reaction reduction.

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Predictors of mortality one year after pelvic fractures in an older population: a retrospective cohort study

Desmet,

Janssens,

Herteleer

et al. 2024

Arch Osteoporos

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Fragility Fractures of the Pelvis: Current Practices and Future Directions

Cited by 7 publications

References 82 publications

Current consensus and clinical approach to fragility fractures of the pelvis: an international survey of expert opinion

Current consensus and clinical approach to fragility fractures of the pelvis: an international survey of expert opinion

Perioperative impact of ultrasound-guided ilioinguinal and iliohypogastric nerve blocks in patients undergoing pelvic fracture surgery

Predictors of mortality one year after pelvic fractures in an older population: a retrospective cohort study

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