Fragilitätsfrakturen des Beckenrings

In der Alterstraumatologie hat die Behandlung von Beckenringverletzungen aufgrund des demografischen Wandels zunehmend an Bedeutung gewonnen. Fragilitätsfrakturen des Beckens (FFP) entstehen durch eine verminderte Knochendichte und stellen eine Herausforderung in der konservativen und operativen Behandlung dar. Eine korrekte Diagnostik, Klassifikation und Therapie sind entscheidend, den Umfang der Therapie zeitnah festzulegen.

Abstract

The treatment of pelvic ring injuries in geriatric traumatology had become increasingly important due to demographic change. Fragility fractures of the pelvis (FFP) arise due to reduced bone density in the area of age-related or comorbid osteoporosis and represent a challenge in conservative and surgical treatment. Correct diagnosis, classification and treatment are decisive in determining the extent of treatment in a time-efficient procedure.

Schlüsselwörter

Fragilitätsfraktur des Beckenrings - FFP - Osteoporose - Beckenchirurgie - geriatrische Frakturen

Keywords

fragility fracture of the pelvic ring - FFP - osteoporosis - pelvic surgery - geriatric fractures

Publication History

Article published online:
11 December 2024

• Literatur

• 1 Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 2006; 17: 1726-1733
• 2 Khan AA, Slart RHJA, Ali DS. et al. Osteoporotic Fractures: Diagnosis, Evaluation, and Significance From the International Working Group on DXA Best Practices. Mayo Clin Proc 2024; 99: 1127-1141
• 3 Agarwal N, Feng T, Maclullich A. et al. Early mobilisation after hip fracture surgery is associated with improved patient outcomes: A systematic review and meta-analysis. Musculoskeletal Care 2024; 22: e1863
• 4 Borgström F, Karlsson L, Ortsäter G. et al. Fragility fractures in Europe: burden, management and opportunities. Arch Osteoporos 2020; 15: 59
• 5 Burge R, Dawson-Hughes B, Solomon DH. et al. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 2007; 22: 465-475
• 6 Ando J, Takahashi T, Ae R. et al. Epidemiology of fragility fracture of the pelvic ring: a regional population-based study in Northern Japan. Arch Osteoporos 2023; 18: 131
• 7 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
• 8 Fuchs J, Scheidt-Nave C, Kuhnert R. 12-Monats-Prävalenz von Osteoporose in Deutschland. J Health Monit 2017;
• 9 Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: Recommendations for surgical treatment. Injury 2013; 44: 1733-1744
• 10 Ullrich BW, Schnake KJ, Spiegl UJA. et al. OF-Pelvis classification of osteoporotic sacral and pelvic ring fractures. BMC Musculoskeletal Disorders 2021; 22: 992
• 11 Oberkircher L, Ruchholtz S, Rommens PM. et al. Osteoporotic Pelvic Fractures. Dtsch Arztebl Int 2018; 115: 70-80
• 12 Tosounidis G, Wirbel R, Culemann U. et al. Fehleinschätzung bei vorderer Beckenringfraktur im höheren Lebensalter. Unfallchirurg 2006; 109: 678-680
• 13 Oda T, Kitada S, Hirase H. et al. Evaluation of a treatment protocol based on conservative therapy for fragility fractures of the pelvis. Eur J Trauma Emerg Surg 2024; 50: 1173-1181
• 14 Hotta K, Kobayashi T. Functional treatment strategy for fragility fractures of the pelvis in geriatric patients. Eur J Trauma Emerg Surg 2021; 47: 21-27
• 15 Rommens PM, Hopf JC, Arand C. et al. Prospective assessment of key factors influencing treatment strategy and outcome of fragility fractures of the pelvis (FFP). Eur J Trauma Emerg Surg 2022; 48: 3243-3256
• 16 Yoshida M, Tajima K, Saito Y. et al. Mobility and mortality of 340 patients with fragility fracture of the pelvis. Eur J Trauma Emerg Surg 2021; 47: 29-36
• 17 Rommens PM, Boudissa M, Krämer S. et al. Operative treatment of fragility fractures of the pelvis is connected with lower mortality. A single institution experience. PLoS One 2021; 16: e0253408
• 18 Thiesen DM, Althoff G, Strahl A. et al. Conservative versus operative treatment of FFP II fractures in a geriatric cohort: a prospective randomized pilot trial. Scientific Reports 2023; 13: 16124
• 19 Yamamoto N, Someko H, Tsuge T. et al. Prevalence of fracture progression in fragility fractures of the pelvis: Systematic review and meta-analysis. Injury 2024; 55
• 20 Arand C, Mehler D, Sauer A. et al. Do we need to fix the anterior fracture component in insufficiency fractures of the pelvis? A biomechanical comparison on an FFP type IIIc fracture in an osteoporotic pelvic bone model. Injury 2023; 54: 111096
• 21 Rommens PM, Graafen M, Arand C. et al. Minimal-invasive stabilization of anterior pelvic ring fractures with retrograde transpubic screws. Injury 2020; 51: 340-346
• 22 Rommens PM, Arand C, Hofmann A. et al. When and How to Operate Fragility Fractures of the Pelvis?. Indian J Orthop 2019; 53: 128-137
• 23 Cintean R, Fritzsche C, Zderic I. et al. Sacroiliac versus transiliac–transsacral screw osteosynthesis in osteoporotic pelvic fractures: a biomechanical comparison. Eur J Trauma Emerg Surg 2023; 49: 2553-2560
• 24 Gericke L, Fritz A, Osterhoff G. et al. Percutaneous operative treatment of fragility fractures of the pelvis may not increase the general rate of complications compared to non-operative treatment. Eur J Trauma Emerg Surg 2022; 48: 3729-3735
• 25 Rommens PM, Hofmann A, Kraemer S. et al. Operative treatment of fragility fractures of the pelvis: a critical analysis of 140 patients. Eur J Trauma Emerg Surg 2022; 48: 2881-2896
• 26 Taillandier J, Langue F, Alemanni M. et al. Mortality and functional outcomes of pelvic insufficiency fractures in older patients. Joint Bone Spine 2003; 70: 287-289
• 27 Rommens PM, Arand C, Hopf JC. et al. Progress of instability in fragility fractures of the pelvis: An observational study. Injury 2019; 50: 1966-1973
• 28 Kramer A, Naisan M, Kindel S. et al. Retrospective evaluation of percutaneous 3D-navigated screw fixation for fragility fractures of the sacrum: technical notes and four-year experience. Sci Rep 2023; 13: 12254
• 29 Delsmann MM, Leonhardt L-G, Alimy A-R. et al. Biopsies from patients with sacral insufficiency fracture are characterized by low bone matrix mineralization and high turnover. JBMR Plus 2024; 8