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RESEARCH PRODUCT

Classification of Fragility Fractures of the Pelvis

subject

description

The characteristics of fragility fractures of the pelvis are different from pelvic fractures in adolescents and adults. There are specific fracture morphologies such as U- or H-shaped fractures of the sacrum and bilateral fractures. The classification systems of AO/ASIF and Young-Burgess reflect the trauma mechanism and the type of instability in high-energy pelvic injuries. Not all types of fragility fractures of the pelvic ring fit into these classification systems. A new, comprehensive classification (FFP classification) includes all morphologies of fragility fractures of the pelvis, whether acute or chronic. It provides a framework for how to look at these lesions. The first criterion of the classification is the degree of instability due to the fracture(s). FFP Type I is an anterior pelvic ring lesion only. FFP Type II is a non-displaced posterior pelvic ring lesion. FFP Type III is a displaced, but unilateral posterior ring lesion. FFP Type IV is a bilateral displaced posterior ring lesion. The second criterion of the classification, giving place to the subtypes, is the localization of the fracture in the posterior pelvic ring. Ilium fractures are distinguished from sacroiliac (fracture) dislocations and sacral fractures. There is an increasing loss of stability from FFP Type I to FFP Type IV. The classification is connected with recommendations for treatment. FFP Type III and FFP Type IV should be treated operatively. FFP Type I is treated conservatively. The treatment of FFP Type II starts conservatively. When not successful, minimal invasive surgical fixation is recommended. The subtypes give hints for the most adequate technique of fixation.