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RESEARCH PRODUCT

Personality of Fragility Fractures of the Pelvis

subject

description

The personality of pelvic fractures in the elderly differs in many ways from pelvic ring lesions in adults. Only high-energy trauma leads to pelvic ring disruptions. Concomitant lesions of the soft tissues occur frequently. In the elderly, low-energy falls are the rule. The most important symptom is pain, which restricts mobility. Hemodynamic instability in fragility fractures of the pelvis is rare. Emergency stabilization with pelvic binders or sheets, C-clamping or emergency external fixation are not needed. Arteriography and selective embolization is only recommended in the rare patients, who develop an active arterial bleeding due to the pelvic fracture. Especially patients, who are treated with anticoagulants, are in danger for such bleeding. Elderly patients have reduced bone strength due to osteoporosis. Decrease of bone mass follows a specific pattern in the sacrum. Altered bone mass distribution is responsible for the typical fracture patterns of the pelvic fragility fractures. U- or H-type sacral fractures and bilateral fractures are frequently observed. We also see some patients with a slow but continuous progress of instability in the pelvic ring. There are radiological signs of chronic instability such as marginal callus formation and bone defects at the fracture site. This phenomenon may be observed at the pubic symphysis, at the pubic rami or at the sacral ala.