Surgical solution to fragility fractures of the pelvis——cement augmented transiliac internal fixator / 中华创伤骨科杂志

ABSTRACT

Objective To describe and analyze a new method of treating fragility fractures of the pelvis in the elderly patients,a cement augmentable Transiliac Internal Fixator (TIFI).Methods We reviewed 196 patients older than 59 years with a pelvic ring fracture who had been treated in the period from January 2004 through November 2014.They were 11 men and 93 women,aged from 59 to 94 years (average,77.5 ± 7.6 years).By the Romens classification,there were 31 cases of type Ⅰ,39 ones of type Ⅱ,19 ones of type Ⅲ and 15 ones of type Ⅳ.The causes for fracture included fall from standing height (89 cases),fall from a height of less than 3 meters (8 cases) and absence of a definite trauma (7 cases).Of them,65 received conservative management and 39 surgery.TIFI was used in 17 patients in whom cannulated and perforated Schanz screws were placed from the posterior superior iliac spine to the anterior inferior iliac spine and fixated into the supraacetabular bone canal.Results Of the 65 patients receiving conservative management,on the day of discharge,one could sit on a wheel-chair,26 could walk,8 could go upstairs and downstairs,and 30 were not recorded.Of the 39 patients receiving surgery,on the day of discharge,6 could sit on a wheel-chair,26 could walk,one could go upstairs and downstairs,and 6 were not recorded.Of the 34 patients receiving fixation with Schanz screws,the sacro-iliac joint was penetrated by the screws in 2.In the 16 patients receiving fixation with Schanz screws plus cement augmentation,no cement leakage into the sacro-iliac joint was observed.The average length of TIFI placement was 100 ± 20 mm and the average length of connective rod 62 ± 16 mm.Of the 17 patients receiving TIFI fixation,postoperative haematoma occurred in 2,superfical wound infection in one,and deep infection or implant infection in none.Conclusions Fragility fractures of the pelvis in the elderly patients can be treated according to their Romens classifications.The new technique,TIFI,is a minimally invasive and safe treatment for fragility fractures of the pelvis.