The diagnostic and management challenge for concomitant fragility fractures of pelvis and hip - a Case series with literature review.

BACKGROUND: Fragility fractures of hip and pelvis in the elderly population are common. They do co-exist but are frequently missed and undertreated. METHODS AND RESULTS: 3 cases of concomitant fragility fractures of hip and pelvis were identified. Hip fractures were treated with cemented hemiarthroplasty or cephalomedullary nail fixation, while pelvic fractures were treated with percutaneous screw fixation in same general anesthesia session. Anti-osteoporotic treatments were offered. Subjects were followed up for 1 year. CONCLUSION: Surgical treatment of fragility hip and pelvic fractures improves fracture stability, achieves better pain relief and allows earlier mobilization. Anti-osteoporotic treatment is essential as secondary prevention in fragility fractures.

Three-dimensional-guided navigation percutaneous screw fixation of fragility fractures of the pelvis.

BACKGROUND: Three-dimensional (3D)-guided navigation percutaneous screw fixation of pelvi-acetabular fractures has been reported in patients with high-energy trauma. Its use in fragility fractures of the pelvis is expanding and its results are promising. METHODS: We report a series of 17 consecutive patients with fragility fractures of the pelvis treated with 3D-guided navigation percutaneous screw fixation from 2016 to 2017. Percutaneous screw trajectories were planned preoperatively for the majority of patients. Closed reduction was performed prior to fixation in grossly displaced fractures. RESULTS: The mean time to surgery was 8.6 ± 2.4 days, and the mean intraoperative blood loss was 94.1 ± 26.6 mL. One early surgical complication occurred involving an infected pelvic external fixator iliac pin track site, and there were no cases of neurological deficits after fixation. In total, 7 of the 14 patients had screw backout, and the mean backout distance was 8.3 ± 4.4 mm. Cortical perforation was seen in one patient involving an anterior column screw by 5.7 mm; 14 patients were followed up for a mean of 18.7 ± 2.8 months; 13 patients achieved complete fracture union, and 1 patient had a fracture non-union. Premorbid ambulatory function was restored in 8 of the 14 patients. The mean visual analogue scale for pain severity at follow-up was 0.36 ± 0.50. There were no cases of 30-day and 1-year mortality. CONCLUSION: 3D-guided navigation percutaneous screw fixation is a safe, precise, and effective surgical technique for managing fragility fractures of the pelvis.