|Beitragstitel||Good functional outcome in 34 patients suffering insufficiency fractures of the pelvic ring treated with percutaneous screw stabilisation|
Pelvic ring fractures in the elderly occur with increasing incidence after low-energy trauma and are a domaine of conservative treatment. This can be associated with severe complications. Since 2010 we perform surgical stabilization of the posterior pelvic ring in patients with symptomatic fragility fractures of the pelvis.
Patients with CT-verified persistently symptomatic low-energy fractures of the posterior pelvic ring were stabilised surgically with CT-guided implantation of 1-2 sacro-iliac screws. All patients who received surgical stabilisation from 5/2010 to 12/2015 were invited for follow-up (FU) in 2016, minimum one year after the operation. Radiographic examination, Timed Up and Go test (TUG), pain assessment with Visual Analog Scale (VAS) and housing situation were prospectively assessed, intra-operative details and complications were recorded retrospectively.
51 patients were operated in this 5-year period. 6 patients died, 9 declined participation and 2 had left Switzerland. 34 patients completed the assessments with a mean 817 days FU. The mean age of all 51 operated patients was 79 years (SD 8). The mean duration of symptoms was 128 days (SD 104).
Of 51 patients, 13 had surgery-related complications; 1 patient had a minor bleeding and 1 patient an intra-foraminal screw placement. 5 patients had to be re-operated for insufficient initial stabilisation. In 6 patients one or several posterior screws backed out but in only 2 patients screw removal was necessary.
The mean TUG was 19.2 sec. (SD 10), the mean VAS at FU 1.3/10 (SD 1.8). Preoperative 39 patients lived independently, 2 lived in nursing homes and on 10 we had no information. After the operation 4 patients lost independence and were institutionalised, 35 still live independently.
The high number of patients living independently after surgical treatment indicates a good functional level after surgical stabilization of pelvic fragility fractures. In comparison, 30% of 132 a similar Patient cohort with a mean age of 83 treated conservatively from 2009 to 2011 at our institution lost independence. The TUG after surgery is slower than in the healthy age-matched population but better than in patients one year after hip fracture. The radiation dose acquired with the intervention equals the dose of a diagnostic pelvic CT, which seems justifiable. We had to re-operate 9 out of 51 patients (17%) due to insufficient stabilization or other complications.