Osteoporotic pelvic fractures : Diagnosis and Management

Abstract

Osteoporotic pelvic fractures are severe injuries that often require a long healing period. There is often a significant impairment of function and an increased risk for considerable morbidity. The majority of these presented as 'pubic rami fractures'. In fact, many of these fall injuries could result in pelvic ring instability. METHOD: From December 2006 till November 2007, we recruited patients admitted through the emergency department presented with pubic rami fractures. Patients were examined and sent for CT scans for documentation. The patients that had both radiologically and clinically unstable pelvic ring injuries were operated. Their walking ability was assessed 3 months post injury. RESULTS: 40 patients were recruited. 36 of them were female. Average age was 85. After careful examination and CT scans, 25 patients (62.5%) were found to have significant posterior involvement. Mean age was 83. They were either lateral compression I or II injury (Young and Burgess). 9 patients (36%) had the more unstable type II injury. Out of these 25 patients, 10 patients were operated and all of them could return to the premorbid walking state or had a mild deterioration in walking ability in 3 month time. The remaining 30 non-operated patients' results varied in 3 month time. CONCLUSION: A simple fall in osteoporotic patients could result in a lateral compression type of pelvic ring injury. Computer tomography is invaluable in detecting occult posterior injuries. Operative treatment could be considered for fracture stabilization and early ambulation and help these patients to return to walking early.