Heiman Erick, Gencarelli Pasquale, Tang Alex, Yingling John M, Liporace Frank A, Yoon Richard S
Division of Orthopedic Trauma and Adult Reconstruction, Department of Orthopedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA.
Hip Pelvis. 2022 Jun;34(2):69-78. doi: 10.5371/hp.2022.34.2.69. Epub 2022 Jun 7.
Fragility fractures of the pelvis (FFP) and fragility fractures of the sacrum (FFS), which are emerging in the geriatric population, exhibit characteristics that differ from those of pelvic ring disruptions occurring in the younger population. Treatment of FFP/FFS by a multidisciplinary team can be helpful in reducing morbidity and mortality with the goal of reducing pain, regaining early mobility, and restoring independence for activities of daily living. Conservative treatment, including bed rest, pain therapy, and mobilization as tolerated, is indicated for treatment of FFP type I and type II as loss of stability is limited with these fractures. Operative treatment is indicated for FFP type II when conservative treatment has failed and for FFP type III and type IV, which are displaced fractures associated with intense pain and increased instability. Minimally invasive stabilization techniques, such as percutaneous fixation, are favored over open reduction internal fixation. There is little evidence regarding outcomes of patients with FFP/FFS and more literature is needed for determination of optimal management. The aim of this article is to provide a concise review of the current literature and a discussion of the latest recommendations for orthopedic treatment and management of FFP/FFS.
骨盆脆性骨折(FFP)和骶骨脆性骨折(FFS)在老年人群中日益凸显,其表现出的特征与年轻人群中发生的骨盆环损伤有所不同。多学科团队对FFP/FFS进行治疗,有助于降低发病率和死亡率,目标是减轻疼痛、恢复早期活动能力并恢复日常生活的独立性。对于I型和II型FFP,由于这些骨折的稳定性丧失有限,保守治疗是合适的,包括卧床休息、疼痛治疗以及根据耐受情况进行活动。当保守治疗失败时,II型FFP以及III型和IV型FFP(这些是伴有剧痛和稳定性增加的移位骨折)则需要手术治疗。与切开复位内固定相比,经皮固定等微创稳定技术更受青睐。关于FFP/FFS患者的治疗结果,证据较少,需要更多文献来确定最佳治疗方案。本文旨在对当前文献进行简要综述,并讨论FFP/FFS骨科治疗和管理的最新建议。