Caudron M, Boudissa M, Tonetti J
Department of Orthopaedic and Trauma Surgery, Grenoble University Hospital, Univ. Grenoble Alpes, La Tronche 38700, France.
TIMC-IMAG lab, University Grenoble-Alpes, CNRS UMR 5525, La Tronche 38700, France.
Trauma Case Rep. 2022 Nov 3;42:100731. doi: 10.1016/j.tcr.2022.100731. eCollection 2022 Dec.
We report a case of a 79-years old man who sustained a Fragility Fracture of the Pelvis (FFP) classified type IVb according to Rommens and Hofmann. After a delayed diagnosis with persistence of pain and loss of mobility, a bilateral sacroplasty was performed. Although pain relief was achieved, a fracture progression (FP) occurred with bilateral neurologic compression of L5 and S1 nerve roots with pain recurrence. A percutaneous ilio-lumbar reduction was attempted with cemented augmentation and bilateral ilio-sacral screwing. Reduction was not achieved and screws finally pulled-out. The patient died one year after institutionalization with a significant loss of mobility and autonomy.
Misunderstanding in management of FFP according to Rommens and Hofmann recommendations can lead to bad results with fracture progression, implants failure, pain recurrence, loss of function, loss of autonomy and finally death of the patient.
我们报告一例79岁男性，其发生了根据罗曼斯（Rommens）和霍夫曼（Hofmann）分类为IVb型的骨盆脆性骨折（FFP）。在延迟诊断且疼痛持续和活动能力丧失后，进行了双侧骶骨成形术。尽管实现了疼痛缓解，但仍发生了骨折进展（FP），伴有L5和S1神经根双侧神经受压及疼痛复发。尝试进行经皮髂腰复位并使用骨水泥强化及双侧髂骶螺钉固定。复位未成功，螺钉最终拔出。患者在入院一年后死亡，活动能力和自主能力严重丧失。
根据罗曼斯和霍夫曼的建议，对骨盆脆性骨折的处理存在误解可能导致不良后果，包括骨折进展、植入物失败、疼痛复发、功能丧失、自主能力丧失，最终导致患者死亡。
