Journal List > J Korean Fract Soc > v.30(4) > 1129886

Seo, Kim, and Kim: Clinical Features and Outcomes of Pelvic Insufficiency Fractures

Abstract

Purpose

The purpose of this study was to investigate the radiological and epidemiological characteristics, as well as the clinical course of pelvic insufficiency fractures in the elderly population.

Materials and Methods

At a Haeundae Paik Hospital, we retrospectively reviewed patients with pelvic insufficiency fractures between March 2010 and May 2017. The demographic data of patients were analyzed, and bone mineral density and bone turnover markers were evaluated to estimate the metabolic status of the bone. The radiological characteristics were evaluated by comparing the simple x-ray images with the computed tomography images, and the types of fractures were classified via computed tomography images. For clinical course evaluation, we investigated comorbid complications, and compared the walking ability scale before and 6 months after the fracture.

Results

A total of 42 patients were included, with an average age of 76.5 years. All were female except one case. In 5 cases where the initial medical examination was from another institution, the fracture was not found in 3 cases. All cases received conservative treatment. After the diagnosis of pelvic bone fracture using a simple x-ray imaging, additional fractures were found in 81.0% of the study population using a computed tomography. Initiation of gait occurred at an average of 2.8 weeks, and every case except 1 (97.6%) fully recovered their gait ability.

Conclusion

We concluded that there was a limitation with diagnosing pelvic insufficiency fracture using only a simple x-ray imaging technique. In general, cases in this study showed conservative treatment yielded favorable clinical outcome with relatively less critical complications.

Figures and Tables

Fig. 1

(A) Initial pelvis Anteroposterior image of an 86-year-old female showing a non-displaced fracture at the right inferior ramus (arrow). (B) Outlet view showing right inferior ramus fracture (arrow). (C) Inlet view showing no definite posterior ring disruption. (D) Computed tomography images revealing both sacral alar fractures.

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Table 1

AO/OTA Classification of Pelvic Fracture

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AO/OTA classification Number of case (%)
A2 13 (31.0)
B2 15 (35.7)
B3 8 (19.0)
C1 4 (9.5)
C2 2 (4.8)
Total 42 (100)
Table 2

Rommens Classification of Fragility Fractures of the Pelvic Ring

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Rommens classification Number of case (%)
Ia 9 (21.4)
Ib2 4 (9.5)
IIa 1 (2.4)
IIb 18 (42.9)
IIc 7 (16.7)
IIIa 2 (4.8)
IIIb 1 (2.4)
IIIc 0
IV 0
Total 42 (100)

The sum of the percentages does not equal 100% because of rounding.

Table 3

Walking Ability

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Post-injury 6 months walking ability Number of case (%)
Independent walking 21 (50.0)
Walking with an assistant device 19 (45.2)
Requiring a wheelchair 2 (4.8)
Bedridden 0
Recovery rate of ambulation to pre-injury levels 41 (97.6)

Notes

Financial support This research was supported by Basic Science Research Program through the National Research Foundation of Korea(NRF) funded by the Ministry of Education(2017R1D1A3B03035185).

Conflict of interests None.

References

1. World Health Organization. Guidelines for preclinical evaluation and clinical trials in osteoporosis. Geneva: World Health Organization;1998.
2. Dell R, Greene D, Schelkun SR, Williams K. Osteoporosis disease management: the role of the orthopaedic surgeon. J Bone Joint Surg Am. 2008; 90:Suppl 4. 188–194.
crossref
3. Lin JT, Lane JM. Osteoporosis: a review. Clin Orthop Relat Res. 2004; (425):126–134.
4. Rowe SM, Yoon TR, Ryang DH. An epidemiological study of hip fracture in Honam, Korea. Int Orthop. 1993; 17:139–143.
crossref
5. Carretta E, Bochicchio V, Rucci P, Fabbri G, Laus M, Fantini MP. Hip fracture: effectiveness of early surgery to prevent 30-day mortality. Int Orthop. 2011; 35:419–424.
crossref
6. Khan MA, Hossain FS, Ahmed I, Muthukumar N, Mohsen A. Predictors of early mortality after hip fracture surgery. Int Orthop. 2013; 37:2119–2124.
crossref
7. Saracen A, Kotwica Z. Treatment of multiple osteoporotic vertebral compression fractures by percutaneous cement augmentation. Int Orthop. 2014; 38:2309–2312.
crossref
8. O'Connor TJ, Cole PA. Pelvic insufficiency fractures. Geriatr Orthop Surg Rehabil. 2014; 5:178–190.
9. Moon SW, Lee DH, Kim YC, Kim YB, Lee SJ, Kim JW. Parathyroid hormone 1-34(teriparatide) treatment in pelvic insufficiency fractures: a report of two cases. J Bone Metab. 2012; 19:147–151.
crossref
10. Taillandier J, Langue F, Alemanni M, Taillandier-Heriche E. Mortality and functional outcomes of pelvic insufficiency fractures in older patients. Joint Bone Spine. 2003; 70:287–289.
crossref
11. Yoo JI, Ha YC, Ryu HJ, et al. Teriparatide treatment in elderly patients with sacral insufficiency fracture. J Clin Endocrinol Metab. 2017; 102:560–565.
crossref
12. Bergström U, Björnstig U, Stenlund H, Jonsson H, Svensson O. Fracture mechanisms and fracture pattern in men and women aged 50 years and older: a study of a 12-year population-based injury register, Umeå, Sweden. Osteoporos Int. 2008; 19:1267–1273.
crossref
13. Holick MF. Vitamin D deficiency. N Engl J Med. 2007; 357:266–281.
crossref
14. Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury. 2013; 44:1733–1744.
crossref
15. Finiels H, Finiels PJ, Jacquot JM, Strubel D. Fractures of the sacrum caused by bone insufficiency. Meta-analysis of 508 cases. Presse Med. 1997; 26:1568–1573.
16. Babayev M, Lachmann E, Nagler W. The controversy surrounding sacral insufficiency fractures: to ambulate or not to ambulate? Am J Phys Med Rehabil. 2000; 79:404–409.
17. Rommens PM, Ossendorf C, Pairon P, Dietz SO, Wagner D, Hofmann A. Clinical pathways for fragility fractures of the pelvic ring: personal experience and review of the literature. J Orthop Sci. 2015; 20:1–11.
crossref
18. Cabarrus MC, Ambekar A, Lu Y, Link TM. MRI and CT of insufficiency fractures of the pelvis and the proximal femur. AJR Am J Roentgenol. 2008; 191:995–1001.
crossref
19. Lapina O, Tiškevičius S. Sacral insufficiency fracture after pelvic radiotherapy: a diagnostic challenge for a radiologist. Medicina (Kaunas). 2014; 50:249–254.
crossref
20. Chen CK, Liang HL, Lai PH, et al. Imaging diagnosis of insufficiency fracture of the sacrum. Zhonghua Yi Xue Za Zhi (Taipei). 1999; 62:591–597.
21. Fujii M, Abe K, Hayashi K, et al. Honda sign and variants in patients suspected of having a sacral insufficiency fracture. Clin Nucl Med. 2005; 30:165–169.
crossref
22. Gotis-Graham I, McGuigan L, Diamond T, et al. Sacral insufficiency fractures in the elderly. J Bone Joint Surg Br. 1994; 76:882–886.
crossref
23. Krestan CR, Nemec U, Nemec S. Imaging of insufficiency fractures. Semin Musculoskelet Radiol. 2011; 15:198–207.
crossref
24. Koval KJ, Aharonoff GB, Schwartz MC, et al. Pubic rami fracture: a benign pelvic injury? J Orthop Trauma. 1997; 11:7–9.
crossref
25. Young Y, Brant L, German P, Kenzora J, Magaziner J. A longitudinal examination of functional recovery among older people with subcapital hip fractures. J Am Geriatr Soc. 1997; 45:288–294.
crossref
26. Peichl P, Holzer LA, Maier R, Holzer G. Parathyroid hormone 1-84 accelerates fracture-healing in pubic bones of elderly osteoporotic women. J Bone Joint Surg Am. 2011; 93:1583–1587.
crossref
TOOLS
ORCID iDs

Yong Min Seo
https://orcid.org/0000-0002-2141-4945

Young Chang Kim
https://orcid.org/0000-0001-5768-777X

Ji Wan Kim
https://orcid.org/0000-0002-3524-8706

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