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Operative Management

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Fragility Fractures of the Pelvis

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Abstract

The surgical management of patients with fragility fractures of the pelvis can be divided into 4 distinct phases: the initial assessment and resuscitation, the post-resuscitation phase, the operative procedure and the post-operative mobilization. Haemodynamic monitoring is strongly recommended within the first 24–48 h after admission, because blood loss can be continuous and delayed, also in non- or minimally displaced fractures. Many elderly patients take anticoagulants, which enhances the risk of bleeding. Blood pressure and heart rate may be misleading parameters. Primary management exists in volume replacement, blood transfusion, pharmacotherapy and angiography with selective embolization. It is very important to minimize the length of stay in the intensive care unit in the post-resuscitation phase. In this phase, a definitive treatment plan for reconstruction of the pelvic ring should be made. The main goals of surgical treatment must be early ambulation and optimal functional recovery, avoiding complications related to the surgical procedure. The state of the soft tissues and the underlying bone quality must be critically assessed. An individual treatment is inevitable. In pelvic injuries where a non-displaced fracture of the sacrum is recognized, operative treatment should be considered. In patients with displaced fractures or fracture-dislocations of the posterior pelvic ring, surgical treatment is the only treatment option. The surgeon must be familiar with several reduction techniques and the use of different stabilization procedures. Combinations of osteosynthesis techniques are frequently used to enhance stability and minimize the risk of implant loosening. A stable fixation will allow for early full weight bearing on the uninjured side and partial weight bearing for 6 weeks after the operation to the injured side. In cases where the bone stock is rather poor and the lesion is bilateral, a period of non-weight bearing in a wheelchair allows control of painful stimuli, and reduces the risk of early implant failure.

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Authors and Affiliations

  1. Academic Department Trauma and Orhopaedic Surgery, School of Medicine, University of Leeds, Great George Street, Leeds, UK

    Peter V. Giannoudis MB, BSc, MD, FACS, FRCS (Eng) & Dionysios Giannoulis M.D.

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  1. Peter V. Giannoudis MB, BSc, MD, FACS, FRCS (Eng)
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  2. Dionysios Giannoulis M.D.
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Correspondence to Peter V. Giannoudis MB, BSc, MD, FACS, FRCS (Eng) .

Editor information

Editors and Affiliations

  1. Department of Orthopaedics and Traumatology, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany

    Pol Maria Rommens

  2. Department of Traumatology and Orthopaedics, Westpfalz-Clinics Kaiserslautern, Kaiserslautern, Germany

    Alexander Hofmann

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Giannoudis, P.V., Giannoulis, D. (2017). Operative Management. In: Rommens, P., Hofmann, A. (eds) Fragility Fractures of the Pelvis. Springer, Cham. https://doi.org/10.1007/978-3-319-66572-6_9

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  • DOI: https://doi.org/10.1007/978-3-319-66572-6_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-66570-2

  • Online ISBN: 978-3-319-66572-6

  • eBook Packages: MedicineMedicine (R0)

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