Rommens / Hofmann Fragility Fractures of the Pelvis

1. Auflage 2017
ISBN: 978-3-319-66572-6
Verlag: Springer International Publishing
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 314 Seiten

Reihe: Medicine (R0)

Thanks to an increasing life expectancy of our populations the number of elderly persons is steadily growing and will continue to do so. Among these, the rate of persons with illnesses and degenerative diseases is significant. The prevalence of osteoporosis is especially high in elderly women and leads to typical fracture patterns. Hip fractures, proximal humerus fractures, distal radius fractures and fractures of the vertebral column are the most common. In the last decade, we are confronted with a sharp increase of fragility fractures of the pelvis.Until now, there is no consensus on how to identify and classify these lesions and there are no guidelines for treatment and after treatment. In particular, there is no common view on which patients need an operative treatment and which technique of osteosynthesis should be used. This book fills the gap in available literature and gives a state of the art guide to the treatment of fragility fractures of the pelvis. With the sharp increase of these fractures and the lacking consensus, Fragility Fractures of the Pelvis will become indispensable for the physicians who take care of elderly patients with this pathology. Written by a team of expert opinion leaders, the aim of this book is to contribute to the scientific discussion in this area and to help provide the optimal care for these patients.

Professor Pol M. Rommens and Professor Alexander Hofmann are well-known and respected pelvic and acetabular surgeons. They have published numerous papers on the treatment and outcome of pelvic fractures, and developed a comprehensive classification of fragility fractures of the pelvis, combined with recommendations for treatment.

Autoren/Hrsg.

Rommens, Pol Maria

Hofmann, Alexander

Inhaltsverzeichnis

1;Foreword;7
2;Preface;9
3;Contents;11
4;Part I: General Aspects;14
4.1;1: Epidemiology and Demographics;15
4.1.1;1.1 Introduction;15
4.1.2;1.2 Osteoporosis;15
4.1.3;1.3 Fragility Fractures in General;16
4.1.4;1.4 Fragility Fractures of the Pelvis;16
4.1.5;References;19
4.2;2: Personality of Fragility Fractures of the Pelvis;21
4.2.1;2.1 Introduction;21
4.2.2;2.2 Trauma Mechanism;22
4.2.3;2.3 Clinical Picture;24
4.2.4;2.4 Hemodynamic Condition;24
4.2.5;2.5 Emergency Stabilization;25
4.2.6;2.6 Strength of Bone and Stiffness of Ligaments;29
4.2.7;2.7 Unique Fracture Morphology;30
4.2.8;2.8 Progress of Instability;31
4.2.9;References;32
4.3;3: Sacral Morphology;35
4.3.1;3.1 Introduction;35
4.3.2;3.2 Sacral Morphology;35
4.3.3;3.3 Corridors;36
4.3.4;3.4 Radiographic Assessment of the Corridor;39
4.3.5;3.5 Author’s Preferred Method;43
4.3.6;References;44
4.4;4: Bone Mass Distribution in the Sacrum;46
4.4.1;4.1 Introduction;46
4.4.2;4.2 Osteoporosis in Statistical Bone Models;46
4.4.3;4.3 Bone Structure of the Sacrum;47
4.4.4;4.4 Statistical Model of the Sacral Bone Mass;47
4.4.5;4.5 Implications on Fracture Morphology;50
4.4.6;4.6 Implications for Operative Treatment;50
4.4.7;4.7 Sacroplasty in the Light of Sacral Bone Mass Distribution;50
4.4.8;References;51
5;Part II: Clinical and Radiological Aspects;54
5.1;5: Clinical Presentation;55
5.1.1;5.1 Introduction;55
5.1.2;5.2 Mechanism of Injury and Patient History;55
5.1.3;5.3 Non-traumatic Fractures;56
5.1.4;5.4 Site of Pain and Fracture Localization;56
5.1.5;5.5 Comorbidities and General Condition;57
5.1.6;5.6 Fracture Patterns;58
5.1.7;5.7 Massive Arterial Hemorrhage;60
5.1.8;5.8 Pelvic Nonunion;61
5.1.9;5.9 Summary;62
5.1.10;References;62
5.2;6: Radiological Assessment;65
5.2.1;6.1 Introduction;65
5.2.2;6.2 Plain Radiography;65
5.2.3;6.3 Computed Tomography;68
5.2.4;6.4 Magnetic Resonance Imaging;71
5.2.5;6.5 Bone Scintigraphy;72
5.2.6;6.6 Differential Diagnosis;72
5.2.7;6.7 Diagnostic Algorithm;74
5.2.8;References;74
6;Part III: Classification;76
6.1;7: Classification of Fragility Fractures of the Pelvis;77
6.1.1;7.1 Introduction;77
6.1.2;7.2 Classification Systems;77
6.1.3;7.3 Classification Systems for Pelvic Ring Lesions;78
6.1.4;7.4 Comprehensive Classification of Fragility Fractures of the Pelvic Ring;80
6.1.5;References;87
7;Part IV: Treatment of Fragility Fractures of the Pelvis;89
7.1;8: Non-Operative Treatment;90
7.1.1;8.1 Introduction;90
7.1.2;8.2 Elements of Non-operative Management;91
7.1.2.1;8.2.1 Bed Rest;91
7.1.2.2;8.2.2 Pain Management;92
7.1.2.3;8.2.3 Mobilization;92
7.1.2.4;8.2.4 Medication with Influence on Bone Metabolism;92
7.1.2.4.1;8.2.4.1 Vitamin D and Calcium;92
7.1.2.4.2;8.2.4.2 Antiresorptive Agents;92
7.1.2.4.2.1;Bisphosphonates;92
7.1.2.4.2.2;Calcitonin;93
7.1.2.4.2.3;Raloxifene;93
7.1.2.4.2.4;Teriparatide;93
7.1.2.5;8.2.5 Low Intensity Pulsed Ultrasound (LIPUS);94
7.1.3;8.3 Failure of Conservative Treatment;94
7.1.4;8.4 Finite Element Analysis of Stress Distribution in the Posterior Pelvis;99
7.1.5;References;101
7.2;9: Operative Management;103
7.2.1;9.1 General Considerations;103
7.2.2;9.2 Different Phases of Operative Management;103
7.2.2.1;9.2.1 Initial Assessment and Resuscitation;103
7.2.2.2;9.2.2 Post-Resuscitation Phase;104
7.2.2.3;9.2.3 Operative Reconstruction;104
7.2.2.4;9.2.4 Mobilization Phase;105
7.2.3;9.3 Indications for Surgery and Operative Techniques;106
7.2.3.1;9.3.1 FFP Type II: Non-displaced Posterior Ring Injuries;106
7.2.3.2;9.3.2 FFP Type III: Unilateral Displaced Posterior Ring Injuries;107
7.2.3.3;9.3.3 FFP Type IV: Bilateral Displaced Posterior Ring Injuries;107
7.2.4;References;110
7.3;10: Sacroplasty;111
7.3.1;10.1 Introduction;111
7.3.2;10.2 History and Definition;112
7.3.3;10.3 Rationale;113
7.3.4;10.4 Procedure;113
7.3.4.1;10.4.1 Patient Selection;113
7.3.4.2;10.4.2 Surgical Technique;114
7.3.4.3;10.4.3 Imaging;115
7.3.4.4;10.4.4 Cement Application;116
7.3.5;10.5 Complications and Outcome;118
7.3.5.1;10.5.1 Cement Leakage;118
7.3.5.2;10.5.2 Clinical Results;118
7.3.6;10.6 Summary and Conclusion;119
7.3.7;References;121
8;Part V: Stabilization Techniques for the Posterior Pelvic Ring;124
8.1;11: Iliosacral Screw Osteosynthesis;125
8.1.1;11.1 Introduction;125
8.1.2;11.2 Rationale;126
8.1.3;11.3 The Iliosacral Corridor;128
8.1.4;11.4 Biomechanical Studies;129
8.1.5;11.5 Surgical Technique;133
8.1.5.1;11.5.1 Supine Position;134
8.1.5.2;11.5.2 Prone Position;138
8.1.6;11.6 Results;138
8.1.7;References;140
8.2;12: Iliosacral Screw Fixation with Cement Augmentation;142
8.2.1;12.1 Introduction;142
8.2.2;12.2 Surgical Technique;143
8.2.3;12.3 Results;147
8.2.4;References;147
8.3;13: Transsacral Bar Osteosynthesis;148
8.3.1;13.1 Introduction;148
8.3.2;13.2 Rationale and Development;149
8.3.3;13.3 Preoperative Planning;150
8.3.4;13.4 Surgical Technique;150
8.3.4.1;13.4.1 General Remarks;150
8.3.4.2;13.4.2 Patient Positioning;151
8.3.4.3;13.4.3 Surgical Steps;151
8.3.4.4;13.4.4 Pitfalls;152
8.3.5;13.5 After-Treatment;155
8.3.6;13.6 Outcomes;156
8.3.7;References;158
8.4;14: Bridging Plate Osteosynthesis;160
8.4.1;14.1 Introduction;160
8.4.2;14.2 Indications;163
8.4.3;14.3 Surgical Technique;164
8.4.4;14.4 Results and Personal Experience;165
8.4.5;References;167
8.5;15: Transiliac Internal Fixator;168
8.5.1;15.1 Indications;168
8.5.2;15.2 Biomechanical Data;168
8.5.3;15.3 Surgical Technique;169
8.5.3.1;15.3.1 The Transiliac Internal Fixator with Screws in Cranio-Caudal Direction;169
8.5.3.2;15.3.2 The Transiliac Internal Fixator with Screws in Dorso-Ventral Oblique Direction;169
8.5.4;15.4 Postoperative Care;174
8.5.5;15.5 Results;174
8.5.6;References;177
8.6;16: Triangular Osteosynthesis and Lumbopelvic Fixation;178
8.6.1;16.1 Introduction;178
8.6.2;16.2 General Considerations;178
8.6.3;16.3 Indications;181
8.6.4;16.4 Patient Evaluation;183
8.6.5;16.5 Surgical Management and Technical Aspects;185
8.6.6;16.6 Surgical Technique;186
8.6.7;16.7 Postoperative Treatment;190
8.6.8;References;192
8.7;17: Plate and Screw Fixation of the Ilium;193
8.7.1;17.1 Introduction;193
8.7.2;17.2 Anatomical Considerations;194
8.7.3;17.3 Clinical Presentation and Diagnostic Evaluation;194
8.7.4;17.4 Indications for Surgery;194
8.7.5;17.5 Preparation for Surgery and Surgical Approach;195
8.7.6;17.6 Fracture Reduction and Internal Fixation;197
8.7.7;17.7 After Treatment;202
8.7.8;References;202
9;Part VI: Stabilization Techniques for the Anterior Pelvic Ring;204
9.1;18: External Fixation;205
9.1.1;18.1 Biomechanical Considerations;205
9.1.2;18.2 Indications for External Fixation;205
9.1.3;18.3 Surgical Technique;207
9.1.4;18.4 Aftercare and Removal;210
9.1.5;References;210
9.2;19: Retrograde Transpubic Screw Fixation;211
9.2.1;19.1 Introduction;211
9.2.2;19.2 Rationale;212
9.2.3;19.3 The Anterior Column Corridor;213
9.2.4;19.4 Biomechanical Studies;215
9.2.5;19.5 Surgical Technique;216
9.2.6;19.6 Results;220
9.2.7;References;222
9.3;20: Plate Osteosynthesis, Subcutaneous Internal Fixation and Anterior Pelvic Bridge Fixation;224
9.3.1;20.1 General Considerations;224
9.3.2;20.2 Plate Osteosynthesis;227
9.3.2.1;20.2.1 Surgical Technique;229
9.3.2.2;20.2.2 Results;231
9.3.3;20.3 Subcutaneous Internal Fixation;231
9.3.3.1;20.3.1 General Description;231
9.3.3.2;20.3.2 INFIX: Anterior Subcutaneous Crossover Internal Pelvic Fixator;231
9.3.3.2.1;20.3.2.1 Surgical Technique;232
9.3.3.2.2;20.3.2.2 Results;234
9.3.3.3;20.3.3 Anterior Pelvic Bridge;235
9.3.3.3.1;20.3.3.1 Surgical Technique;236
9.3.3.3.2;20.3.3.2 Results;236
9.3.3.3.3;20.3.3.3 Own Results;238
9.3.4;20.4 Anterior Subcutaneous Three-Point Pelvic Fixator;239
9.3.4.1;20.4.1 Introduction;239
9.3.4.2;20.4.2 The Anterior Subcutaneous Three-Point Pelvic Fixator;239
9.3.4.2.1;20.4.2.1 Operative Procedure;240
9.3.4.2.2;20.4.2.2 Advantages and Disadvantages of the Procedure;241
9.3.4.2.3;20.4.2.3 Risks and Limitations;243
9.3.4.3;20.4.3 Indications;244
9.3.5;References;245
10;Part VII: Adjuvant Drug Therapy;248
10.1;21: Anti-Resorptive Therapy;249
10.1.1;21.1 Introduction;249
10.1.2;21.2 Calcium and Vitamin D;249
10.1.3;21.3 Hormone Replacement Therapy (HRT) and Selective Estrogen Receptor Modulators (SERMs);250
10.1.4;21.4 Bisphosphonates;251
10.1.5;21.5 Denosumab;251
10.1.6;21.6 Strontium Ranelate;252
10.1.7;21.7 New Therapeutic Targets for Osteoporosis;253
10.1.7.1;21.7.1 Cathepsin K Inhibitors;253
10.1.7.2;21.7.2 Anti-Sclerostin Therapy;254
10.1.8;References;254
10.2;22: Parathyroid Hormone;258
10.2.1;22.1 Introduction;258
10.2.2;22.2 Parathyroid Hormone Physiology;258
10.2.3;22.3 Genetic Variations of PTH with Bone Mineral Density and Fracture Risk;259
10.2.4;22.4 PTH—The Paradox Effect;259
10.2.5;22.5 Fracture Healing;260
10.2.6;22.6 Experimental Studies;260
10.2.7;22.7 Clinical Studies;261
10.2.8;22.8 Delayed-Unions and Non-Unions;261
10.2.9;22.9 Fracture Healing in Osteoporotic Fractures;261
10.2.10;22.10 Stress Fractures;262
10.2.11;22.11 Atypical Fractures Associated with Bisphosphonate Therapy;263
10.2.12;References;263
11;Part VIII: Aftertreatment;265
11.1;23: Aftercare;266
11.1.1;23.1 Non-operative Treatment;266
11.1.1.1;23.1.1 Introduction;266
11.1.1.2;23.1.2 Setting of Care;266
11.1.1.3;23.1.3 The Fracture Pattern, Presence of a Sacral Fracture;266
11.1.1.4;23.1.4 Comorbidities and Their Management;267
11.1.1.5;23.1.5 Acute Medical Conditions;267
11.1.1.6;23.1.6 Chronic Medical Conditions;269
11.1.1.7;23.1.7 Osteoporosis Work-Up and Management;269
11.1.1.8;23.1.8 Pain Management;270
11.1.1.9;23.1.9 Supportive Care;270
11.1.1.9.1;23.1.9.1 Rehabilitation;270
11.1.1.9.2;23.1.9.2 Discharge Destination;270
11.1.1.9.3;23.1.9.3 System of Care and Its Importance;270
11.1.1.10;23.1.10 Outcomes;270
11.1.2;23.2 Operative Treatment;272
11.1.2.1;23.2.1 Indications and Techniques of Operative Treatment;272
11.1.2.2;23.2.2 Soft Tissue Management;273
11.1.2.3;23.2.3 Rehabilitation After Surgery;274
11.1.2.4;23.2.4 Anticoagulation;274
11.1.2.5;23.2.5 Healing Time and Outcome;274
11.1.3;References;275
12;Part IX: Outcome;276
12.1;24: Outcome;277
12.1.1;24.1 Outcome Measurement;277
12.1.2;24.2 Outcome;278
12.1.2.1;24.2.1 Mortality;278
12.1.2.2;24.2.2 Length of Hospital Stay;279
12.1.2.3;24.2.3 Medical Complications;279
12.1.2.4;24.2.4 Surgical Complications;280
12.1.2.5;24.2.5 Pain;280
12.1.2.6;24.2.6 Mobility and Independence;281
12.1.2.7;24.2.7 Functional Outcome;281
12.1.2.8;24.2.8 Bony Union;282
12.1.3;24.3 Recommendations and Level of Evidence;282
12.1.4;References;283
13;Part X: Case Presentations;286
13.1;25: Case Presentations;287
13.1.1;25.1 Introduction;287
14;Index;308