gms | German Medical Science

Objectives: Background: Pelvic fractures with posterior ring instability are most often treated with ilio-sacral screw fixation or open plating techniques. As an alternative, the lumbopelvine stabilisation may be used in a minimal invasive technique especially in elderly patients with minor bone quality and higher operative risk. We present the technique, outcome and complication rate in a series of 14 geriatric patients.

Methods: Materials: The study includes a consecutive series of 14 elderly patients (mean age 72 years, range 51-91) with posterior ring fracture due to low energy trauma from September 2013 to December 2014. All of them underwent an angular stable instrumentation (Medtronic, Longitude). One patient had a pathological fracture in a multiple myeloma. Bilateral fractures were diagnosed in 7 patients. All of them were prospectively evaluated for complications and clinical outcome. The Visual Analog Scale (VAS), Glascow Outcome Scale (GOS), Instrumental activities of daily living (IADL) and Barthel- Index were monitored. Radiological follow-ups were done after 6 weeks, 3 and 6 months including CT scan after 6 month.

Results and Conclusion: Results: Seven lumbopelvic stabilisations were done bilaterally. None of the patient had a wound- healing disorder or infection, the CT scan after 6 month proved a complete consolidation of the fracture in all patients. The monitored clinical scores 3 and 6 month postoperatively were not significantly different to the preoperative values (p>0.05) and patients satisfaction was high. Two patients died within the first 6 month for reasons unrelated to the surgical treatment. Operational time was 49 minutes in unilateral and 72 minutes in bilateral stabilisation, the medial duration of the hospital stay was 12.8 days (range, 8-20).

The clinical results conclude that the minimal invasive lumbopelvine stabilisation is an accurate technique for traumatic unilateral and bilateral posterior pelvic ring fractures or insufficiency fractures in elderly patients with poor bone quality. The operational time is short, the complication rate is low and the patients satisfaction is high.