Fragility fractures of the pelvis

Abstract

Fragility fractures of the pelvis are common and the incidence is increasing with the aging population. The primary risk factor is osteoporosis. Diagnosis is challenging and advanced imaging with computed tomography (CT), bone scintigraphy, and magnetic resonance imaging (MRI) is helpful. These injuries result in significant morbidity, including prolonged hospitalization, immobility, and loss of autonomy in previously active patients. The mortality rate is high, similar to hip fracture patients. This problem is underappreciated and deserves attention. An opportunity exists to improve outcomes with medical and surgical management.

Figures

Fig. 1

Case example. An 87-year-old female, with history of bilateral hip fractures treated with sliding hip screws, and vertebral compression fractures treated with kyphoplasty, who sustained a simple fall and presented with low back and pelvic pain. Panel a: AP pelvis on presentation. Note the sacral fracture is extremely difficult to appreciate on this radiograph. Panel b: Axial CT. Note severe osteoporosis throughout the sacrum. Panel c: Sagittal CT. Note kyphosis at the level of S1-S2 indicating the horizontal component of this U-shaped fracture. Panel d: Post-operative AP pelvis. Transsacral screws were placed at S1 and S2 and augmented with calcium phosphate cement at the sacral fracture sites bilaterally