Fragility fractures of the pelvis: An update

Fragility fractures of the pelvis (FFP) are becoming a frequent diagnosis in clinical practice. FFP typically appear after a low-energy trauma in female patients of old age with osteoporosis. The characteristics of FFP differ from pelvic injuries after high-energy trauma. The new comprehensive FFP-classification reflects the specific morphology of the fractures and distinguishes different categories of instability. Key factors for operative treatment are the degree of instability, late presentation, and failure of conservative treatment. It is recommended to treat FFP type I and FFP type II conservatively, whereas FFP type III and FFP type IV should be treated operatively. Surgical stabilization should be as minimal-invasive as possible. Alternatives for the posterior pelvic ring are ilio-sacral screw osteosynthesis with or without cement augmentation, the transiliac internal fixator, the trans-sacral bar, and lumbopelvic fixation. Alternatives for the anterior pelvic ring are the retrograde transpubic screw, the internal fixator, and plate osteosynthesis. The length of hospital stay and complication ratio is higher after operative treatment, whereas mortality is lower than in the conservative group. Quality of life and mobility are reduced in all patients, independent of the classification and treatment type. The FFP-classification and the treatment recommendations provide a framework for searching for the best solution for each individual patient.