Succession of failures in surgical management of fragility fracture of the pelvis

Abstract

Case: We report a case of a 79-years old man who sustained a Fragility Fracture of the Pelvis (FFP) classified type IVb according to Rommens and Hofmann. After a delayed diagnosis with persistence of pain and loss of mobility, a bilateral sacroplasty was performed. Although pain relief was achieved, a fracture progression (FP) occurred with bilateral neurologic compression of L5 and S1 nerve roots with pain recurrence. A percutaneous ilio-lumbar reduction was attempted with cemented augmentation and bilateral ilio-sacral screwing. Reduction was not achieved and screws finally pulled-out. The patient died one year after institutionalization with a significant loss of mobility and autonomy. Conclusions: Misunderstanding in management of FFP according to Rommens and Hofmann recommendations can lead to bad results with fracture progression, implants failure, pain recurrence, loss of function, loss of autonomy and finally death of the patient.

Keywords

• Gerontology-traumatology
• Classification of pelvic ring fractures
• Fragility fractures of the pelvis
• Fracture progression
• Sacroplasty
• Internal fixation