Spinal anesthesia in the percutaneous fixation of fragility fractures of the pelvis

Abstract

Introduction: The number of geriatric patients with a pelvic ring fracture is rising and minimal invasive fixation techniques are increasingly popular. The patient characteristics of these fragile patients are similar to those of patients with a proximal femur fracture. In the field of proximal femur fracture surgery spinal anesthesia is a very commonly used anesthetic technique in this more fragile patient population. Methods: All patients were treated between January 2022 and May 2022 in the Amsterdam UMC location AMC in The Netherlands. The operations were performed by a surgeon who specialized in pelvic and acetabular fracture surgery in a hybrid operating theatre. All patient in this case series received spinal anesthesia using 2–2.5 ml glucosated bupivacaine 5 mg/ml. Results: We describe, for the first time, four cases of percutaneous pelvic ring fracture fixation using spinal anesthesia. There were no perioperative or direct postoperative complications. Patients quickly regained the ability to mobilize, reported little pain complaints, and could be safely discharged to either a rehabilitation center or home. Conclusion: We believe spinal anesthesia could be a safe alternative to general anesthesia for the percutaneous fixation of pelvic ring injuries in a selected group of frail elderly patients. A proper assessment should determine whether or not spinal anesthesia is an option in pelvic fracture fixation, taking patient preference, the advice of the anesthetist, the choice of operative technique, and fracture pattern into consideration.

Keywords

• Spinal anesthesia
• Pelvic fragility fracture
• Osteoporotic fracture
• Percutaneous fixation
• Case reports