Comprehensive classification of fragility fractures of the pelvic ring: Recommendations for surgical treatment.
Rommens PM, Hofmann A. Injury 2013 · PMID 23871193 · doi:10.1016/j.injury.2013.06.023
- Question
- How should fragility fractures of the pelvis in older people be classified so that treatment can be matched to instability?
- Design
- Single-centre analysis of a consecutive series of older patients with pelvic fragility fractures, used to develop a new classification.
- Patients
- Older patients with low-energy (fragility) fractures of the pelvic ring.
- Intervention
- FFP classification (types I-IV by increasing instability, from isolated anterior injury to bilateral posterior displacement) with treatment recommendations
- Comparison
- Classifications designed for high-energy injuries (Tile, Young-Burgess)
- Primary outcome
- Morphological fracture patterns and degree of instability
- Key result
- Fragility pelvic fractures differ from high-energy pelvic ring injuries and are poorly described by existing systems. Most are minimally displaced and settle without surgery, but some progress to displacement, nonunion and persistent instability; the proposed graded classification links instability to treatment, from minimally invasive fixation to complex reconstruction.
- Limitations
- Derived from a single-centre case series; treatment recommendations were expert opinion rather than trial-based, and reliability has been variable in later studies.
- Impact on practice
- Encourages CT of older patients with low-energy pelvic fractures and persistent pain to detect posterior injury, and a graded approach in which failure to mobilise prompts consideration of minimally invasive fixation.