Abstract text (incl. references and figure legends)
Introduction: the "isolated" anterior ring injury in the elderly is a recurring problem. We often find that our patients with "simple" pelvic anterior fractures, remain painful and unable to walk. An unrecognized posterior injury is not an unknown problem.
Material and method: in the last five years, in our institute, we have been conducting monitoring of our elderly patients with pelvic ring injuries: based on conventional x-rays, we examined the load-bearing and walking ability with isolated anterior pelvic ring injuries. In the cases where we detected a problem with these, we performed an additional CT scan, which concluded with the results of the posterior ring to be treated. We tried to combine minimally invasive and stability-enhancing principles. Accordingly, (incl. patients with proven posterior injuries), we treated our patients with cemented ilioscarial screwing.
Results: isolated front ring injuries in elderly are rare, mostly the result of insufficient diagnostics. At least one-third of the patients had an additional finding. In elderly we could detect injuries affecting the posterior pelvic ring like "fragility" or "insufficiency" fractures. In this way, we were able to reliably improve the patients' walking ability and long-term quality of life (including the proven posterior-ring diagnosed patients). Since the positioning of the screw is not easy (no "surgical" findings, no resistance or radiological image), and the cement injection - due to weakness of tissues – is not clear, we introduced a 3D navigation (O-Arm control) in addition to cement augmentation. Thanks to the new method, we achieved accurate screw placement and cement augmentation (without ex-flow). After a short rehabilitation, patients started exercising and returned to their daily activities.
Summary: thanks to extended diagnostics and care, we have been able to improve the mobility and long-term results of pelvic injured elder patients in our institute over the past five years.
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