Zusammenfassung
Die Inzidenz der Fragilitätsfraktur des Beckens nimmt erheblich zu. Die Fraktur ist
Folge eines niedrigenergetischen Traumas. Risikofaktoren sind das Alter, das weibliche
Geschlecht und die Osteoporose. Die Patienten leiden an immobilisierenden Schmerzen
im Bereich der Schamregion, der Leiste oder des tiefen Rückens. Die Diagnostik beruht
auf der konventionellen Bildgebung und der Computertomographie. Die Morphologie dieser
Frakturen unterscheidet sich von denen eines hochenergetischen Traumas. Die neue FFPKlassifikation
differenziert vier Kategorien des Stabilitätsverlusts unterschiedlichen Ausmaßes.
Die Subtypen unterscheiden verschiedene Lokalisationen der Frakturen im posterioren
Beckenring. Die Behandlung beinhaltet Schmerztherapie, Physiotherapie, aktivierende
Pflege und eine spezifische Osteoporose-Therapie. Bei Fragilitätsfrakturen mit Beteiligung
des posterioren Beckenrings sollte eine operative Stabilisierung in Betracht gezogen
werden. Die chirurgische Behandlung sollte möglichst wenig invasiv sein. Die Wiederherstellung
der Stabilität ist entscheidender als die Wiederherstellung der Anatomie. Verschiedene
minimalinvasive Verfahren für den posterioren und anterioren Beckenring werden vorgestellt.
Summary
The incidence of fragility fractures of the pelvis (FFP) is increasing. Risk factors
are age, female sex and osteoporosis. Patients present with immobilizing pain in the
pubic region, the groin and/or the lower back. Diagnosis is made with conventional
radiographs and computed tomography. The morphology of the fractures is different
from those in highenergy trauma. In more than 80% of cases, the posterior and anterior
pelvic ring are involved in the fracture pattern. The sacral ala is very frequently
fractured, because of the important decrease of bone density in this region. Over
time, new fractures may add to the original ones, which make the pelvic ring even
more unstable. The new FFP-classification distinguishes between four different categories
of increasing instability. FFP Type I has an anterior pelvic ring fracture only, FFP
Type II an undisplaced posterior pelvic ring fracture. FFP Type III is characterized
by a displaced but unilateral posterior pelvic ring injury, FFP Type IV by a displaced
bilateral posterior pelvic ring injury. The subtypes differentiate between the localisation
of the posterior pelvic ring lesion: through the ilium, through the iliosacral joint
or through the sacrum. Management is multidisciplinary and contains pain therapy,
physiotherapy, activating care and therapy of osteoporosis. FFP Type I are treated
conservatively. The most important goals are regaining mobility and independency for
activities of daily life. Out-of-bed mobilization is started as early as possible
when tolerated by the patient. The patient is discharged when distinct prerequisites
of mobility and pain control are fulfilled. FFP Type II are also treated conservatively.
We may expect a more cumbersome mobilization because of the involvement of the posterior
pelvic ring. If mobilization has not been successful after one week, a surgical stabilization
must be taken into account. FFP Type III and FFP Type IV should be treated operatively.
It is recommended to stabilize both the posterior and the anterior pelvic ring. The
principles of surgery for fragility fractures are different than for high-energy pelvic
trauma. The surgical procedure must be as less invasive as possible, restoration of
stability is more important than restoration of anatomy. Several minimal invasive
procedures for the stabilization of posterior and anterior pelvic ring fractures have
been developed. Sacroplasty, iliosacral screw osteosynthesis with or without cement
augmentation, sacral bar fixation, transiliac internal fixation and iliolumbar fixation
are alternative procedures for the posterior pelvic ring. Several techniques can be
combined enhancing stability of the bone-implants-construction. Retrograde transpubic
screw fixation, anterior internal fixation and plate osteosynthesis are alternative
procedures for the anterior pelvic ring. Prospective studies are needed evaluating
the benefits of the different procedures and outcome of fragility fractures of the
pelvis.
Schlüsselwörter
Fragilitätsfraktur des Beckens - Klassifikation - minimalinvasive chirurgische Stabilisierung
Keywords
Fragility fractures of the pelvis - diagnosis - classification - minimal-invasive
surgical stabilisation
