Low-energy pelvic injury on the background of osteoporosis

An elderly patient falls on his side and doesn't break proximal femur, but he still can't get up and walk and feels pain. What does he actually break? It appears that proximal femur fracture is not the only injury he can get. Such a strong structure as pelvis can be broken as well. These patients need the same care as patients with femur fractures. Otherwise they may just die. The earlier and the less invasive fixation we perform – the faster recovery the patient gets. 

As an example, this clinical case of 80 y.o. female patient 

A domestic injury, she fell at home 

Delivered by ambulance to the hospital with a preliminary diagnosis of a femoral neck fracture. On the pelvic radiographs a right pubic bone fracture. CT scan showed right pubic bone fracture and a fracture of the right sacrum bone mass. Repeated careful CT investigation and subsequent MRI revealed left sacrum bone mass fracture as well. Doppler sonography showed left ileofemoral thrombosis with no floatation and a proximal border 6-7 cm higher the inguinal fold. The patient had a pancreas adenocarcinoma history (T4NxMx). She was admitted to 14th department of the city hospital n.b. N.V. Solovyov (Yaroslavl city). No absolute contraindications for surgery were found. 

Thus the patient had a low-energy pelvic trauma due to the 4th type osteoporosis according to Rommers-Hofmann. 

Due to the small size of the medial fragment of the pubic bone and bilateral fracture of the sacrum it was decided to perform osteosynthesis of the pubic bone with NsN nail and osteosynthesis of the sacrum with cannulated screws from the both sides. 

Blood loss – 100ml, 

Operation time – 90 min. 

This tactics allowed to mobilize the patient at the 2nd day after the surgery.

Pelvic fractures