Abstract:
BACKGROUND :
As our population ages, the incidence of pelvic fragility fractures will rise accordingly. Despite
these fractures having similar mortality rates to proximal femur fractures, there exist discrepancies
between the management of these injuries. Although a number of pelvic fragility fractures can be
treated successfully with conservative means, early treatment with appropriate surgical means
should be considered in those failing conservative treatment or with unstable fracture patterns.
CASE REPORT :
We present an 84-year-old female who sustained a pelvic fragility fracture after a low-energy
fall. Despite adequate conservative treatment, she was unable to mobilise. She was taken for
anterior and posterior fixation, using our modified minimally invasive subcutaneous technique (the
Bridging Infix) for anterior fixation. At the six-week follow-up she had regained full independent
mobility. She had three syncope-related falls during this period, but radiographs revealed no
sign of implant displacement. One year after her surgery she had complete union of her fracture,
good function and no desire to have the implant removed.
DISCUSSION :
With the expected increase in pelvic fragility fractures due to the growing elderly population, our
understanding of these injuries has begun to change. Occult posterior ring injuries have been
described in up to 80% of cases, while fracture progression to unstable patterns can occur in
up to 15% of stable patterns. Despite conservative management being the primary treatment
of choice, these patients suffer morbidity and mortality rates comparable to proximal femur
fractures. Early appropriate surgical management should be considered in patients failing to
mobilise. Various surgical techniques have been described, each with their own advantages and
disadvantages. Newer minimally invasive techniques are gaining favour, especially for use in
elderly patients. These constructs combine the low profile benefits of internal plate fixation with
ex-fix principles.
CONCLUSION :
The Bridging Infix is a modified technique for minimally invasive subcutaneous anterior pelvic
fixation. Its use can strongly be considered by even the general orthopaedic surgeon in cases
where patients are too frail for extensive or invasive surgeries, such as open reduction and
internal fixation with plate and screws.
