TREATMENT OF POSTERIOR PELVIC OSTEOPOROTIC INJURIES WITHOUT SIGNIFICANT DISPLACEMENT
Authors: A.A. Ryzhkin , S.K. Shakola , I.I. Litvinov , I. Harraz 
Published: February 2023

Relevance. The prevalence of osteoporosis and, as a result, the risk of life-threatening pathological fractures increases. At the same time, the optimal treatment tactic for low-energy injuries of the posterior half-ring of the pelvis without significant displacement has not been determined, which actualizes further studies of this type of damage. The aim of the study was to analyze the experience of diagnosing and treating osteoporotic injuries of the posterior pelvic half-ring without significant displacement. Materials and methods. The prospective controlled study included 63 patients aged 60-93 years who were treated in 2018-2020 for osteoporotic fractures of the posterior half-ring of the pelvis without significant displacement. Comprehensive examination of patients was carried out, including standard radiography and X-ray computed tomography (CT) of the pelvis, correction of comorbid conditions, analgesia, prevention of thromboembolism. In one outpatient observation based on standard radiography, pelvic ring injury was not detected in a timely manner. In 57 patients hospitalized up to 5 days after injury, early functional conservative treatment was used. In 33 of them, this treatment led to restoration of function, fusion. In 24 of 57 patients, in the conditions of early functional conservative treatment, a significant pain syndrome persisted and pelvic ring instability was determined, they underwent prompt minimally invasive pelvic stabilization followed by early activation. Intensive therapy for advanced heart and renal failure was performed in 2 patients 86 and 82 years hospitalized up to 5 days after the injury. In 4 patients hospitalized within more than 5 days after injury with significant pain syndrome and pelvic ring instability, its urgent operative minimally invasive stabilization was carried out with subsequent early activation. For minimally invasive stabilization of the rear half-ring, cannulated screws were used, the front half-ring - cannulated screws, lockable rods, in two - plate osteosynthesis. The outcome was assessed using the S.A. Majeed scale 6 months after hospitalization. Results. Three patients (4.8%) died due to decompensation of severe comorbid somatic pathology. There were no nonunions, thromboembolic and infectious complications. The terms of restoration of motor activity of patients with conservative treatment amounted to 8-24 weeks, with operative - 8-16 weeks. One patient had a screw migration from the anterior pelvic half-ring under the skin. The results were evaluated in 52 patients (82.5%): excellent - 26 (50%), good - 22 (42%), satisfactory - 1 (2%), bad - 3 (6%). Conclusions. 1. post-traumatic pelvic pain, impaired motor activity, and no detection of bone traumatic changes with standard pelvic radiography should be an indication for performing pelvic computed tomography. 2. The low mortality rate - 4.8% - and the high level of excellent and good results - 92% - in the group of elderly, senile and long-lived patients with osteoporotic fractures of the posterior half-ring of the pelvis without significant displacement indicate the adequacy of the applied protocol of multidisciplinary, early functional treatment of these injuries. 3. Minimally invasive osteosynthesis using blockable rods and cannulated screws of the front and rear half-rings of the pelvis in case of their instability allows early activation of elderly, senile and long-lived patients, accompanied by a low risk of complications.