The estimated incidence of osteoporotic pelvic fractures among persons over age 60 in Germany is 224 per 100 000 persons per year, and rising. A number of surgical treatment options are available, but clinical long-term data are lacking. This review is based on pertinent publications and guidelines retrieved by a selective literature search, and on the authors' clinical experience. Patients often report one or more relatively trivial traumatic incidents leading up to the fracture. They complain of pain in the hip, groin, or lower lumbar region, or of low back pain and sciatica. A new classification scheme entitled Fragility Fractures of the Pelvis (FFP) takes the morphology of the fracture into account and can be used as an aid to therapeutic decision-making (evidence level IV). The goal of treatment is early mobilization with adequate pain relief. Isolated anterior pelvic ring fractures (FFP I) and nondisplaced posterior pelvic ring fractures (FFP II) are usually stable and can be treated conservatively. Type III and IV injuries are unstable and should generally be treated surgically. Retrospective analyses have shown that osteoporotic pelvic fractures are associated with decreased mobility and independence and with a one-year mortality ranging from 9.5% to 27%. Prospective therapeutic trials are urgently needed.

The direct anterior approach (DAA) has gained popularity in total hip arthroplasty (THA) over the past decade. A large number of studies have compared the DAA to other approaches with inclusion of a learning curve phase. The aim of this study was to compare the complication rate and bleeding between the DAA and the anterolateral approach after the learning curve phase. For this retrospective, single-institutional study, propensity score matching was performed, from an initial cohort of 1408 patients receiving an elective THA. Two matching groups were created, comprising of 396 patients each. After matching, both groups were similar in age, gender, body mass index, anesthesiologist’s score and surgeon’s experience. Average age in the matched groups was 68.7 ± 10.3 years. The total blood loss was similar in both groups, 450 vs 469 mL (p = 0.400), whereas the transfusion rate (14.1 vs 5.8%, p < 0.001) and the overall complication rate (17.6 vs 12.1%, p = 0.018) were lower in the DAA group. The overall fracture rate was comparable, 1.5 vs 1% (p = 0.376), as well as the early infection rate, 0.3 vs 1% (p = 0.162). The dislocation rate was significantly increased in the DAA group, 2.2 vs 0.5% (p = 0.032). The direct anterior approach has comparable short-term surgical complications with reduced transfusion and general complication rates. Level III retrospective study.

Background: The aim of the present study was to describe specific characteristics of patients suffering from pelvic fragility fractures and evaluate factors that might influence treatment decisions which may optimize treatment pathways and patient mobility in the future. Methods: A prospective study with patients suffering from fractures of the pelvis and aged 60 years or above was performed between 2012 and 2016. Data acquisition took place at admission, every day during hospitalization and at discharge. Results: One hundred thirty-four patients (mean age of 79.93 (± 7.67) years), predominantly female (84%), were included. Eighty-six patients were treated non-operatively. Forty-eight patients underwent a surgical procedure. The main fracture types were B2 fractures (52.24%) and FFP IIb fractures (39.55%). At the time of discharge, pain level (NRS) could be significantly reduced (p < 0.001). Patients who underwent a surgical procedure had a significantly higher pain level on day three and four compared to the non-operative group (p = 0.032 and p = 0.023, respectively). Significant differences were found in the mobility level: patients treated operatively on day four or later were not able to stand or walk on day three as compared to non-operatively treated patients. Regarding B2 fractures, a significantly higher mobility level difference between time of admission and discharge was found in patients treated with a surgical procedure compared to patients treated non-operatively (p = 0.035). Conclusions: Fracture type, mobility level and pain level influence the decision to proceed with surgical treatment. Especially patients suffering from B2 fractures benefitted in terms of mobility level at discharge when treated operatively. Level of evidence: II