Background: Fragility fractures of the pelvic ring (FFPs) represent a fast-growing entity in geriatric traumatology with increasing incidence worldwide. This study aimed to analyze the epidemiology, treatment concepts, and surgical strategies for FFPs based on data collected by the German Pelvic Multicenter Study Group documented in the German Pelvic Fracture Registry. It is the largest cohort study of its kind. Methods: This retrospective cohort study included patients aged 65 years or older after FFPs, as classified according to the Rommens and Hofmann classification. Data were collected from July 2018 onward and analyzed for demographics; fracture classifications; treatment modalities (operative vs. non-operative); and details of surgery, including timing and choice of implants. Patients after high-energy trauma were excluded. Statistical analyses included descriptive metrics and subgroup comparisons. Results: Among 1242 patients (84% female; median age 83.4 years), FFP Type II was the most common fracture type (50.8%), followed by Type IV (21.1%). Non-operative management was employed in 68.8% of cases, while 30.9% underwent surgery. Surgical intervention was more frequent in higher-grade FFPs (e.g., 72.1% in Type IV). The most common surgical technique for the posterior pelvic ring was percutaneous screw fixation (61.3%), with navigation used in 47.4% of cases. Conclusions: This study highlights the variability in treatment strategies for FFPs, with conservative management predominating in lower-grade fractures and surgical approaches increasingly utilized for more complex cases. The findings underscore the need for standardized, evidence-based guidelines and further research to optimize treatment and long-term outcomes for geriatric patients with FFPs.

Background/Objectives: Patients suffering from fractures are often treated with clopidogrel during the phase of bone healing due to multiple comorbidities. Studies indicate that clopidogrel suppresses osteoblast proliferation and the formation of trabecular bone. However, it is unknown whether clopidogrel also affects fracture healing under ischemic conditions, as they may occur in multimorbid patients. Methods: To test this in the present study, a murine ischemia model was performed in CD-1 mice by ligating the right deep femoral artery to induce mild ischemia of the right lower limb. A closed fracture of the femur was then stabilized by inserting an intramedullary lag screw. The animals received either 3 mg/kg body weight clopidogrel daily per os or vehicle (control). Bone healing was assessed by biomechanical, radiological, histomorphometrical and Western blot analyses 2 and 5 weeks postoperatively. Results: The fractured femurs in the clopidogrel group exhibited no increase in biomechanical stiffness throughout the observation period in contrast to controls. While the radiological analysis showed no differences between both groups, histomorphometric analyses demonstrated a significantly reduced bridging score, less bone and more connective tissue within the callus of clopidogrel-treated animals. Western blot analyses revealed a significantly reduced expression of the osteogenic marker bone morphogenetic protein (BMP)-4 and an increased expression of the blood vessel marker CD31. Conclusions: These results show that clopidogrel may impair fracture healing under challenging ischemic conditions, which is associated with a shift in angiogenic and osteogenic expression markers in the callus tissue. Therefore, clopidogrel treatment may not be recommended in fracture patients with tissue ischemia.

Purpose: Traumatic open book injuries of the pubic symphysis require stable fixation while minimizing surgical morbidity. Traditional symphyseal plating is associated with complications such as implant failure and infections. This study aims to evaluate the biomechanical performance of a novel minimally invasive technique using an internal fixator (IF) compared to conventional plating (symphyseal locking dynamic compression plate [SLDCP]) in human cadaveric pelvises. Methods: Ten human cadaveric pelvises were assigned to two groups ( n = 5 each). After anatomical reduction, either SLDCP or IF stabilization was applied. Intrasymphyseal compression forces, contact area and interfragmentary motion were assessed using pressure‐sensitive sensor films and an optical tracking system under incrementally applied axial loads up to 600 N. Bone density and symphyseal dimensions were measured and were comparable across both groups. Results: At key loading stages (400 and 600 N), the IF group demonstrated significantly higher intrasymphyseal compression forces (IF 61.78 ± 31.98 N vs. SLDCP 15.98 ± 8.2 N at 400 N and IF 42.82 ± 25.2 N vs. SLDCP 9.42 ± 5.81 N at 600 N) and larger contact areas (IF 453 ± 137.6 mm ² vs. SLDCP 216 ± 135 mm ² at 400 N and IF 337.6 ± 168.45 mm ² vs. SLDCP 154 ± 59.73 mm ² at 600 N), with more homogeneous segmental force and area distributions. Higher compression forces, particularly in the caudal symphyseal region (IF 23.68 ± 18.69 N vs. SLDCP 13.78 ± 10.1 N), were achieved. Three‐dimensional analysis showed reduced fragment displacement in the IF group under load. Conclusion: The proposed technique using an internal fixator provided superior biomechanical stability compared to standard plating, offering a promising minimally invasive alternative for managing open book injuries. The technique facilitates uniform force transmission and improved contact conditions, which may enhance healing and reduce complications. Level of Evidence: N/A.

Introduction: A transitional “grey-zone” exists between typical locations of classical trapezoidal anterior wall and large-fragment posterior wall acetabular fractures. Part of this grey zone is the superior acetabular dome, which is commonly involved in acetabular fracture patterns, especially in geriatric patients. The aim of this study was to characterize isolated acetabular superior wall fractures and to assess their relevance as a distinct fracture pattern. Methods: A retrospective analysis of pelvic fracture databases from three tertiary trauma centers was performed. Acetabular fractures with superior dome involvement were screened, and cases with isolated superior articular involvement were included. Overall, seven patients were identified. Clinical and radiological data were analyzed regarding fracture morphology, associated fracture characteristics (including dislocation, comminution, marginal impaction, intra-articular fragments, and femoral head injury), concomitant pelvic ring injuries, treatment, and clinical outcomes. Results: Isolated superior wall acetabular fractures occurred following both high-energy and low-energy mechanisms, including simple falls. The mean age was 48 years and four of seven patients were male. Hip dislocation or subluxation was observed in four cases (anterior-superior or purely superior). Surgical treatment was performed in six cases, predominantly using anterior approaches (mainly the iliofemoral approach) with screw and/or plate fixation. Outcomes were frequently unfavorable, with relevant joint degeneration or persistent symptoms, likely related to substantial articular damage of the superior weight-bearing zone. Conclusion: Acetabular superior wall fractures present a distinct fracture pattern that differs from classical anterior and posterior wall fractures and is less commonly observed. These injuries involve the superior weight-bearing dome and are frequently associated with comminution and substantial articular damage of both the acetabulum and femoral head. Even in cases with restored joint congruence, outcomes appear inferior, underscoring the clinical relevance of this fracture entity.

Background: Chronic anterior pelvic instability may require symphyseal arthrodesis when conservative treatment and isolated plating fail. Therefore, dual plating has been clinically used to improve stability, however the technique requires extended surgical exposure. As a novel augmentation FiberTape® cerclage may provide comparable mechanical stability while reducing invasiveness and providing radiolucency for improved analysis of bone healing. Methods: Twenty-four synthetic pelvic models (n = 8 per group) were stabilized using symphyseal plating, dual plating, or plate–cerclage constructs. Cyclic axial loading (50–400 N) was applied in a unilateral stance and bilateral-leg stance biomechanical model.Results: The plate–cerclage resulted in significantly higher compression force (131.5 ± 31.7 N) compared to plate-only fixation (88.2 ± 20.9 N; p = 0.019), corresponding to a 49% increase. Dual plating reduced contact area (p ≤ 0.049). No significant differences were observed in one-leg stance.Conclusion: Fiber-Tape cerclage augmentation significantly enhances distraction resistance and preserves contact area compared to dual plating. Furthermore, this technique will allow improved radiological visualization of the area of interest in the pubic symphysis after arthrodesis to analyze bone healing and osteointegration.