Abstract
Introduction
Posterior locked lateral compression injury (PLLCI) of the pelvic ring is an infrequent variant of lateral compression injury, a condition described in only eight reported cases since 2000. Lateral compression injury usually results from high-energy trauma and is characterized by locking between the medially translated fractured ilium and the anterior border of the sacrum, regardless of whether the fractured ilium involves the sacroiliac joint. However, in our experience, lateral compression injury can also result from low-energy trauma as a manifestation of pelvic fragility fracture. The aim of the present study was to describe this rare form of PLLCI in a case series of geriatric patients.
Methodology
A retrospective analysis of consecutive patients with pelvic ring injuries who were admitted to our hospital from January 2008 to April 2015 identified seven geriatric patients (1 male and 6 females; median age 81 years) with a form of PLLCI.
Results
All injuries were due to falls from a standing position onto the ground. All seven cases demonstrated characteristics of a locking fractured ilium over the anterior border of the sacrum on axial computed tomography images, but were not detected on plain radiographs. All underwent follow-up at 1 year or later with improved mean visual analogue scale scores (range 0–3). Regarding Koval walking ability scores, patients who underwent pelvic brim plating with anterior external fixation were more likely to regain their pre-injury walking ability than patients who only underwent anterior external fixation or conservative treatment.
Conclusion
Geriatric patients can experience PLCCIs of the pelvis due to low-energy trauma. These fractures have different characteristics from those associated with severe injuries due to high-energy trauma, and they comprise an infrequent form of Rommens fragility fracture of the pelvis (type IIIa). In these cases, appropriate surgical management that includes sacroiliac plating combined with anterior external fixation can yield good outcomes.
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References
Young JW et al (1986) Pelvic fractures: value of plain radiography in early assessment and management. Radiology 160(2):445–451
Eggers GW (1952) Dislocations of the os coxae. Am J Surg 83(3):300–307
Ansari S, Rollins J, Ebraheim NA (2003) Locked pubic symphysis with ipsilateral fracture neck of a femur. J Trauma 54(2):376–378
O’Toole RV et al (2006) Superior pubic ramus osteotomy to treat locked pubic symphysis. A case report. J Bone Joint Surg Am 88(7):1609–1614
Botanlioglu H et al (2012) Open reduction technique for overlapping and locked pubic symphysis. Acta Orthop Traumatol Turc 46(1):77–81
Schildhauer TA, Wilber JH, Patterson BM (2000) Posterior locked lateral compression injury of the pelvis: report of three cases. J Orthop Trauma 14(2):107–111
Feinblatt JS, Phieffer LS, Lawyer RB (2010) Anterior sacroiliac dislocation. Orthopedics 33(12):920
Trikha V, Singh V, Kumar VS (2015) Anterior fracture dislocation of sacroiliac joint: a rare type of crescent fracture. Indian J Orthop 49(2):255–259
Rommens PM, Hofmann A (2013) Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury 44(12):1733–1744
Koval KJ et al (1995) Ambulatory ability after hip fracture. A prospective study in geriatric patients. Clin Orthop Relat Res 310:150–159
Fuchs T et al (2011) Pelvic ring fractures in the elderly. Underestimated osteoporotic fracture. Unfallchirurg 114(8):663–670
Soles GL, Ferguson TA (2012) Fragility fractures of the pelvis. Curr Rev Musculoskelet Med 5(3):222–228
Rommens PM et al (2015) Clinical pathways for fragility fractures of the pelvic ring: personal experience and review of the literature. J Orthop Sci 20(1):1–11
Tile M (1988) Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br 70(1):1–12
Young JW et al (1986) Lateral compression fractures of the pelvis: the importance of plain radiographs in the diagnosis and surgical management. Skelet Radiol 15(2):103–109
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Lee, SW., Kim, WY., Koh, SJ. et al. Posterior locked lateral compression injury of the pelvis in geriatric patients: an infrequent and specific variant of the fragility fracture of pelvis. Arch Orthop Trauma Surg 137, 1207–1218 (2017). https://doi.org/10.1007/s00402-017-2752-5
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DOI: https://doi.org/10.1007/s00402-017-2752-5