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Internal fixation of radiation-induced fragility fractures of the pelvis: a case series

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

The optimal treatment for radiation-induced fragility fractures of the pelvis (RI-FFP) is not well evaluated due to the rarity of the condition.

Purpose

The aim of this retrospective study was to assess the prevalence of RI-FFP, the radiological and clinical outcomes as well as the complications of patients treated with internal fixation.

Methods

A retrospective review of our database was performed to identify all surgically treated patients with RI-FFP. Surgical stabilization was recommended for patients with FFP type III and FFP type IV. Surgical stabilization was also recommended after 5–7 days for patients with FFP type II in case of unsuccessful conservative treatment. Demographic data, fracture patterns according to the FFP classification of Rommens and Hofmann, type of treatment and surgery-related complications including nonunion, hardware failure, fracture progression (secondary fracture) or infection were documented.

Results

Among 500 patients with FFP, the prevalence of patients with RI-FFP was 1% (5/500): 5 patients with a median age of 79 years (76–79). The median time interval from radiation to fracture was 18 months (18–24). All of them underwent internal fixation. Two patients experienced surgery-related complications, one due to hardware failure and one due to fracture progression. At median follow-up of 27 months, all fractures had healed. Patients reached a good level of mobility with a median Parker Mobility Score of 7 and suffered moderate pain with a median value of 2.5 on the numeric rating scale.

Conclusion

RI-FFP remains a rare injury (1%). In our experience, patients, who underwent surgical treatment, obtained a high level of mobility and a moderate pain score after 2 years of follow-up. Internal fixation can be recommended in RI-FFP. Because bone healing may be impaired due to previous irradiation, highly stable constructs are required to avoid fracture progression or revision surgery.

Level of evidence

III, retrospective study

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Funding

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Authors and Affiliations

  1. Department of Orthopedics and Traumatology, University Medical Center Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany

    Mehdi Boudissa, Geoffrey Porcheron, Daniel Wagner, Frank Traub, George Farah & Pol Maria Rommens

Authors
  1. Mehdi Boudissa
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  2. Geoffrey Porcheron
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  3. Daniel Wagner
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  4. Frank Traub
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  5. George Farah
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  6. Pol Maria Rommens
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Contributions

Conceptualization: MB, PMR. Data curation: MB, GP. Methodology: GF, DW. Supervision: PMR. Writing—original draft: MB, PMR. Writing—review and editing: PMR, FT.

Corresponding author

Correspondence to Mehdi Boudissa.

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The authors have no conflicts of interest in relation with this work.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Consent to participate was obtained from all individual participants included in the study.

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Boudissa, M., Porcheron, G., Wagner, D. et al. Internal fixation of radiation-induced fragility fractures of the pelvis: a case series. Arch Orthop Trauma Surg 143, 865–871 (2023). https://doi.org/10.1007/s00402-022-04358-9

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  • DOI: https://doi.org/10.1007/s00402-022-04358-9

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