Emerging Options Using Osteobiologics Treatment for FFP Type IA Comminuted Stable Fragility Fractures Involving the Pubic Rami

Abstract

Introduction: For many elderly patients who sustain a pubic rami fracture after a fall, the traditional treatment of extended bed rest and restricted mobility is often not practical. A classification for pubic rami fractures has been developed to recommend treatment. There is a technique to augment the biologic fracture environment using Calcium Phosphate through a minimally invasive procedure. In this study FFP Type Ia fractures were treated using Calcium phosphate. Methods: Our study, from January 1, 2018, to December 31, 2019, identified eighty-eight patients with FFP Type Ia fractures, who were treated with Calcium Phosphate. There were 9 males and 79 females, average ages were 78 and 86 respectively. Admission workup included pelvic x-rays as well as a CT scan. All received Calcium Phosphate for fracture fixation. They were followed in the outpatient clinic with pelvic radiographs at 3 weeks, 6 weeks, 6 months. 9 months and 1 year. Evidence of incorporation of the Calcium Phosphate in the fracture healing were documented. Results: There were no infections, no vascular, and no urological complications with this technique. All treated fractures went on to heal. Incorporation of the Calcium Phosphate was noted as early as 12 weeks. Residual presence of Calcium Phosphate was seen at 1 year and was consistent with the research literature. Conclusion: This new method of minimally invasive internal fixation using a bone biologic enhancement material provides an immediate improvement of post injury pain and an increase in immediate post treatment mobility. This treatment is applicable for all pelvic fragility fractures, including Type Ia who present with comminution. Risks with this treatment are low and benefits to the patient are high.