Minimally invasive stabilization of the anterior pelvic ring in fragility fractures using a submuscularly implanted internal fixator - a retrospective case series of 34 geriatric patients.

Purpose: Various surgical techniques for osteosynthesis in fragility fractures of the pelvis (FFP) are described. Since 2012, a submuscularly placed internal fixator has been used to stabilize the anterior pelvic ring. Indications for this procedure are a dislocation in the anterior pelvic ring and/or severe pain with associated immobility. This technique potentially has several advantages compared to subcutaneous procedures, including improved patient comfort, less irritation, and enhanced biomechanical stability due to the deeper rod placement.

Methods: Digital files of patients aged ≥ 65 years, who were treated with an internal fixator at a Level I trauma center in Germany between 2012 and 2021, were retrospectively analyzed.

Results: Thirty-four patients (median age 79 years, 77% female, 61.8% ASA III) were treated. Most fractures were caused by ground-level falls (64.7%), followed by road traffic accidents (11.8%). In patients with low impact trauma, the most common fracture types were FFP IIb (37.04%) and FFP IIIc (18.52%). Complications during surgery occurred in 4 patients (11.76%) and postoperative complications in 6 patients (17.6%), with hematoseroma being the most common. Non-surgical complications occurred in 20 patients (total: 58.8%; Clavien-Dindo type 2 in 70%). After 12 months, the majority of all patients had the same mobility level as before the fracture.

Conclusion: The submuscularly placed internal fixator is an effective technique for stabilizing anterior pelvic ring fractures in geriatric patients, offering advantages in cases of high dorsoventral instability or persistent severe anterior pain.