OSTEOPOROTIC VENTRAL PELVIC RING INJURIES

Relevance. Low-energy fractures of the pelvic ring account for 64% of all pelvic ring injuries and 94% of pelvic ring injuries in the group of people over 60 years of age. Due to the increase in life expectancy and the aging of the population, the number of low-energy fractures of the pelvic bones is steadily increasing. The treatment strategy for isolated anterior ring injuries (FFP I) remains controversial due to the lack of clinical guidelines. The purpose of this study: to analyze the outcomes of conservative treatment for low-energy osteoporotic fractures of the anterior pelvic ring (FFP I) compared to minimally invasive surgical treatment for combined low-energy osteoporotic injuries of the anterior and non-displaced posterior pelvic ring (FFP IIb,c). Materials and methods. The controlled study (2018-2023) included 65 patients: FFP I group (n=30; age 79.1±6.8 years; 28 women/2 men) and FFP IIb,c group (n=35; age 77.3±7.2 years; 32 women/3 men). All patients underwent CT with 3D reconstruction. Patients in the FFP I group were treated conservatively with early mobilization (on average, 3.3±1.8 days after hospitalization) using a pelvic bandage and walkers. Patients in the FFP IIb,c group were treated using minimally invasive surgical fixation of the pelvis: posterior half-ring - iliosacral screws, anterior half-ring - locking plates or cannulated screws. The evaluation of the results according to the Majeed scale was carried out in periods from 1 to 5 years, statistical analysis was carried out using the Mann-Whitney U-test (the distribution differed from normal, p<0.05 according to Shapiro-Wilk). Results. The mean Majeed score was 63.8±12.5 in the FFP I group versus 74.0±10.8 in the FFP IIb/c group (p=0.012). In 4% of cases of conservative treatment, progression of the injury to unstable was noted. Age and comorbidity indices did not significantly affect outcomes (p>0.05). Conclusions. The results of conservative treatment of osteoporotic injuries of the anterior pelvic ring (FFPI) according to S.A. Majeed (63.8 ± 12.5 points) were significantly worse (p < 0.05) than the results of minimally invasive surgical treatment of osteoporotic injuries of the anterior pelvic ring in combination with injuries of the posterior pelvic ring without displacement (FFP IIb,c) (74.0 ± 10.8), which provides grounds for revising the tactics of FFPI treatment in favor of minimally invasive stabilization of the anterior pelvic ring.