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

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

doi:10.1007/s00402-022-04358-9

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

Arch Orthop Trauma Surg. 2023 Feb;143(2):865-871. doi: 10.1007/s00402-022-04358-9. Epub 2022 Feb 2.

Authors

Mehdi Boudissa¹, Geoffrey Porcheron², Daniel Wagner², Frank Traub², George Farah², Pol Maria Rommens²

Affiliations

¹ Department of Orthopedics and Traumatology, University Medical Center Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany. mehdicale@gmail.com.
² Department of Orthopedics and Traumatology, University Medical Center Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.

PMID: 35107637
DOI: 10.1007/s00402-022-04358-9

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.

Keywords: Complication; Fragility fracture of the pelvis; Internal fixation; Operative; Radiation induced.

MeSH terms

Aged
Fracture Fixation, Internal
Fractures, Bone* / surgery
Humans
Osteoporotic Fractures* / surgery
Pain
Pelvic Bones* / injuries
Pelvic Bones* / surgery
Pelvis
Retrospective Studies