Biomechanical Considerations for the Treatment of (Geriatric) Pelvic Ring Fractures

Recent data suggest that early mobilization is a key in reducing mortality and morbidity in fragility fracture of the pelvis. Therefore, operative stabilization is recommended in case of conservative treatment failure. Several years ago, we have clinically shown that sacro-iliac screws (SI-screws) provide sufficient safety and usability, despite specific risks [1]. Especially SI-screw fixation in unstable pelvic ring fractures was recently shown to result in good quality of life and long term functional outcome [2 Based on these findings, we tried to increase biomechanical understanding. Using a pelvic simulator, we found that fixations of both, the anterior and posterior pelvic ring provides the highest overall stability. This was achieved with sacroiliac screw combined with anterior plating or retrograde trans pubic screw fixation [3]. The superior stabilization potential of retrograde trans pubic screws and equality to anterior plating was shown in another study [4]. As clinically shown [1], there was a measurable stability effect of cement augmentation in sacro-iliac screw fixation [5]. The presented results increase understanding of biomechanics in pelvic stabilization and can be used as a foundation to rate further investigations.