Minor pelvic fractures in the older adult
- James Fiechtl, MD
James Fiechtl, MD
- Assistant Professor, Departments of Emergency Medicine and Orthopaedics
- Vanderbilt University
- Section Editors
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Maria E Moreira, MD
Maria E Moreira, MD
- Section Editor — Adult Trauma
- Associate Professor, Department of Emergency Medicine
- University of Colorado Denver School of Medicine
- Residency Program Director
- Denver Health Residency in Emergency Medicine
Minor pelvic fractures in the elderly involve either low energy mechanisms or repetitive stresses in osteoporotic bone (insufficiency fractures). These fractures may be either displaced or non-displaced and generally involve both anterior and posterior elements of the pelvis. For the purposes of this review, low energy and pelvic insufficiency fractures will be considered together as some degree of insufficiency is universally present.
The diagnosis and management of minor low-energy and insufficiency pelvic fractures in elder patients is reviewed here. Such fractures consist primarily of fractures of the pubic rami and the sacral ala. Osteoporosis, hip fractures, and major pelvic trauma are discussed separately. (See "Osteoporotic fracture risk assessment" and "Overview of the management of osteoporosis in postmenopausal women" and "Hip fractures in adults" and "Pelvic trauma: Initial evaluation and management" and "Severe pelvic fracture in the adult trauma patient".)
Incidence and mortality — Pelvic fractures represent approximately 3 percent of all skeletal injuries, regardless of age; however, data about minor pelvic fractures specifically in elder patients are limited . A Finnish population study determined the incidence for pelvic insufficiency fractures to be 92 per 100,000. This number represents approximately one-fifth the incidence of femoral neck fractures . The incidence of these fractures is increasing: from 1988 to 2000, the incidence increased 58.4 percent in men and 110.8 percent in women .
A retrospective review of 181 elder patients with pelvic insufficiency fractures reported an associated mortality rate of 23 percent at one year . This rate did not vary significantly with fracture location or the degree of fracture displacement.
Risk factors — Risk factors for these injuries are similar to those for osteoporosis: advanced age, prior pelvic fracture, glucocorticoid therapy, low body weight, smoking, and excess alcohol intake. Additional risk factors include a history of pelvic radiation, Pagets disease, rheumatoid arthritis, and multiple myeloma . (See "Osteoporotic fracture risk assessment", section on 'Clinical risk factor assessment'.)
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- Incidence and mortality
- Risk factors
- CLINICAL FEATURES
- Physical examination
- DIAGNOSTIC IMAGING
- Approach to imaging
- Plain radiograph
- Computed tomography
- Magnetic resonance imaging
- SPECT imaging
- DIFFERENTIAL DIAGNOSIS
- INITIAL MANAGEMENT
- DEFINITIVE MANAGEMENT
- Specialty consultation
- SUMMARY AND RECOMMENDATIONS