LOW-ENERGY OSTEOPOROTIC INJURIES OF THE PELVIC RING WITH UNILATERAL DORSAL DISPLACEMENT

Relevance. With increasing life expectancy, the incidence of osteoporotic low-energy pelvic ring injuries is increasing. These injuries, accompanied by displacement and instability of the posterior pelvic ring, require, according to most authors, urgent open reduction and internal fixation. However, the potential for minimally invasive treatment options for posterior osteoporotic low-energy pelvic ring injuries with displacement has not been adequately studied. The aim of this study was to analyze the treatment outcomes for low-energy osteoporotic pelvic ring injuries with unilateral dorsal displacement. Materials and methods. A controlled study (2018-2023) included 18 patients with low-energy osteoporotic pelvic ring injuries with unilateral dorsal displacement. One 91-year-old female patient developed progressive cardiac and pulmonary failure after a pelvic injury and received intensive care. Four patients aged 71–76 years (mean age 73.8 years) were treated conservatively due to the functional decline of surgery in two patients and the presence of severe dementia and cognitive impairment, considered a contraindication to surgery in two. In 10 patients aged 64–87 years (mean age 75.5 years) without a vertical component of dorsal displacement of the pelvic ring, minimally invasive orthopedic correction and percutaneous pelvic stabilization were performed. In three patients aged 54, 58, and 69 years with a vertical component of dorsal displacement of the pelvic ring, open reduction and osteosynthesis of the dorsal pelvic half-ring were performed using S1-iliac and lumbopelvic fixators. The results were assessed using the modified Majeed scale. Results. One 91-year-old female patient died in the early post-traumatic period in the intensive care unit due to progression of cardiac and respiratory failure during intensive treatment. The results of conservative functional treatment were excellent in 25% of patients and poor in 75%, minimally invasive stabilization of the pelvic ring - excellent in 77.8% and good in 22.2%, open reduction and osteosynthesis of the dorsal pelvic half-ring - excellent in all. Conclusions. Thus, the poor results of conservative functional treatment for low-energy osteoporotic pelvic ring injuries with unilateral dorsal displacement in 75% of patients demonstrates the ineffectiveness of this treatment for these injuries and the need for careful analysis and correction of comorbid conditions considered contraindications to surgical pelvic stabilization. The achievement of only excellent and good results in our study with percutaneous pelvic ring stabilization for low-energy osteoporotic injuries with unilateral dorsal displacement without a vertical component allows us to consider this type of surgical treatment as the primary treatment for these injuries. The use of S1-iliac and lumbopelvic fixators for the correction of irreversible vertical unilateral dorsal displacements in low-energy osteoporotic pelvic ring injuries with minimally invasive techniques allows us to achieve excellent outcomes.