Clinical challenges and innovations in the treatment of pelvic fractures

Abstract

Pelvic fractures occur in two distinct patient populations: young patients following high-energy trauma and, with increasing frequency, frail elderly patients after low-energy injury. Optimal diagnostic and treatment algorithms for fragility fractures of the pelvis (FFP) remain lacking. This thesis demonstrates that routine CT imaging in geriatric patients presenting with a pelvic ring fracture at the emergency department is not routinely indicated. Additional posterior fractures, for which CT is generally performed, have limited clinical consequences, as treatment is primarily dictated by the patient's pain levels and mobility. Persistent pain and reduced mobility following an initial period of conservative treatment are indications for minimally invasive surgical fixation. Strict follow-up remains essential. When surgical intervention is indicated, percutaneous screw fixation is the preferred approach in this frail patient population. 3D-navigated screw fixation demonstrates high accuracy with a very low risk of screw misplacement and consequently no neurovascular injury at the sacral neuroforamina. Hardware removal appears to be necessary primarily in younger patients with persistent pain and seems to result in meaningful clinical improvement, although the precise underlying mechanism remains unclear. This thesis aims to contribute to more refined indications for both diagnostics and surgical intervention, and broader implementation of 3D navigation techniques in the fixation of pelvic fractures.