As we age, our bone density decreases, creating greater risk of fractures of the pelvis. Women especially are at increased risk of fractures due to hormonal changes experienced durin menopause that directly affect bone density and strength. Men in their 70s experience a similar weakening of their bones due to the loss of testosterone, affecting bone density.

Some facts about FFP:

• It is estimated there will be more than 150,000 geriatric pelvic fractures in 2023, 75% of which will be diagnosed in women.1,2
• FFP diagnoses are increasing in many countries due to longer life expectancy.3
• The growing use of computed tomography (CT) and magnetic resonance imaging (MRI) enables healthcare providers to better diagnose FFP.3

While the most common cause of FFP is a fall from a standing or sitting position, a pelvic fragility fracture may also occur spontaneously in patients with severe osteoporosis or low-bone density.4 In these cases, the bones of the pelvis break in the areas where resistance is lowest.3 People who have osteoporosis, long-term immobility, long-term cortisone intake and/or who underwent radiation treatment in the pelvic area, such as for cancer, are at greater risk of FFP.3

Nonsurgical treatment for FFP

Today, the most common treatment for geriatric pelvic fractures is nonsurgical, also referred to as conservative management. This includes bed rest to help minimize symptoms, physical therapy, and mobility aids such as crutches or walker, as well as prescription medication for pain relief.5 However, conservatively managed patients often experience a worsening of symptoms leading to lengthy hospitalizations, functional decline, high nursing home admittance, and a higher rate of mortality compared to geriatric patients who don’t sustain a pelvic fracture. 

The importance of surgical treatment

Like fragility fractures of the hip, FFP are very painful and can result in long periods of immobility; however, only 10% of FFP patients undergo surgery today, compared to 95% of hip fracture patients. The goal of surgery for FFP is to stabilize the broken bones to alleviate the pain, increasing the likelihood of mobilization (the ability to get up and move/walk) while fracture healing takes place, which can take up to 12 weeks. This is especially important for geriatric patients who often suffer from other health issues that put them at greater risk of complications when they can’t mobilize, even if only for a few days. 

Limitations of conventional surgical treatment

Today, many FFP patients who are treated surgically are treated with conventional methods. These methods fix pelvic fractures using bone plates and straight screws which, given the curved nature of the pelvic bone, have limitations when used to treat FFP. Specifically:

• Surgeries with bone plates are invasive with longer surgical times, resulting in higher blood loss, risk of implant loosening and failure, and higher risk of post operative infections than minimally invasive options. 
• Straight screws are implanted with a minimally invasive surgery but have limitations and challenges for patients with FFP. The curviness of the pelvic bone can limit the width and length of the screw used, leading to a high risk of screw loosening, failure or backout, which creates instability in the broken bone(s).8-11

Curved fixation for FFP

CurvaFix offers a revolutionary surgical option for FFP patients—intramedullary (in the bone canal) fixation of the pelvis with the CurvaFix® IM Implant, available in 7.5mm and 9.5mm sizes. 

Advantages of the CurvaFix IM implant:

• The CurvaFix IM Implant has the ability to follow the natural curved bones of the pelvis, allowing a wider and longer implant to be used.
• The larger implant reaches and crosses the fracture site and fills the space inside the bone, creating strong, stable fixation as the pressure from the fracture is distributed along the length of the device.
• Once the implant is locked in place, it holds the fractured bone(s) together with the intent of reducing fracture instability, decreasing pain, and increasing the likelihood of early mobility and faster recovery for patients.
• The CurvaFix IM Implant is inserted using a minimally invasive procedure that is typically faster than open alternatives with less blood loss, less anesthesia time, and lower risk of infection. 

To date, more than 300 patients have been treated with the CurvaFix procedure, more than 60% of whom are geriatric and/or suffer from FFP. According to Mark Foster, CEO of CurvaFix:

“The new, smaller, 7.5mm device is designed to address fractures in smaller boney pathways, providing surgeons with the ability to treat more patients and more fracture types with a curved device. Additionally, surgeons have reported that our novel device has been shown to offer many geriatric patients immediate pain relief and early mobility, which is critically important in older patients for whom mobility is such a key to life.

“Loss of autonomy, disability and even death are potentially the tragic outcomes for patients suffering from FFP. With this novel treatment option, the future is more hopeful.”

Patients and families should ask their doctors which solutions for FFP will allow the patient to walk or mobilize soon after surgery and reduce the risk of complications post-surgery.

References

1. Burge R, Dawson-Hughes B, Solomon DH, et al. Incidence and Economic Burden of Osteoporosis-Related Fractures in the United States. 2005–2025. J Bone Miner Res. 2006;22(3):465–475. doi: 10.1359/jbmr.061113
2. Soles G, Ferguson T. Fragility Fractures of the Pelvis. Curr Rev Musculoskelet Med. 2012;5:222–228. doi: 10.1007/s12178-012-9128-9
3. Rommens PM, Hofmann A. Fragility fractures of the pelvis: An update. Journal of Musculoskeletal Surgery and Research. 2022;7(1):1–10. doi: 10.25259/JMSR_141_202
4. Rommens PM, Hofmann A. Comprehensive classification of fragility fractures on the pelvic ring: Recommendations for surgical treatment. Injury. 2013;44(12):1733–1744. https://doi.org/10.1016/j.injury.2013.06.023
5. MedicalNewsToday. What are the treatment options for pelvic fractures in older adults? 2023. https://www.medicalnewstoday.com/articles/pelvic-fracture-treatment-in-elderly
6. Wilson DGG, Kelly J, and Rickman M. Operative management of fragility fractures of the pelvis – a systematic review. BMC Muscoskeletal Disorders. 2021;22:717. https://doi.org/10.1186/s12891-021-04579-w
7. Yanagisawa Y, Watanabe Y, Matsumoto Y, et al. Closed reduction and minimally invasive surgical treatment of type IIIa fragility fractures of the pelvis associated with ipsilateral periprosthetic femur fracture: A case report. 2020 Dec;30:100374. doi: 10.1016/j.tcr.2020.100374
8. Griffin DR, Starr AJ, Reinert CM, Jones AL, Whitlock S. Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict fixation failure? J Orthop Trauma. 2006 Jan;20(1 Suppl):S30-6; discussion S36. 
9. Starr AJ, Nakatani T, Reinert CM, Cederberg K. Superior pubic ramus fractures fixed with percutaneous screws: what predicts fixation failure? J Orthop Trauma. 2008 Feb;22(2):81-7
10. Eckardt H, Egger A, Hasler RM, Zech CJ, Vach W, Suhm N, Morgenstern M, Saxer F. Good functional outcome in patients suffering fragility fractures of the pelvis treated with percutaneous screw stabilisation: Assessment of complications and factors influencing failure. Injury. 2017 Dec;48(12):2717-2723.
11. Wagner D, Hofmann A, Kamer L, Sawaguchi T, Richards RG, Noser H, Gruszka D, Rommens PM. Fragility fractures of the sacrum occur in elderly patients with severe loss of sacral bone mass. Arch Orthop Trauma Surg. 2018 Jul;138(7):971-977