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Osteoporotic Fractures of the Pelvis, Hip and Femur: Current Challenges...
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Osteoporotic Fractures of the Pelvis, Hip and Femur: Current Challenges and New Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 10 April 2025 | Viewed by 3540

Special Issue Editor

Dr. Andreas Hoch

E-Mail Website
Guest Editor
Department for Orthopaedics, Trauma Surgery and Plastic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany
Interests: pelvic fracture; geriatric acetabular fracture; osteoporotic fractures of the pelvis; polytrauma; periprosthetic fracture; proximal femoral fracture

Special Issue Information

Dear Colleagues,

We cordially invite your expert contributions to our Special Issue of the Journal of Clinical Medicine. Osteoporotic fractures, particularly pelvic, periprosthetic and proximal femoral fractures, present intricate healthcare burdens globally. This issue delves into the latest advancements and novel approaches in managing these fractures and non-operative supportive therapies, including osteoporosis treatment. We encourage submissions showcasing innovative diagnostic techniques, surgical interventions, rehabilitation strategies and pharmaceutical approaches aimed at enhancing patient outcomes and quality of life. As Guest Editors, we aim to cultivate a deep understanding of the multifaceted aspects surrounding osteoporotic fractures, providing a platform for insightful discussions and evidence-based research. Your invaluable contributions will play a pivotal role in shaping the future landscape of osteoporotic fracture management. We eagerly anticipate your insights.

Dr. Andreas Hoch
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • osteoporosis
  • fracture management
  • pelvic fractures
  • periprosthetic fractures
  • proximal femoral fractures
  • non-operative therapies

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Published Papers (5 papers)

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Research

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8 pages, 1574 KiB  
Article
Comparison of Spectral CT and MRI in Pelvic Ring Fragility Fractures: A Prospective Diagnostic Accuracy Study
by Mark Unthan, Bernhard W. Ullrich, Camilla Heinen, Felix C. Kohler, Philipp Schenk, Tobias Franiel and Florian Bürckenmeyer
J. Clin. Med. 2024, 13(18), 5446; https://doi.org/10.3390/jcm13185446 - 13 Sep 2024
Viewed by 528
Abstract
Background/Objectives: Fragility fractures of the pelvis (FFP) are characterized by inadequate trauma to a structurally compromised bone, primarily in osteoporosis. Conventional CT studies can be inadequate in identifying FFPs. An MRI of the pelvis is considered the gold standard in diagnosing FFPs. Spectral [...] Read more.
Background/Objectives: Fragility fractures of the pelvis (FFP) are characterized by inadequate trauma to a structurally compromised bone, primarily in osteoporosis. Conventional CT studies can be inadequate in identifying FFPs. An MRI of the pelvis is considered the gold standard in diagnosing FFPs. Spectral CT or Dual-Energy CT may have comparable diagnostic accuracy. It provides additional insights into associated bone marrow edema. The aim of this prospective monocentric study is to evaluate the diagnostic accuracy of Spectral CT compared to the gold standard MRI in diagnosing FFP. Methods: Over a 2-year period, patients presenting in the emergency department with clinical suspicion of an FFP were consecutively included. They underwent Spectral CT (GE Revolution 16 cm GSI) upon admission, followed by an MRI. The gold standard for diagnosing FFP is pelvic MRI, showing sensitivity and specificity ranging from 97% to 100%. The acquired images were evaluated and classified using the osteoporotic fractures of the pelvis (OFP) classification. Results: Compared to the reference test, which was the MRI pelvis, the sensitivity of the CT pelvis was determined to be 86.8 (95% confidence interval (CI) 71.9–95.6%) with a specificity of 84.6% (95% CI: 54.6–98.1%, p = 0.453). Spectral CT could identify an additional FFP correctly, exhibiting a sensitivity of 89.5% (95% CI: 75.2–97.1%, p = 0.688), while maintaining the same specificity as the conventional CT. The inter-rater reliability assessment for Spectral CT, conducted by four independent raters, resulted in a Fleiss’ Kappa value of 0.516 (95% CI: 0.450–0.582, p < 0.001). Conclusion: The sensitivity of Spectral CT in the detection of pelvic ring fragility fractures shows a slightly lower sensitivity compared to MRI. There were no statistically significant differences observed when compared to conventional CT or MRI. In conclusion, Spectral CT may be beneficial in distinguishing FFP, particularly in cases where a definitive diagnosis is uncertain. Level of Evidence: II. Full article
(This article belongs to the Special Issue Osteoporotic Fractures of the Pelvis, Hip and Femur: Current Challenges and New Perspectives)
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14 pages, 3474 KiB  
Article
Lumbopelvic Stabilization with Two Methods of Triangular Osteosynthesis: A Biomechanical Study
by Niklas Grüneweller, Julia Leunig, Ivan Zderic, Boyko Gueorguiev, Christian Colcuc, Dirk Wähnert and Thomas Vordemvenne
J. Clin. Med. 2024, 13(16), 4744; https://doi.org/10.3390/jcm13164744 - 13 Aug 2024
Viewed by 630
Abstract
(1) Background: Pelvic fractures, and particularly instabilities of the dorsal pelvic ring, are becoming increasingly prevalent, particularly in orthogeriatric patients. Spino-pelvic triangular osteosynthesis is an effective approach to achieve sufficient stabilization in vertically unstable fractures. This study compares two types of osteosynthesis: [...] Read more.
(1) Background: Pelvic fractures, and particularly instabilities of the dorsal pelvic ring, are becoming increasingly prevalent, particularly in orthogeriatric patients. Spino-pelvic triangular osteosynthesis is an effective approach to achieve sufficient stabilization in vertically unstable fractures. This study compares two types of osteosynthesis: the conventional one and a novel instrumentation where the iliosacral screw is placed through a fenestrated iliac screw. (2) Methods: Sixteen artificial osteoporotic L5+pelvis models with an unstable sacral fracture have been instrumented with either an iliac screw connected with a rod to a L5 pedicle screw and an iliosacral screw (TF) or a fenestrated ilium screw connected with a rod to a L5 pedicle screw and an iliosacral screw passing through the fenestra of the iliac screw (TFS). Biomechanical testing was performed using cyclic loading until failure. (3) Results: Both configurations yielded comparable results with regard to initial stiffness, implant loosening, and cycles to failure. The TFS exhibited markedly higher values for cycles to failure and markedly lower values for loosening. However, due to the characteristics of the artificial bone model, these findings were not significant. (4) Conclusions: The novel triangular fixation systems demonstrated comparable results to the standard triangular osteosynthesis configuration. Full article
(This article belongs to the Special Issue Osteoporotic Fractures of the Pelvis, Hip and Femur: Current Challenges and New Perspectives)
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12 pages, 1772 KiB  
Article
Early Hip Fracture Surgery in Patients Taking Direct Oral Anticoagulants Improves Outcome
by Benjamin K. Devlieger, Pol M. Rommens, Andreas Baranowski and Daniel Wagner
J. Clin. Med. 2024, 13(16), 4707; https://doi.org/10.3390/jcm13164707 - 11 Aug 2024
Viewed by 758
Abstract
Background/Objectives: The increasing numbers of already endemic hip fractures in the elderly taking anticoagulants is a growing concern for daily surgical practice. Ample evidence demonstrates decreased morbidity and mortality in the general population when surgery is performed at the earliest possibility. Direct [...] Read more.
Background/Objectives: The increasing numbers of already endemic hip fractures in the elderly taking anticoagulants is a growing concern for daily surgical practice. Ample evidence demonstrates decreased morbidity and mortality in the general population when surgery is performed at the earliest possibility. Direct anticoagulants are relatively new drugs that can cause increased perioperative bleeding. Current guidelines propose stopping the drug to allow for elimination before performing elective surgery. Optimal management in urgent hip surgery is presently based on expert opinion with arbitrary cut-offs. In this study, we investigated whether patients taking direct anticoagulants would benefit from early surgical treatment, regardless of the timing since last intake. Methods: A total of 340 patients were included in the analysis, of which 59 took direct anticoagulants. The primary outcomes were time to surgery, postoperative transfusion rate, postoperative hemoglobin decrease, length of postoperative in-hospital stay (LOPS), revision rate, and complication rate (medical and surgical). Results: Our findings showed that the anticoagulated group was fit for discharge earlier when operated on within 24 h (p = 0.0167). Postoperative transfusion and medical complication rate tended to be lower when the operation was performed earlier. Revision rate due to hematomas were higher in the direct anticoagulant group without a relationship to time to surgery. Simple linear regression could not determine a relationship between postoperative hemoglobin change and time to surgery. Conclusions: We suggest that directly anticoagulated patients needing hip fracture surgery must be considered for early surgery. Full article
(This article belongs to the Special Issue Osteoporotic Fractures of the Pelvis, Hip and Femur: Current Challenges and New Perspectives)
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15 pages, 2809 KiB  
Article
Treatment Trends and Epidemiologic Changes in Acetabular Fracture Management over the Course of 10 Years: An Analysis Based on 2853 Patients as Treated by the German Pelvic Multicenter Study Group
by Silvan Wittenberg, Daniel Rau, Melissa Paraskevaidis, Vera Jaecker, Ulrich Stöckle and Sven Märdian
J. Clin. Med. 2024, 13(16), 4601; https://doi.org/10.3390/jcm13164601 - 6 Aug 2024
Viewed by 615
Abstract
Background/Objectives: Acetabular fractures, traditionally linked to high-impact trauma in younger adults, are increasingly observed in the elderly due to falls and poor bone quality. This demographic shift necessitates updated treatment approaches. This study analyzes demographic trends and treatment evolution over a decade using [...] Read more.
Background/Objectives: Acetabular fractures, traditionally linked to high-impact trauma in younger adults, are increasingly observed in the elderly due to falls and poor bone quality. This demographic shift necessitates updated treatment approaches. This study analyzes demographic trends and treatment evolution over a decade using the German pelvic fracture registry. Methods: Data on acetabular fractures were analyzed from the German pelvic fracture registry of the German Trauma Society. Parameters included classification, demographics, treatment methods, and surgical details. Trends were assessed by grouping patients based on treatment intervals and age, comparing treatment methods, surgical approaches, and reduction quality across these groups, considering fracture types and treatment volume. Results: The study included 2853 unilateral acetabular fractures with a mean patient age of 61.5 years, showing an increasing age trend. A shift from simple to complex fractures involving the anterior acetabular column was observed. Operative treatment was performed in 62.5% of cases, more common in non-geriatric patients and those with posterior column involvement. The use of anterior intrapelvic approaches increased over time, replacing the Ilioinguinal extrapelvic approach. Anatomical reduction was achieved in 47.4% of cases, with 31.7% having imperfect reductions and 20.9% poor reductions. High-volume centers had significantly better reduction outcomes, particularly for simple fractures. Geriatric patients exhibited worse reduction quality compared to younger patients. In-hospital mortality was stable at 3.3%. Conclusions: The study highlights a demographic shift towards an older patient population, leading to more complex fracture patterns. Despite advancements in surgical techniques and new implant technologies, these demographic changes have resulted in lower reduction quality for complex fractures. Emphasis is placed on careful patient selection for reconstructive surgery or endoprosthetic replacement to ensure high-quality outcomes. Full article
(This article belongs to the Special Issue Osteoporotic Fractures of the Pelvis, Hip and Femur: Current Challenges and New Perspectives)
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Review

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14 pages, 32477 KiB  
Review
Treatment of Geriatric Acetabular Fractures Using the Modified Stoppa Approach: A Review Article of Technique, Tips, and Pitfalls
by Mikolaj Bartosik, Eckart Mayr and Ulf Culemann
J. Clin. Med. 2024, 13(19), 5867; https://doi.org/10.3390/jcm13195867 - 1 Oct 2024
Viewed by 565
Abstract
The surgical treatment of geriatric acetabular fractures is becoming increasingly important due to a demographic change in age. While acetabular fractures used to occur more frequently in younger patients, they are currently more prevalent in geriatric patients. This change has also led to [...] Read more.
The surgical treatment of geriatric acetabular fractures is becoming increasingly important due to a demographic change in age. While acetabular fractures used to occur more frequently in younger patients, they are currently more prevalent in geriatric patients. This change has also led to an increase in the frequency of anterior and combined anterior acetabular fractures. Surgery for geriatric acetabular fractures is very challenging, and surgeons need years of experience to be able to deal with the advantages and disadvantages of pelvic surgery. This is why a high level of surgical expertise is required. The aim of this article is to provide an insight into the topic of geriatric acetabular fractures with a critical narrative review of the current literature and a focus on minimally invasive surgical treatment using the modified Stoppa approach without patients’ own assessment. The modified Stoppa approach offers excellent visibility of the anterior structures of the acetabulum and can address the quadrilateral surface effectively. Pelvic surgery, in particular acetabular surgery, offers patients many advantages, such as rapid mobilization and the quick relief of pain symptoms. Total hip arthroplasty is currently being discussed as an alternative with good results for certain types of acetabular fractures in older patients, though it requires clarification of studies and recommendations. Full article
(This article belongs to the Special Issue Osteoporotic Fractures of the Pelvis, Hip and Femur: Current Challenges and New Perspectives)
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