Chirurgische Versorgung typischer osteoporotischer Frakturen

Zusammenfassung

Die steigende Inzidenz Osteoporose-assoziierter Frakturen stellt eine zunehmende Herausforderung für die operative Versorgung dar. Diese Arbeit bietet einen Überblick über die aktuellen Strategien zur Versorgung der häufigsten osteoporotischen Frakturen. Ziel ist es Wissen über aktuelle Techniken zu vermitteln und für spezifische Herausforderungen zu sensibilisieren. Hierzu wurde eine Übersicht über operative Verfahren für Frakturen des proximalen Femurs, des Beckens, der Wirbelsäule, des distalen Radius und des proximalen Humerus erstellt. Die operative Versorgung Osteoporose-assoziierter Frakturen erfordert aufgrund der verminderten Knochenqualität und -quantität sowie der häufigen Multimorbidität der Patienten einige Besonderheiten. Zunehmend angewendet werden verschiedene Augmentationstechniken, die die Stabilität von Osteosynthesen steigern und eine frühzeitige Mobilisation ermöglichen. Bei Frakturen der Wirbelsäule und des Beckenringes hat die schmerzbedingte Immobilität oftmals fatale Folgen für die Betroffenen. Die operative Versorgung beinhaltet hier einen teilweise präventiven Aspekt. Minimalinvasive Verfahren, wie die perkutane Schraubenosteosynthese bei Beckenringfrakturen, haben sich als risikoarme Methode etabliert. Die Kyphoplastie bei osteoporotischen Wirbelkörperfrakturen kann durch eine Hybrid-Versorgung mit zusätzlicher dorsaler Instrumentierung ergänzt werden. Vor allem bei Frakturen der oberen Extremität hat die konservative Therapie weiterhin ihren Stellenwert. Hüftgelenksnahe Femurfrakturen werden unmittelbar operativ versorgt. Weitere Forschung ist notwendig, um evidenzbasierte Standardverfahren für die Anwendung von Augmentationstechniken bei verschiedenen Frakturtypen zu etablieren.

Abstract

The rising incidence of osteoporotic fractures presents an increasing challenge for surgical treatment. This work provides an overview of the current strategies for managing the most common osteoporotic fractures. The aim is to share knowledge on modern techniques and raise awareness of specific challenges. A review of surgical procedures for fractures of the proximal femur, pelvis, spine, distal radius, and proximal humerus was conducted. The surgical management of osteoporotic fractures requires special considerations due to the reduced bone quality and quantity, as well as the frequent multimorbidity of the patients. Various augmentation techniques are increasingly being used to enhance the stability of osteosyntheses and enable early mobilization. In fractures of the spine and pelvic ring, pain-induced immobility often has severe consequences for patients. Here, surgical intervention can also have a preventive aspect. Minimally invasive techniques, such as percutaneous screw osteosynthesis for pelvic ring fractures, have proven to be low-risk methods. Kyphoplasty for osteoporotic vertebral fractures can be supplemented by hybrid techniques with additional dorsal instrumentation. Conservative treatment still holds a significant role, particularly for fractures of the upper extremity, while hip fractures near the joint are treated surgically without delay. Further research is needed to establish evidence-based standards for the use of augmentation techniques across various fracture types.

Schlüsselwörter

Alterstraumatologie - Augmentation - Fragilitätsfrakturen - Osteoporose - Alterschirurgie

Keywords

orthogeriatric comanagement - augmentation - fragility fractures - osteoporosis - geriatric surgery

Publikationsverlauf

Eingereicht: 01. Oktober 2024

Artikel online veröffentlicht:
22. November 2024

• Literatur

• 1 Rupp M, Walter N, Pfeifer C, Lang S, Kerschbaum M, Krutsch W, Baumann F, Alt V. The Incidence of Fractures Among the Adult Population of Germany–an Analysis From 2009 through 2019. Deutsches Ärzteblatt international 2021; 118: 665-669
• 2 Ström O, Borgström F, Kanis JA, Compston J, Cooper C, McCloskey EV, Jönsson B. Osteoporosis: burden, health care provision and opportunities in the EU: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Archives of Osteoporosis 2011; 6: 59-155
• 3 Dyer SM, Crotty M, Fairhall N, Magaziner J, Beaupre LA, Cameron ID, Sherrington C. A critical review of the long-term disability outcomes following hip fracture. BMC geriatrics 2016; 16: 158
• 4 Maier GS, Kolbow K, Lazovic D, Horas K, Roth KE, Seeger JB, Maus U. Risk factors for pelvic insufficiency fractures and outcome after conservative therapy. Archives of gerontology and geriatrics 2016; 67: 80-85
• 5 Loggers SAI, Joosse P, Jan Ponsen K. Outcome of pubic rami fractures with or without concomitant involvement of the posterior ring in elderly patients. European journal of trauma and emergency surgery: official publication of the European Trauma Society 2019; 45: 1021-1029
• 6 Wicklein S, Gosch M. Osteoporose und Multimorbidität. Zeitschrift fur Gerontologie und Geriatrie 2019; 52: 433-439
• 7 Eickhoff AM, Cintean R, Fiedler C, Gebhard F, Schütze K, Richter PH. Analysis of partial weight bearing after surgical treatment in patients with injuries of the lower extremity. Archives of Orthopaedic and Trauma Surgery 2022; 142: 77-81
• 8 Pankratz C, Dehner C, Gebhard F, Schuetze K. Augmentationstechniken zur Versorgung osteoporoseassoziierter Frakturen der Extremitäten. Unfallchirurgie (Heidelberg, Germany) 2024; 127: 253-262
• 9 Windolf M. Biomechanik der Implantataugmentation. Der Unfallchirurg 2015; 118: 765-771
• 10 Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D. Risk of Mortality Following Clinical Fractures. Osteoporosis International 2000; 11: 556-561
• 11 Muratore M, Ferrera A, Masse A, Bistolfi A. Osteoporotic vertebral fractures: predictive factors for conservative treatment failure. A systematic review. European Spine Journal 2018; 27: 2565-2576
• 12 Park J-S, Park Y-S. Survival analysis and risk factors of new vertebral fracture after vertebroplasty for osteoporotic vertebral compression fracture. The Spine Journal 2021; 21: 1355-1361
• 13 Bo J, Zhao X, Hua Z, Li J, Qi X, Shen Y. Impact of sarcopenia and sagittal parameters on the residual back pain after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fracture. Journal of orthopaedic surgery and research 2022; 17: 111
• 14 Rodriguez AJ, Fink HA, Mirigian L, Guañabens N, Eastell R, Akesson K, Bauer DC, Ebeling PR. Pain, Quality of Life, and Safety Outcomes of Kyphoplasty for Vertebral Compression Fractures: Report of a Task Force of the American Society for Bone and Mineral Research. Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 2017; 32: 1935-1944
• 15 Zhu R-S, Kan S-L, Ning G-Z, Chen L-X, Cao Z-G, Jiang Z-H, Zhang X-L, Hu W. Which is the best treatment of osteoporotic vertebral compression fractures: balloon kyphoplasty, percutaneous vertebroplasty, or non-surgical treatment? A Bayesian network meta-analysis. Osteoporosis International 2019; 30: 287-298
• 16 Wang B, Zhao C-P, Song L-X, Zhu L. Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral compression fracture: a meta-analysis and systematic review. Journal of orthopaedic surgery and research 2018; 13: 264
• 17 Pron G, Hwang M, Smith R, Cheung A, Murphy K. Cost-effectiveness studies of vertebral augmentation for osteoporotic vertebral fractures: a systematic review. The Spine Journal 2022; 22: 1356-1371
• 18 Ullrich BW, Schenk P, Scheyerer MJ, Bäumlein M, Katscher S, Schnake KJ, Zimmermann V, Schwarz F, Schmeiser G, Scherer M, Müller M, Sprengel K, Osterhoff G, Liepold K, Schramm S, Baron C, Siekmann H, Franck A, Isik N, Klauke F, Spiegl UJA. Georg Schmorl prize of the German spine society (DWG) 2022: current treatment for inpatients with osteoporotic thoracolumbar fractures-results of the EOFTT study, European spine journal: official publication of the European Spine Society. the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2023; 32: 1525-1535
• 19 Blattert TR, Schnake KJ, Gonschorek O, Gercek E, Hartmann F, Katscher S, Mörk S, Morrison R, Müller M, Partenheimer A, Piltz S, Scherer MA, Ullrich BW, Verheyden A. Zimmermann V. Nonsurgical and Surgical Management of Osteoporotic Vertebral Body Fractures: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global spine journal 2018; 8: 50S-55S
• 20 Pawar A, Badhe V, Gawande M. Treatment of Osteoporotic Compression Fractures at Thoracolumbar Spine With Neurodeficit: Short-Segment Stabilization With Cement-Augmented Fenestrated Pedicle Screws and Vertebroplasty by Minimally Invasive Percutaneous Technique. International journal of spine surgery 2022; 16: 465-471
• 21 Aboud N, Eckardt N, Kamp MA, Senft C, Schwarz F. Occurrence of adjacent segment fractures after surgical treatment of an osteoporotic vertebral fracture: a retrospective comparison between two different treatment methods. Archives of orthopaedic and trauma surgery 2023; 143: 2333-2339
• 22 Cheng Y, Li Y, Cheng X, Mu J, Wu J, Wu H. Incidence and risk factors of adjacent vertebral fracture after percutaneous vertebroplasty or kyphoplasty in postmenopausal women: a retrospective study. Scientific Reports 2024; 14: 1-8
• 23 Rapp K, Büchele G, Dreinhöfer K, Bücking B, Becker C, Benzinger P. Epidemiologie von Hüftfrakturen: Systematisches Literaturreview deutscher Daten und ein Überblick über die internationale Literatur. Zeitschrift fur Gerontologie und Geriatrie 2019; 52: 10-16
• 24 Williamson S, Landeiro F, McConnell T, Fulford-Smith L, Javaid MK, Judge A, Leal J. Costs of fragility hip fractures globally: a systematic review and meta-regression analysis. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 2017; 28: 2791-2800
• 25 Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, Debeer J, Bhandari M. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ: Canadian Medical Association journal = journal de l'Association medicale canadienne 2010; 182: 1609-1616
• 26 Xu BY, Yan S, Low LL, Vasanwala FF, Low SG. Predictors of poor functional outcomes and mortality in patients with hip fracture: a systematic review. BMC Musculoskeletal Disorders 2019; 20: 568
• 27 Moja L, Piatti A, Pecoraro V, Ricci C, Virgili G, Salanti G, Germagnoli L, Liberati A, Banfi G. Timing Matters in Hip Fracture Surgery: Patients Operated within 48 Hours Have Better Outcomes. A Meta-Analysis and Meta-Regression of over 190,000 Patients. PLoS ONE 2012; 7: e46175
• 28 Gemeinsamer Bundesausschuss. Richtlinie des Gemeinsamen Bundesausschusses über Maßnahmen zur Qualitätssicherung zur Versorgung von Patienten mit einer hüftgelenknahen Femurfraktur gemäß § 136 Absatz 1 Satz 1 Nummer 2 für nach § 108 SGB V zugelassene Krankenhäuser. Richtlinie zur Versorgung der hüftgelenknahen Femurfraktur/QSFFx-RL 2023.
• 29 Bhandari M, Swiontkowski M. Management of Acute Hip Fracture. The New England journal of medicine 2017; 377: 2053-2062
• 30 Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH Investigators.). Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial. Lancet (London, England) 2017; 389: 1519-1527
• 31 Krupik Y, Haziza S, Thein R. Dynamic Locking Plate versus Multiple Cancellous Screws for the Fixation of Intracapsular Femoral Neck Fractures: Long-Term Results and Quality-Of-Life Assessment Based on Patient-Reported Outcome Measures. Journal of Clinical Medicine 2024; 13: 1123
• 32 Schuetze K, Burkhardt J, Pankratz C, Eickhoff A, Boehringer A, Degenhart C, Gebhard F, Cintean R. Is new always better: comparison of the femoral neck system and the dynamic hip screw in the treatment of femoral neck fractures. Archives of Orthopaedic and Trauma Surgery 2023; 143: 3155-3161
• 33 Xia Y, Zhang W, Zhang Z, Wang J, Yan L. Treatment of femoral neck fractures: sliding hip screw or cannulated screws? A meta-analysis. Journal of orthopaedic surgery and research 2021; 16: 54
• 34 Ramadanov N, Jóźwiak K, Hauptmann M, Lazaru P, Marinova-Kichikova P, Dimitrov D, Becker R. Cannulated screws versus dynamic hip screw versus hemiarthroplasty versus total hip arthroplasty in patients with displaced and non-displaced femoral neck fractures: a systematic review and frequentist network meta-analysis of 5703 patients. Journal of orthopaedic surgery and research 2023; 18: 625
• 35 Bhandari M, Einhorn TA, Guyatt G, Schemitsch EH, Zura RD, Sprague S, Frihagen F, Guerra-Farfán E, Kleinlugtenbelt YV, Poolman RW, Rangan A, Bzovsky S, Heels-Ansdell D, Thabane L, Walter SD, Devereaux PJ. Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture. The New England journal of medicine 2019; 381: 2199-2208
• 36 Li N, Zhong L, Wang C, Xu M, Li W. Cemented versus uncemented hemi-arthroplasty for femoral neck fractures in elderly patients: A systematic review and meta-analysis of randomized controlled trials. Medicine 2020; 99: e19039
• 37 Li L, Zhao X, Yang X, Yang L, Xing F, Tang X. Cemented versus uncemented hemiarthroplasty for the management of femoral neck fractures in the elderly: a meta-analysis and systematic review. Archives of Orthopaedic and Trauma Surgery 2021; 141: 1043-1055
• 38 Xu H, Liu Y, Sezgin EA, Tarasevičius Š, Christensen R, Raina DB, Tägil M, Lidgren L. Comparative effectiveness research on proximal femoral nail versus dynamic hip screw in patients with trochanteric fractures: a systematic review and meta-analysis of randomized trials. Journal of orthopaedic surgery and research 2022; 17: 292
• 39 Lobo-Escolar A, Joven E, Iglesias D, Herrera A. Predictive factors for cutting-out in femoral intramedullary nailing. Injury 2010; 41: 1312-1316
• 40 Kammerlander C, Hem ES, Klopfer T, Gebhard F, Sermon A, Dietrich M, Bach O, Weil Y, Babst R, Blauth M. Cement augmentation of the Proximal Femoral Nail Antirotation (PFNA) – A multicentre randomized controlled trial. Injury 2018; 49: 1436-1444
• 41 Kammerlander C, Doshi H, Gebhard F, Scola A, Meier C, Linhart W, Garcia-Alonso M, Nistal J, Blauth M. Long-term results of the augmented PFNA: a prospective multicenter trial. Archives of Orthopaedic and Trauma Surgery 2013; 134: 343-349
• 42 Schuetze K, Ehinger S, Eickhoff A, Dehner C, Gebhard F, Richter PH. Cement augmentation of the proximal femur nail antirotation: is it safe?. Archives of Orthopaedic and Trauma Surgery 2021; 141: 803-811
• 43 Chen Y, Chen X, Li Z, Yan H, Zhou F, Gao W. Safety and Efficacy of Operative Versus Nonsurgical Management of Distal Radius Fractures in Elderly Patients: A Systematic Review and Meta-analysis. The Journal of hand surgery 2016; 41: 404-413
• 44 Luokkala T, Laitinen MK, Hevonkorpi TP, Raittio L, Mattila VM, Launonen AP. Distal radius fractures in the elderly population. EFORT open reviews 2020; 5: 361-370
• 45 Hohmann E, Keough N, Glatt V, Tetsworth K. Surgical treatment is not superior to nonoperative treatment for displaced proximal humerus fractures: a systematic review and meta-analysis. Journal of shoulder and elbow surgery 2023; 32: 1105-1120
• 46 Barlow JD, Logli AL, Steinmann SP, Sems SA, Cross WW, Yuan BJ, Torchia ME, Sanchez-Sotelo J. Locking plate fixation of proximal humerus fractures in patients older than 60 years continues to be associated with a high complication rate. Journal of shoulder and elbow surgery 2020; 29: 1689-1694
• 47 Porschke F, Bockmeyer J, Nolte P-C, Studier-Fischer S, Guehring T, Schnetzke M. More Adverse Events after Osteosyntheses Compared to Arthroplasty in Geriatric Proximal Humeral Fractures Involving Anatomical Neck. Journal of Clinical Medicine 2021; 10: 979
• 48 Krappinger D, Bizzotto N, Riedmann S, Kammerlander C, Hengg C, Kralinger FS. Predicting failure after surgical fixation of proximal humerus fractures. Injury 2011; 42: 1283-1288
• 49 Biermann N, Prall WC, Böcker W, Mayr HO, Haasters F. Augmentation of plate osteosynthesis for proximal humeral fractures: a systematic review of current biomechanical and clinical studies. Archives of Orthopaedic and Trauma Surgery 2019; 139: 1075-1099
• 50 Etemad-Rezaie A, Dienes S, Gohal C, Politis-Barber V, Searle S, Nam D, Sheth U. Bone grafting augmentation choices in complex proximal humerus fractures: A systematic review. Journal of Orthopaedics. 2024
• 51 Röderer G, Scola A, Schmölz W, Gebhard F, Windolf M, Hofmann-Fliri L. Biomechanical in vitro assessment of screw augmentation in locked plating of proximal humerus fractures. Injury 2013; 44: 1327-1332
• 52 Schuetze K, Boehringer A, Cintean R, Gebhard F, Pankratz C, Richter PH, Schneider M, Eickhoff AM. Feasibility and Radiological Outcome of Minimally Invasive Locked Plating of Proximal Humeral Fractures in Geriatric Patients. Journal of Clinical Medicine 2022; 11: 6751
• 53 Katthagen JC, Lutz O, Voigt C, Lill H, Ellwein A. Cement augmentation of humeral head screws reduces early implant-related complications after locked plating of proximal humeral fractures. Obere Extremität 2018; 13: 123-129
• 54 Shi BY, Upfill-Brown A, Kelley BV, Brodke DJ, Mayer EN, Devana SK, Kremen TJ, Lee C. Increasing Rate of Shoulder Arthroplasty for Geriatric Proximal Humerus Fractures in the United States, 2010-2019. Journal of shoulder and elbow arthroplasty 2022; 6 24715492221137186
• 55 Klug A, Harth J, Hoffmann R, Gramlich Y. Surgical treatment of complex proximal humeral fractures in elderly patients: a matched-pair analysis of angular-stable plating vs. reverse shoulder arthroplasty. Journal of shoulder and elbow surgery 2020; 29
• 56 Lanzetti RM, Gaj E, Berlinberg EJ, Patel HH, Spoliti M. Reverse Total Shoulder Arthroplasty Demonstrates Better Outcomes Than Angular Stable Plate in the Treatment of Three-part and Four-part Proximal Humerus Fractures in Patients Older Than 70 Years. Clinical orthopaedics and related research 2023; 481: 735-747
• 57 Fraser AN, Bjørdal J, Wagle TM, Karlberg AC, Lien OA, Eilertsen L, Mader K, Apold H, Larsen LB, Madsen JE, Fjalestad T. Reverse Shoulder Arthroplasty Is Superior to Plate Fixation at 2 Years for Displaced Proximal Humeral Fractures in the Elderly: A Multicenter Randomized Controlled Trial. The Journal of bone and joint surgery. American volume 2020; 102: 477-485
• 58 Filip A, Veliceasa B, Puha B, Filip N, Cojocaru E, Pertea M, Carp CA, Huzum B, Alexa O, Rommens PM. Pain Intensity and Degree of Disability after Fragility Fractures of the Pelvis. Medicina (Kaunas, Lithuania) 2022; 58
• 59 Lodde MF, Katthagen JC, Riesenbeck O, Raschke MJ, Hartensuer R. Trends in der operativen Therapie von Frakturen des Beckenrings: Eine bundesweite Analyse von OPS-Daten zwischen 2005 und 2017. Der Unfallchirurg 2021; 124: 373-381
• 60 Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: Recommendations for surgical treatment. Injury 2013; 44: 1733-1744
• 61 Rommens PM, Wagner D, Hofmann A. Surgical management of osteoporotic pelvic fractures: a new challenge. European journal of trauma and emergency surgery: official publication of the European Trauma Society 2012; 38: 499-509
• 62 Gibbs WN, Doshi A. Sacral Fractures and Sacroplasty. Neuroimaging clinics of North America 2019; 29: 515-527
• 63 Bastian JD, Keel MJB, Heini PF, Seidel U, Benneker LM. Complications related to cement leakage in sacroplasty. Acta orthopaedica Belgica 2012; 78: 100-105
• 64 Rommens PM, Hofmann A, Kraemer S, Kisilak M, Boudissa M, Wagner D. Operative treatment of fragility fractures of the pelvis: a critical analysis of 140 patients. European journal of trauma and emergency surgery: official publication of the European Trauma Society 2022; 48: 2881-2896
• 65 Schmitz P, Baumann F, Grechenig S, Gaensslen A, Nerlich M, Müller MB. The cement-augmented transiliacal internal fixator (caTIFI): an innovative surgical technique for stabilization of fragility fractures of the pelvis. Injury 2015; 46: S114-S120
• 66 Mendel T, Schenk P, Ullrich BW, Hofmann GO, Goehre F, Schwan S, Klauke F. Mid-term outcome of bilateral fragility fractures of the sacrum after bisegmental transsacral stabilization versus spinopelvic fixation. The bone & joint journal 2021; 103-B: 462-468
• 67 Mehling I, Hessmann MH, Rommens PM. Stabilization of fatigue fractures of the dorsal pelvis with a trans-sacral bar. Operative technique and outcome, Injury 2012; 43: 446-451
• 68 Schuetze K, Eickhoff A, Dehner C, Blidon A, Gebhard F, Richter PH. Short-term outcome of fragility fractures of the pelvis in the elderly treated with screw osteosynthesis and external fixator. European journal of trauma and emergency surgery: official publication of the European Trauma Society 2022; 48: 2413-2420
• 69 Wagner D, Ossendorf C, Gruszka D, Hofmann A, Rommens PM. Fragility fractures of the sacrum: how to identify and when to treat surgically?. European journal of trauma and emergency surgery: official publication of the European Trauma Society 2015; 41: 349-362
• 70 Richter PH, Blidon A, Eickhoff A, Gebhard F, Schuetze K. Accuracy of screw stabilization of the dorsal pelvic ring using a hybrid operating room: 5 Year experience in a level 1 trauma center. Injury 2021; 52: 2968-2972
• 71 Cintean R, Fritzsche C, Zderic I, Gueorguiev-Rüegg B, Gebhard F, Schütze K. Sacroiliac versus transiliac-transsacral screw osteosynthesis in osteoporotic pelvic fractures: a biomechanical comparison. European journal of trauma and emergency surgery: official publication of the European Trauma Society 2023; 49: 2553-2560
• 72 Zwingmann J, Hauschild O, Bode G, Südkamp NP, Schmal H. Malposition and revision rates of different imaging modalities for percutaneous iliosacral screw fixation following pelvic fractures: a systematic review and meta-analysis. Archives of orthopaedic and trauma surgery 2013; 133: 1257-1265
• 73 van den Bosch EW, van Zwienen CMA, van Vugt AB. Fluoroscopic positioning of sacroiliac screws in 88 patients. The Journal of trauma 2002; 53: 44-48
• 74 Matityahu A, Kahler D, Krettek C, Stöckle U, Grutzner PA, Messmer P, Ljungqvist J, Gebhard F. Three-dimensional navigation is more accurate than two-dimensional navigation or conventional fluoroscopy for percutaneous sacroiliac screw fixation in the dysmorphic sacrum: a randomized multicenter study. Journal of orthopaedic trauma 2014; 28: 707-710
• 75 Wagner D, Ossendorf C, Gruszka D, Hofmann A, Rommens PM. Fragility fractures of the sacrum: how to identify and when to treat surgically?. European journal of trauma and emergency surgery: official publication of the European Trauma Society 2015; 41: 349-362
• 76 Herteleer M, Boudissa M, Hofmann A, Wagner D, Rommens PM. Plate fixation of the anterior pelvic ring in patients with fragility fractures of the pelvis. European journal of trauma and emergency surgery: official publication of the European Trauma Society 2022; 48: 3711-3719
• 77 Rose LD, Bateman G, Ahmed A. Clinical significance of cement leakage in kyphoplasty and vertebroplasty: a systematic review. European Spine Journal. 33. 1484-1489 2024