Search Results (176)

Background: Pubic symphysis plating is a common method for stabilizing traumatic pubic symphysis disruptions, yet reported rates of implant failure vary widely in the literature. This variability may reflect inconsistent definitions and failure to distinguish clinically significant early construct failure from later asymptomatic postoperative radiographic changes. Methods: We performed a retrospective observational study of 30 patients with traumatic pubic symphysis disruption without associated fractures of the pubic body or pubic rami treated with open reduction and plate fixation. Pubic symphysis distance (PSD) was measured on admission CT, immediate postoperative anteroposterior pelvic radiographs, and follow-up CT scans obtained at 3, 6, and ≥12 months. Early mechanical failure, qualitative radiographic signs of implant loosening, and radiographic loss of reduction were predefined. Non-parametric tests were used to compare patients with and without early mechanical failure and to evaluate longitudinal PSD changes; analyses of potential associated factors were exploratory. Results: Early mechanical failure occurred in 4 patients (13.3%) within 30 days and presented as an acute symptomatic event with imaging-confirmed construct compromise requiring revision. In exploratory univariable analysis, early failure was more frequent in female patients and in those with obesity or osteoporosis, although these findings should be interpreted cautiously given the very small number of events. PSD changed significantly over time (p < 0.001), with minimal increase during the first 3 months, greater widening between 3 and 6 months, and little additional change thereafter. Qualitative radiographic signs of implant loosening and widening were observed in 8 patients (26.7%) during follow-up without clinically documented pain, instability, or need for revision. No clear association was demonstrated between PSD widening and final functional outcome measured by the Majeed score, although these analyses were limited by sample size and wide confidence intervals. Conclusions: In this retrospective cohort, postoperative radiographic widening and qualitative signs of implant loosening were not by themselves associated with clinically evident failure requiring revision during the available follow-up. Early failure was identified by acute clinical symptoms with imaging-confirmed construct compromise, whereas delayed widening was often observed without clinically documented pain, instability, or reoperation. These findings suggest that postoperative imaging should be interpreted together with symptoms and overall pelvic stability, while recognizing the methodological limitations of the study. Full article

Objectives: Management of unstable pelvic fractures during pregnancy presents a major therapeutic challenge, requiring careful multidisciplinary evaluation to balance maternal benefits and fetal radiation risks. Methods: We report the case of a 32-year-old patient who presented with a pelvic fracture due to a road traffic accident at three months of pregnancy. A left sacroiliac osteosynthesis was performed to treat a left sacroiliac diastasis with pelvic osteosynthesis using a trans-iliosacral approach under cone-beam CT (CBCT) guidance using a very-low-dose protocol. Radiation parameters and fetal dose estimates were calculated in advance in collaboration with a medical physicist. Tight beam collimation, a reduced field of view, and minimization of fluoroscopic checks were applied to keep fetal exposure as low as reasonably achievable. This article aims to demonstrate the feasibility of managing a complex pelvic fracture using interventional radiology and to review the literature on management options and gestational age-dependent fetal risks. Results: The estimated cumulative fetal dose from initial imaging, open surgery, and CBCT-guided osteosynthesis remained below 70 mGy using a pregnant phantom (Duke Organ Dose–Dosewatch–General Electric system), which is below thresholds associated with deterministic effects. The procedure achieved optimal screw positioning with less than 40 s of fluoroscopy. Maternal postoperative recovery was favorable, and follow-up revealed normal fetal development. Conclusions: This case demonstrates that CBCT-guided percutaneous iliosacral screw fixation can be safely performed during pregnancy with meticulous planning, dose-reduction strategies, and multidisciplinary collaboration, maintaining fetal radiation exposure below accepted safety thresholds. Full article

Background/Objectives: Uroflowmetry is done in the surveillance period after End-to-end Anastomotic Urethroplasty for pelvic fracture urethral injury. But is maximum flow rate a reliable surrogate for urethral calibre in these cases? The above question laid the foundation of the study. The aim of the study was: “Is uroflowmetry alone sufficient to predict a successful outcome following urethroplasty after pelvic fracture urethral injury (PFUI)?” Methods: We conducted a prospective masked study of all patients undergoing end-to-end anastomosis (EEA) urethroplasty for PFUI from January 2017 to September 2022. The first follow-up was 4 weeks after surgery, micturating cystourethrogram (MCU) was done after urethral catheter removal and at the same time, uroflowmetry was also done. The second follow-up was 6 months after surgery, when uroflowmetry was repeated, and urethroscopy was performed. The urologist performing urethroscopy was blinded to the uroflowmetry results. Results: In total, 26 patients were included in the study. After 6 months, 1 patient had poor flow (maximum flow rate [Q max] < 10 mL/s), 7 patients had flow with Q max 10–15 mL/s, and 18 patients had normal flow (Q max > 15 mL/s). On urethroscopy, all patients had a normal and easily passable urethra. The International Prostate Symptom Score (IPSS) and quality of life (QoL) scores showed a positive correlation. The urologist performing urethroscopy and the investigator recording uroflowmetry reached different conclusions. Conclusions: A reduced peak on uroflowmetry after EEA urethroplasty in PFUI does not always indicate surgical failure. Urethroscopy enables direct visualisation of the anastomotic site and provides more detailed information than uroflowmetry. The IPSS score and quality of life are more important than Q max alone. Full article

Background: Pelvic fractures in young patients are typically associated with high-energy trauma and long-term functional impairment. Young women may experience additional gender-specific sequelae following surgical treatment. This study aimed to evaluate functional outcomes and quality of life in young women following pelvic ring injuries. Methods: A retrospective cohort study was conducted including female patients of childbearing age (16–45 years) who sustained pelvic ring injuries and underwent surgical treatment at a single Level 1 trauma centre between 2009 and 2019. Validated PROMs were used to assess quality of life (EQ-5D, EQ-5D-VAS), and functional outcomes (Majeed Pelvic Score), along with a self-designed questionnaire to collect obstetric-related data. Radiographic measurements were performed to assess fracture reduction. PROM results were analysed descriptively and correlations between outcome scores were assessed using Pearson correlation. Results: A total of 32 patients completed all questionnaires and were included in the analysis. The mean EQ-5D index score was 0.61 (SD 0.31), the mean EQ-5D-VAS score was 68 (SD 24), and the mean Majeed Pelvic Score was 77 (SD 21). Most patients achieved good or excellent functional outcomes according to the Majeed score. Strong correlations were observed between PROM scores. Obstetric follow-up data were available for 21 patients; among these patients, 53% reported fear of pregnancy following the injury. Conclusions: Young women treated surgically for pelvic ring injuries demonstrated generally good pelvic-specific functional outcomes but lower quality-of-life scores compared with population norms. Obstetric concerns were commonly reported. Larger prospective studies are required to better understand long-term outcomes in this patient population. Full article

Background and Objectives: Ventral stabilization of thoracolumbar spine fractures can be achieved using different interbody reconstruction techniques, including titanium cages, vertebral body replacements (VBR), and autologous pelvic bone grafts (APBG). Although all approaches aim to restore anterior column stability and alignment, comparative data on long-term patient-reported outcomes remain limited. The objective of this study was to compare long-term patient-reported wellbeing following ventral stabilization using these three techniques. Materials and Methods: A retrospective, non-randomized single-center cohort study with prospective follow-up was analyzed. Treatment allocation was indication-based. Ninety-one patients treated between 2008 and 2018 underwent ventral stabilization using cage implantation (n = 12), vertebral body replacement (n = 45), or autologous pelvic bone grafting (n = 34). Clinical outcome was assessed at least 12 months postoperatively using a modified Visual Analog Scale Spine Score (VAS-Spine). Statistical analysis included linear and ordinal regression adjusted for age and sex. Potential baseline differences between groups were considered in the interpretation of the results. Results: Sixty-three patients (mean age 52 ± 15 years; 41% female) completed follow-up. The mean VAS-Spine score was lowest after cage implantation (2.7 ± 3.6), followed by VBR (3.9 ± 2.8) and APBG (4.9 ± 1.8; p* = 0.021). The observed difference between cage and APBG approached the minimal clinically important difference reported for VAS-based measures. Patients treated with cage implantation reported less pain during rest and activity and fewer limitations in daily life. No significant differences were observed regarding age or sex. Conclusions: In this observational cohort, cage implantation was associated with more favorable patient-reported outcomes compared with VBR and APBG. Autologous pelvic bone grafting was associated with worse patient-reported outcomes, potentially related to donor-site morbidity. Given the non-randomized design and potential confounding, these findings should be interpreted as associative and hypothesis-generating. Full article

Background: We evaluated the association between admission serum glucose-to-potassium ratio (GPR) and injury severity as well as early transfusion requirements in patients with traumatic pelvic fractures. Methods: This single-center, retrospective cohort study included 84 adult patients with isolated or predominantly pelvic fractures admitted between January 2020 and December 2024. Patients with concomitant non-pelvic skeletal fractures were excluded to isolate the metabolic response attributable to pelvic injury. GPR was calculated from admission serum glucose and potassium levels. Higher transfusion requirement (HT) was defined as ≥4 units of packed red blood cells within 24 h. Receiver operating characteristic (ROC) analysis identified the optimal GPR cut-off using the Youden index. Internal validation was performed using bootstrap resampling (1000 iterations), and model calibration was assessed with the Hosmer–Lemeshow test. The incremental discriminatory value of GPR beyond the Injury Severity Score (ISS) was evaluated by comparing AUC values using the DeLong test, and reclassification metrics including the category-free net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated. Sensitivity analyses were conducted using alternative transfusion thresholds (≥6 and ≥10 units). Results: The optimal GPR cut-off was 34 (area under the curve (AUC) = 0.730; 95% CI: 0.593–0.853; sensitivity 78.8%; specificity 59.0%). Patients with GPR ≥ 34 (n = 43) had significantly higher ISS values (median 25 [IQR: 16–34] vs. 9 [5–17]; p < 0.001), greater transfusion volumes (median 3 [0–6] vs. 0 [0–1] units; p < 0.001), and longer intensive care unit (ICU) stays (3 (0–6) vs. 0 (0–1) days; p < 0.001). In univariable logistic regression, GPR was significantly associated with HT (OR = 1.059 per unit increase; 95% CI: 1.015–1.104; p = 0.008); however, significance was not retained in the multivariable model after adjustment for ISS (p = 0.194). ISS remained the sole independent predictor (OR = 1.128; p < 0.001). The combined ISS + GPR model yielded an AUC of 0.857, representing a modest increment over ISS alone (AUC = 0.849; ΔAUC = 0.009; DeLong p = 0.566). Bootstrap-corrected AUCs confirmed minimal optimism (GPR alone: 0.726; ISS + GPR: 0.847). The Hosmer–Lemeshow test indicated adequate calibration for all models (p > 0.05). The category-free NRI was 0.627 (p = 0.009), whereas the IDI did not reach significance (0.017; p = 0.290). Sensitivity analysis at the ≥6-unit threshold yielded consistent results (GPR AUC = 0.709). Conclusions: Admission GPR is significantly associated with injury severity, hemorrhagic burden, and transfusion requirements in patients with traumatic pelvic fractures. Although GPR does not independently predict transfusion needs beyond ISS, it yields significant reclassification improvement and may serve as a practical, rapidly obtainable adjunct for early risk stratification in the acute trauma setting. Level of Evidence: III (retrospective prognostic study). Full article

Background: Lumbosacral plexopathy (LSP) is characterized by severe neuropathic pain, motor weakness, and sensory deficits in the lumbosacral plexus region, often leading to significant functional impairment and reduced quality of life. Post-traumatic LSP is particularly challenging to treat due to its neuropathic nature and limited response to conventional pharmacologic therapies. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique that has shown therapeutic potential for chronic neuropathic pain. Case Report: We report the case of a 16-year-old female who developed LSP following multiple pelvic fractures and subsequently exhibited disabling pain, depressive symptoms, and poor quality of life. High-frequency motor cortex rTMS resulted in meaningful clinical improvement in pain intensity (an NRS reduction from 8 to 2), mood, and daily functioning. Conclusions: This suggests the potential role of rTMS as an adjunctive treatment for refractory neuropathic pain secondary to traumatic LSP. Full article

Background: Kyphotic deformity following osteoporotic vertebral fracture (KDOVF) often requires corrective surgery to restore sagittal alignment; however, mechanical complications, such as proximal junctional failure (PJF) and distal junctional failure (DJF), remain major concerns. Selection of the lower instrumented vertebra (LIV) plays a critical role in balancing mechanical stability and functional preservation; however, the optimal criteria for LIV selection have not been fully established. Methods: This multicenter retrospective cohort study included 52 patients who underwent corrective surgery for KDOVF, with a minimum 1-year follow-up. The patients were classified into a long-fixation group with pelvic fixation (n = 27) and a short-fixation group with lumbar LIV fixation (n = 25). Mechanical complications, radiographic parameters, patient-reported outcomes, and paraspinal muscle fatty degeneration were compared between groups. Subgroup analysis was performed within the short-fixation group to identify the factors associated with DJF. Results: The incidence of PJF was significantly higher in the long-fixation group than in the short-fixation group (37% vs. 8%, p < 0.01), whereas DJF was observed only in the short-fixation group (24%). Within the short-fixation group, patients who developed DJF demonstrated significantly greater preoperative sagittal malalignment, a lower rate of cement-augmented pedicle screw, and more advanced fatty degeneration of the paraspinal muscles. The short-fixation group also showed better postoperative lumbar function. Conclusions: LIV selection in KDOVF surgery is associated with distinct patterns of junctional mechanical complications. Short fixation may be feasible in carefully selected patients who demonstrate preserved compensatory capacity. Full article

Background and Objectives: Pelvic ring injuries with symphyseal disruption are classically associated with high-energy mechanisms such as motor vehicle collisions. Recently, waterslides have emerged as an underrecognized but distinct source of severe pelvic trauma. Waterslide-related pelvic trauma represents a distinct biomechanical entity characterized by a supine or semi-supine body position at splashdown, extreme forced hip abduction, asymmetric lower-limb positioning, and abrupt hydrodynamic deceleration. The high descent velocity, abrupt hydrodynamic deceleration, and forced hip abduction at water entry may combine to generate open-book-type pelvic injuries. Evidence guiding diagnosis and surgical management in this setting remains scarce. Materials and Methods: We retrospectively analyzed a consecutive series of adult patients sustaining waterslide-related anterior–posterior compression type II (APC2) pelvic ring injuries. Demographic data and the body mass index (BMI), fracture classification, surgical strategy, complications, and functional outcomes were reviewed. Only patients with complete imaging, operative records, and follow-up were included. Results: Four patients (38–72 years) met the inclusion criteria. All sustained rotationally unstable open-book pelvic injuries and were classified as APC2; three were AO/OTA 61B2.3 and one 61B3.3. All patients were overweight or obese (BMI 27.2–31.2). Pelvic binders provided an effective acute reduction in symphyseal diastasis; however, in one bilateral injury, CT imaging obtained with the binder in situ masked posterior ligamentous instability. Definitive surgical fixation was performed in all cases. Early mechanical failure occurred in two patients treated with short anterior symphyseal plate constructs. In the bilateral injury, isolated anterior fixation failed repeatedly until posterior sacroiliac stabilization was added. No deep infections or thromboembolic events occurred. Although two patients required short observational ICU stays, none were admitted for hemodynamic instability or pelvic bleeding. Conclusions: At 12-month follow-up, three patients achieved pain-free ambulation without assistive devices, while one patient required intermittent use of a single crutch; all patients regained independence in daily activities. Waterslide accidents represent a high-energy injury mechanism capable of producing severe APC2 pelvic disruptions, particularly in patients with an elevated BMI. Awareness of this mechanism and meticulous assessment of posterior stability are essential to avoid under-treatment and mechanical failure. Full article

Fractures of the pelvic ring are among the most severe injuries in orthopaedic practice and Tile type C lesions are characterized by complete disruption of the posterior arch with both vertical and rotational instability. The optimal construct for posterior ring fixation remains a matter of debate. The aim of this study was to compare, by means of finite element analysis, the biomechanical performance of three different methods of osteosynthesis for Tile type C1.2 pelvic ring fractures: a transiliac plate, one iliosacral screw and two anterior reconstruction plates on the sacroiliac joint. A three-dimensional model of an intact pelvis was reconstructed from computed tomography images of a healthy adult male. A Tile type C1.2 injury pattern was created virtually, and three fixation constructs were designed in Ansys SpaceClaim according to manufacturer specifications. All materials were assumed to be homogeneous, isotropic and linearly elastic. Vertical loads of 400 N and 800 N were applied to the sacral endplate to simulate partial and full weight bearing, while the acetabular regions were constrained to represent standing stance. In this study, mechanical stability was operationally defined as resistance to global displacement under applied vertical load, with lower displacement indicating higher construct stiffness. Construct stiffness, total deformation and von Mises stress were assessed for bone and implants. For both loading conditions, the iliosacral screw construct showed the lowest overall displacement and provided the greatest stiffness. The transiliac plate construct presented larger displacements, whereas the anterior reconstruction plate construct provided intermediate stability with higher stresses at the sacroiliac joint. Among the analyzed constructs, the iliosacral screw provided the greatest stiffness and lowest overall displacement, suggesting superior mechanical performance under vertical loading conditions. Full article

Background/Objectives: Managing acetabular fractures remains a surgical challenge, particularly in cases involving traumatic pelvic discontinuity (PD). The optimal method for achieving primary stability is unclear, and biomechanical evidence comparing established techniques is limited. The goal of this biomechanical study is to evaluate if a Ganz reinforcement ring with the addition of a posterior-column plate and anterior-column screw (GRP) provides stability comparable to a Burch-Schneider reinforcement ring (BSR) with an additional anterior- and posterior-column screws construct. Methods: The primary biomechanical stability of two acetabular “fix-and-replace” techniques—BSR versus GRP—using standardized 4th-generation Sawbones^® hemipelvis models with T-type fractures (PD) was compared. Relative 3D micromotions at the fracture site (Zone 1: Posterior-column; Zone 2: Anterior-column; Zone 3: Oblique to transverse fracture, and Zone 4: Ischiopubic ramus) were measured under increasing cyclic loading (100 cycles per load level) at 200 N, 400 N, 800 N, and 1200 N using an optical motion tracking system. A detected fracture gap of 1000 µm or more during/after the cyclic load was defined as fixation failure. Results: Fixation failure was not observed in any of the six artificial hemipelves with treated (3 BSR, 3 GRP) T-type acetabular fractures. Under cyclic, increasing load (200–1200 N), the mean fracture gap remained small at 200 N and 400 N with no significant differences between techniques. At 800 N, GRP fixation showed a non-significant increase in micromotion. At 1200 N, significantly greater displacements were observed in Zones 2–4 with GRP compared to BSR (p < 0.005), whereas no difference was found in Zone 1 (p = 0.424). Modelled slope and intercept comparisons confirmed a significantly steeper increase in fracture gap with GRP in zones 2–4 at higher loads (≥800 N, p < 0.01) while remaining under 1000 µm. Conclusions: Both fixation methods demonstrated sufficient construct stability without catastrophic failure, with minimal displacement (<1 mm) and with no significant difference in stability at the posterior column. Full article

Background: Fragility fractures of the pelvis (FFPs) are increasingly prevalent given ageing populations. Conservative management is often primarily utilised due to its initial minimal displacement and the high risks of surgery in this vulnerable population. However, this can lead to rapid deconditioning, especially with non-weight-bearing protocols. Parathyroid hormone (PTH), as a bone anabolic agent, has the potential to improve clinical and radiological outcomes in FFPs, but the evidence remains limited. Methods: A systematic review and meta-analysis following PRISMA guidelines was undertaken. Database search results were independently screened by two authors, and data were extracted. The primary outcome measure was time to fracture healing as assessed by imaging, with the secondary outcome measure of pain levels (VAS/NRS). Results: There were 1230 articles screened, and 893 unique results identified. Six studies were included in the final analysis. These compared the use of PTH and its analogues with standard care, placebo, or sacroplasty. The findings suggest that PTH may accelerate fracture healing and reduce pain in this patient population, although evidence is limited and at high risk of bias. Conclusions: Treatment with PTH may improve bone healing and visual analogue pain scores, although the evidence is limited. There may be a benefit from adjunctive PTH treatment for patients with FFPs; however, larger methodologically robust studies are required to confirm this. Full article

Management of septic arthritis of the pubic symphysis (SAS) presents with substantial clinical challenges. Firstly, the SAS is an extremely rare entity. Surgical resection of the symphysis plus targeted antibiotic therapy is a widely adopted treatment course. Some patients suffering from SAS develop posterior pelvic insufficiency fractures because of the weakened anterior pelvic ring or as a result of radiation therapy received during treatment for a malignant disease in the lesser pelvis. The literature demonstrates a lack of standardized strategies for restoring pelvic ring integrity based on pelvic instability and posterior pelvic insufficiency fractures caused by SAS. Background and Objectives: This study aimed to determine whether early, primary stand-alone dorsal fusion can be a viable treatment option in SAS and whether there is a clinical benefit compared with temporary anterior fixation or secondary posterior stabilization after failed anterior fixation. Materials and Methods: We performed a descriptive, retrospective analysis covering an eight-year period (2018–2025) including 21 patients who underwent symphyseal resection for destructive SAS. We evaluated peri- and postsurgical data to describe the different surgical methods and their respective outcomes. Results: Ten patients (10/21, 48%) received posterior stabilization (sacroiliac-joint fusion or spinopelvic stabilization). Seven patients (7/21, 33%) were anteriorly fixated either temporarily with an external fixator or permanently with ventral plate osteosynthesis. Four patients (4/21, 19%) did not receive any pelvic stabilization following symphyseal resection as pelvic integrity was present. Three of them (3/21, 14%) showed spontaneous sacroiliac-joint fusion, while 6/7 (86%) of anteriorly fixed patients presented with debilitating sacral insufficiency fractures, had longer hospital stays and a higher count of readmissions and re-operations. Primary posterior stabilization led to shorter hospital stays, less readmissions, and good clinical outcome. Conclusions: Primary posterior stabilization can be a viable course of treatment of SAS and should be considered especially when spontaneous sacroiliac-joint fusion is not present. We suggest that early stabilization of the posterior pelvic ring could be a sensible course of treatment and may prevent debilitating insufficient fractures. While there are many different surgical options for posterior stabilization available (spinopelvic/lumbosacral stabilization, sacroiliac-joint fusion and others), our preliminary data suggest that primary sacroiliac-joint fusion is a quick, minimally invasive and effective way to establish posterior pelvic stability. Full article

Background: Paediatric pelvic and acetabular fractures are rare and usually the consequence of high-energy trauma, often associated with life-threatening injuries. The majority are managed non-operatively; however, open reduction and internal fixation (ORIF) is indicated in selected, complex, or displaced, acetabular fractures. The modified Stoppa approach is well established in adults, but has been rarely reported in skeletally immature patients, and evidence guiding surgical approach and fixation in children remains limited. Methods: We report the case of an 11-year-old girl who sustained a transverse acetabular fracture following a high-energy trauma. The fracture was treated with ORIF through a modified Stoppa approach. We also performed a systematic review of the literature, focusing on ORIF of acetabular fractures in children. Results: In our patient, ORIF of the acetabular fracture was performed, achieving an anatomical reduction, 10 days after initial damage-control fixation of a concomitant open tibial plateau fracture. Postoperative management consisted of four weeks of non-weight bearing, followed by progressive weight bearing. At six months, she had returned to full daily activities and sports. The review of the literature identified 16 studies (retrospective series and case reports) describing paediatric acetabular fractures treated with ORIF using plates, screws, or flexible nails. In the literature, good to excellent clinical and radiographic outcomes were reported when anatomical reduction and stable fixation were achieved, although growth disturbance and avascular necrosis were described, particularly in cases with delayed reduction or severe triradiate cartilage injury. Conclusions: Our case illustrates the technical feasibility of the modified Stoppa approach in a skeletally immature patient with a complex acetabular fracture, with excellent mid-term outcome. Although it is not contraindicated in paediatric patients, it should be reserved for treating this type of complex fracture. The available literature supports that satisfactory results are reported after ORIF in children, but the heterogeneity and low level of evidence preclude firm recommendations on the optimal approach. Full article

(1) Background: Fragility fractures of the pelvis (FFP) in elderly patients pose significant clinical challenges due to osteoporosis and associated morbidity. Transiliac–transsacral (TITS) screw fixation offers biomechanical advantages for stabilizing unstable posterior pelvic ring injuries, yet clinical outcomes remain underreported. We aim to report radiographic and clinical outcomes of TITS fixation for posterior pelvic ring injuries in FFP. (2) Methods: We conducted a retrospective review of 22 elderly female patients (mean age 79.0 ± 7.9 years) who underwent TITS screw fixation for unstable posterior pelvic ring fragility fractures between 2019 and 2024. Perioperative, radiographic, and functional outcomes were analyzed. (3) Results: Median operative time was 74 min (IQR 55–90 min), with minimal blood loss (median 5 mL). No intraoperative neurovascular injuries occurred. Median hospital stay was 7 days (IQR 5–10 days). At a mean follow-up of 6 months, 81.8% of patients maintained excellent or good reduction. Screw loosening was observed in 18.2% of cases, with only one (4.5%) requiring revision. Median VAS scores (range 0–10) decreased significantly from 5 preoperatively to 2 at discharge (p < 0.001). By discharge, 59.1% of patients were able to ambulate with assistance. (4) Conclusion: TITS screw fixation is a safe and feasible option for stabilizing unstable FFP in elderly, osteoporotic patients. It provides reliable mechanical stability, promotes early mobilization, and is associated with a short hospital stay and low complication rates. Full article