Biomechanical Comparison of Three Methods of Sacral Fracture Fixation in Osteoporotic Bone

Mears, Simon C.; Sutter, E. Grant; Wall, Simon J.; Rose, David M.; Belkoff, Stephen M.

doi:10.1097/brs.0b013e3181cb4fcd

Cited by 63 publications

(37 citation statements)

References 14 publications

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“…It is possible that it was only the combination of cement and two-screw construct that led to the small advantages seen in the cemented group. However, this represents the decisions made in clinical routine, where transsacral one-screw [13,17,28] and sacroiliac two-screw fixation [10,23,24,31,37,42] are common. In addition, transsacral two-screw constructs require the presence of a transsacral corridor in S1 and S2 (or one wide enough in S1), which is not present in approximately 30 % of patients [27].…”

Section: Discussionmentioning

confidence: 99%

“…Unlike other studies [24,40], we added anterior fixation with a retrograde transpubic screw [14] in all specimens. In the clinical context of an osteoporotic lateral compression fracture, the use of additional anterior fixation might be controversial; in the case of our cadaver model, the function of this anterior implant was to standardize and account for the missing soft tissues that usually stabilize the anterior pelvic ring.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, there is no standard in biomechanical testing of pelvic ring fractures. The setup and some of the loads applied in this study were chosen similar to those reported in published studies [24,33,39,43]. In addition, a stepwise increase in loads [12,40] was chosen to simulate the cyclic loading environment resulting from different levels of weightbearing (toe-touch, walking with a walker, full weightbearing) because they would be expected in the heterogeneous elderly population with fragility fractures of the pelvis with very different levels of balance, compliance, and pain.…”

Section: Discussionmentioning

confidence: 99%

“…Operative treatment of these injuries also might accelerate mobilization and restoration of normal gait [34]. Osteoporotic lateral compression fractures with minimal displacement in the area of the anterior pelvic ring can be addressed specifically and successfully by percutaneous sacroiliac screw fixation [10,23,24,31,37,42]. As these fractures most commonly affect older patients, any fixation technique should provide sufficient stability to allow for early full weightbearing.…”

Section: Introductionmentioning

confidence: 99%

“…One option to increase fixation strength is the use of transsacral screws or bars [15,17,24,25]. Owing to variable morphologic features of the sacrum, however, a transverse transsacral corridor in S1 does not exist in at least 20% of individuals [26].…”

Section: Introductionmentioning

confidence: 99%

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Cement Augmentation in Sacroiliac Screw Fixation Offers Modest Biomechanical Advantages in a Cadaver Model

Osterhoff

Dodd

Unno

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Sacroiliac screw fixation in elderly patients with pelvic fractures is prone to failure owing to impaired bone quality. Cement augmentation has been proposed as a possible solution, because in other anatomic areas this has been shown to reduce screw loosening. However, to our knowledge, this has not been evaluated for sacroiliac screws. Questions/purposes We investigated the potential biomechanical benefit of cement augmentation of sacroiliac screw fixation in a cadaver model of osteoporotic bone, specifically with respect to screw loosening, construct survival, and fracture-site motion. Methods Standardized complete sacral ala fractures with intact posterior ligaments in combination with ipsilateral upper and lower pubic rami fractures were created in osteoporotic cadaver pelves and stabilized by three fixation techniques: sacroiliac (n = 5) with sacroiliac screws in S1 and S2, cemented (n = 5) with addition of cement augmentation, and transsacral (n = 5) with a single transsacral screw in S1. A cyclic loading protocol was applied with torque (1.5 Nm) and increasing axial force (250-750 N). Screw loosening, construct survival, and sacral fracture-site motion were measured by optoelectric motion tracking. A sample-size calculation revealed five samples per group to be required to achieve a power of 0.80 to detect 50% reduction in screw loosening. Results Screw motion in relation to the sacrum during loading with 250 N/1.5 Nm was not different among the three groups (sacroiliac: 1.2 mm, range, 0.6-1.9; cemented: 0.7 mm, range, 0.5-1.3; transsacral: 1.1 mm, range, 0.6-2.3) (p = 0.940). Screw subsidence was less in the cemented group (3.0 mm, range, 1.2-3.7) compared with the sacroiliac (5.7 mm, range, 4.7-10

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Cement Augmentation in Sacroiliac Screw Fixation Offers Modest Biomechanical Advantages in a Cadaver Model

Osterhoff

Dodd

Unno

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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Cerclage augmentation of S1–S2 transsacral screw fixation in osteoporotic posterior pelvis ring injuries: A biomechanical feasibility study

Berk

Schwarzenberg

Halvachizadeh

et al. 2023

Journal Orthopaedic Research

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Injuries of the posterior pelvic ring are predominantly associated with osteoporosis. Percutaneously placed screws transfixing the sacroiliac joint have become the gold standard for their treatment. However, screw cut‐out, backing‐out, and loosening are common complications. One promising option could be cerclage reinforcement of cannulated screw fixations. Therefore, the aim of this study was to evaluate the biomechanical feasibility of posterior pelvic ring injuries fixed with S1 and S2 transsacral screws augmented with cerclage. Twenty‐four composite osteoporotic pelvises with posterior sacroiliac joint dislocation were stratified into four groups for S1–S2 transsacral fixation using either (1) fully threaded screws, (2) fully threaded screws with cable cerclage, (3) fully threaded screws with wire cerclage, or (4) partially threaded screws with wire cerclage. All specimens were biomechanically tested under progressively increasing cyclic loading until failure. Intersegmental movements were monitored by motion tracking. The transsacral partially threaded screw fixation with wire cerclage augmentation resulted in significantly less combined angular intersegmental movement in the transverse and coronal plane versus its fully threaded counterpart (p = 0.032), as well as in significantly less flexion versus all other fixations (p ≤ 0.029). Additional cerclage augmentation could be performed intraoperatively to improve the stability of posterior pelvic ring injuries treated with S1–S2 transsacral screw fixation. Further investigations should follow to consolidate the current results on real bones and possibly consider execution of a clinical study.

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Specifics of Surgical Management: Pelvis

Nwankwo

Westrick

Altman

et al. 2022

Senior Trauma Patients

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Biomechanical Comparison of Three Methods of Sacral Fracture Fixation in Osteoporotic Bone

Cited by 63 publications

References 14 publications

Cement Augmentation in Sacroiliac Screw Fixation Offers Modest Biomechanical Advantages in a Cadaver Model

Cement Augmentation in Sacroiliac Screw Fixation Offers Modest Biomechanical Advantages in a Cadaver Model

Cerclage augmentation of S1–S2 transsacral screw fixation in osteoporotic posterior pelvis ring injuries: A biomechanical feasibility study

Specifics of Surgical Management: Pelvis

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