Evaluation of cannulated compression headless screws as an alternative implant for superior pubic ramus fracture fixation: a biomechanical study

Berk, Till; Schwarzenberg, Peter; Pastor, Tatjana; Lesche, Felix; Halvachizadeh, Sascha; Richards, R. Geoff; Gueorguiev, Boyko; Pape, Hans‐Christoph

doi:10.1007/s00264-023-05710-3

Cited by 5 publications

(2 citation statements)

References 36 publications

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“…Prompted by the higher failure rates associated with retrograde rami screws, Berk et al 15 performed a biomechanical study evaluating cannulated partially threaded, fully threaded, and headless compression 7.3 mm screws in a pelvic fracture model. They found that fractures treated with partially threaded screws experienced more displacement than fully threaded screws and headless compression screws with cyclical loading.…”

Section: Discussionmentioning

confidence: 99%

Variables associated with loss of fixation of retrograde rami screws in minimally displaced lateral compression type 1 pelvic ring injuries

Tucker,

Stacey,

Kim

et al. 2024

Journal of Orthopaedic Trauma

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OBJECTIVES: To evaluate variables associated with loss of fixation of retrograde rami screws in the treatment of stress-positive minimally displaced lateral compression type 1 (LC1) injuries. METHODS: Design: Retrospective comparative study Setting: Level one trauma center Patient Selection Criteria: Stress-positive minimally displaced (<1 cm) LC1 pelvic ring injuries treated with retrograde rami screws Outcome Measures and Comparisons : Loss of fixation, defined as >5 mm of pelvic fracture displacement based on the radiographic tear-drop distance, or >5 mm of implant displacement on follow-up radiographs; Revision surgery for loss of fixation RESULTS: 38 patients with 40 retrograde rami screws were analyzed. Median patient age was 64 years (IQR 42.5 to 73.3 years), 71.1% (n=27/38) were female, 52.6% (n=20/38) of injuries were secondary to low-energy mechanisms. Loss of fixation occurred in 17.5% (n=7/40) of screws with 10% (n=4/40) requiring revision surgery. Unicortical rami screws failed at a significantly higher rate than bicortical screws (62.5% (5/8) vs. 3.1% (1/32); observed difference (OD) 59.4%, 95% confidence interval (CI) 22.7% to 85.5%; p=0.0005). Other variables associated with loss of fixation included dynamic displacement on stress radiographs (22.1 vs. 15.4 mm; OD 6.6 mm, CI 2.0 to 11.3; p=0.02), unicortical screws (83.3% vs. 8.8%; OD -74.5%, CI -95.6% to -32.3%; p=0.0005), short screws ending medial to the acetabular sourcil (50.0% vs. 8.8%; OD 41.1%, CI 2.7% to 75.0%; p=0.03), and partially-threaded screws (66.7% vs. 23.5%; OD 43.1%, CI 1.1% to 73.9%; p=0.04). On univariate analysis, patients who had a loss of fixation were more likely to have greater dynamic displacement on stress radiographs (22.0 vs. 15.2 mm; median difference (MD) 5.6 mm, CI -19.2 to 10.3; p=0.04), unicortical rami screws (71.4% vs. 9.1%; PD 62.3%, CI 8.8% to 22.6%; p=0.001), and partially-threaded rami screws (71.4% vs. 21.2%; PD 50.2%, CI 10.0% to 77.6%; p=0.01). The remaining variables had no observed association (p≥0.05) with loss of fixation, including age, gender, BMI, energy of injury mechanism, tobacco use, ASA score, sacral fracture type, distal rami fractures, rami comminution, number of sacral screws, fully-threaded sacral screws, transsacral screws, or rami screw diameter. On multivariate analysis, only unicortical rami screws (p=0.01) remained associated with loss of fixation. CONCLUSIONS: Retrograde rami screws had a high rate of loss of fixation in minimally displaced LC1 pelvic ring injuries and this was associated with unicortical screws. These screws should be avoided when possible. LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Variables associated with loss of fixation of retrograde rami screws in minimally displaced lateral compression type 1 pelvic ring injuries

Tucker,

Stacey,

Kim

et al. 2024

Journal of Orthopaedic Trauma

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“…Subsequent follow‐ups showed that all anterior ring injuries healed well. Biomechanical studies 16 , 17 have shown that the stability effects of the reconstruction plate, intramedullary fixation, and external fixation on the anterior ring are similar.…”

Section: Discussionmentioning

confidence: 99%

Incidence of and Risk Factors for Screw Loosening after Iliosacral Screw Fixation for Posterior Pelvic Ring Injury

Zhou,

Chen,

Pei

et al. 2023

Orthopaedic Surgery

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Purposes: Screw loosening is a common complication of iliosacral screw fixation, with subsequent loss of stability and fracture re-displacement. This study aimed to investigate the incidence of and risk factors for screw loosening after iliosacral screw fixation for posterior pelvic ring injury.Methods: A total of 135 patients with posterior pelvic ring injuries who were treated with iliosacral screw fixation in our department between July 2015 and April 2021 were selected for this retrospective analysis. The possible risk factors for screw loosening were investigated using univariate and multivariate logistic regression analyses of patient demographics and trauma-related and iatrogenic variables, including age, sex, body mass index, Osteoporosis Self-Assessment Tool for Asians (OSTA) index, mechanism of injury, Young-Burgess classification, site of injury, type of injury, type of screw, mode of fixation, numbers of guidewire adjustments, accuracy of screw position, and quality of fracture reduction. Results:The incidence of screw loosening was 15.6% (n = 21). The mean duration for screw loosening was 3.2 AE 1.5 months after operation. Univariate analysis results showed that the Young-Burgess classification, type of injury, site of injury, type of screw, mode of fixation, and OSTA index might be related to screw loosening (p < 0.05). According to the multivariate logistic regression, vertical shear injuries (Odds ratios [OR] 9.80, 95% Confidence intervals ], p = 0.008), type of injury (OR 0.25, 95% CI [0.13-0.79], p = 0.027), common screws (OR 6.94,], p = 0.012), screws insertion only at the level of the first sacral segment (S1) (OR 8.79,], p = 0.034), injury site located in the medial sacral foramina (OR 6.28,], p = 0.033), and lower OSTA index [OR 0.41,, p = 0.001] were significantly related to screw loosening.Conclusions: Vertical shear injuries, sacral fractures, injury site located in the medial sacral foramina, and lower OSTA index are significantly associated with the postoperative occurrence of screw loosening. Transiliac-transsacral screw fixation and screws insertion both at the level of the S1 and second sacral segment can prevent screw loosening.

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Lateral Compression Fragility Fractures of the Pelvis: Diagnosis, Classifications, and Modern Management

Patterson,

Parry

2024

Curr Osteoporos Rep

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Purpose of Review To describe the diagnosis, classification, and modern management of lateral compression fragility fractures of the pelvis. Recent Findings Practice patterns are shifting toward early operative treatment of fragility fractures of the pelvis among patients who are unable to mobilize or whose injuries demonstrate occult instability on stress imaging. Early internal fixation appears to decrease pain, facilitate mobilization, accelerate hospital discharge, and minimize morbidity in this population. Summary Lateral compression pelvic ring injuries are the most common type of fragility fracture of the pelvis. Similar to fragility fractures of the hip, lateral compression fragility fractures of the pelvis are typically sustained in a ground level fall. These injuries are associated with long acute hospital and post-acute facility admissions, loss of physical function, loss of independence, mortality, anxiety, sleep disturbance, and caregiver burnout. Unlike hip fractures, for which urgent operative treatment and early mobilization reduce mortality, lateral compression fragility fractures of the pelvis are commonly treated without surgery. Recommendations for nonoperative management of these injuries in older adults may be inappropriately generalized from studies of younger patient populations with high-energy mechanisms of pelvis fracture. However, strong evidence to support early internal fixation of these injuries practice is lacking. High quality investigations of early surgical intervention for lateral compression fragility fractures of the pelvis are needed to guide care for these patients.

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Evaluation of cannulated compression headless screws as an alternative implant for superior pubic ramus fracture fixation: a biomechanical study

Cited by 5 publications

References 36 publications

Variables associated with loss of fixation of retrograde rami screws in minimally displaced lateral compression type 1 pelvic ring injuries

Variables associated with loss of fixation of retrograde rami screws in minimally displaced lateral compression type 1 pelvic ring injuries

Incidence of and Risk Factors for Screw Loosening after Iliosacral Screw Fixation for Posterior Pelvic Ring Injury

Lateral Compression Fragility Fractures of the Pelvis: Diagnosis, Classifications, and Modern Management

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