In-screw polymethylmethacrylate-augmented sacroiliac screw for the treatment of fragility fractures of the pelvis: a prospective, observational study with 1-year follow-up

Abstract

BackgroundThe incidence of pelvic ring fractures in the elderly significantly increased. Because of persistent pain and immobilization associated with this injury, surgical treatment is recommended. To minimise comorbidities and surgical risk, percutaneous techniques are becoming more relevant. In-screw cement augmentation of sacroiliac screw fixation is a promising procedure; however, clinical follow-up data remain scarce. This study investigated the safety and possible complications of the procedure along with a 1-year follow-up.MethodsThirty-four patients (treated with 43 screws) were prospectively included. Data on patients’ age and sex, the mechanism of accident, fracture pattern, duration of hospital stay, surgery and adverse events were recorded. Data were obtained postoperatively on the reduction of pain and complications, such as infection, cement leakage and neurological deficits, and at 1-year follow-up on pain, quality of life according to the 12-Item Short Form Survey and mobility. Implant failure was defined as retraction or dislocation of screws and was also documented.ResultsScrew-related complications occurred with 2 of 43 screws. None of these complications were related to cement augmentation. In-hospital adverse events occurred in 6 of 34 patients. Postoperative pain, measured by the visual analogue scale, was significantly reduced from 6.7 ± 1.4 preoperatively to 2.7 ± 1.0 postoperatively (p < 0.001). Although patients complained of pain at the 1-year follow-up, they reported a significant decline compared with pain at admission (3.4 ± 2.3; p < 0.001). Results on the quality of life were comparable with those for the age- and gender matched German population. All patients were mobile, and no implant failure was detected.ConclusionsThe results indicate that in-screw augmented sacroiliac screw fixation for fragility fractures of the pelvis is a safe technique. Pain was significantly reduced immediately after surgery compared to the preoperative state. Furthermore, significant pain reduction after one year compared to the preoperative state and quality of life was comparable to the age- and gender- matched German population. Thus, we recommend in-screw augmentation for screw fixation for sacral fragility fractures of the pelvis following failed conservative treatment.

Minimally invasive posterior locked compression plate osteosynthesis shows excellent results in elderly patients with fragility fractures of the pelvis

“…In our data the mean hospital stay until surgery was 6.7 days (SD 5.1) and the mean hospital stay overall was 21.2 days (SD 7.7), which goes in line with other studies, where the mean hospital stay varies from 13 to 23.7 days [16,31,33,34,36].…”

“…Similar to other studies we found a mean age of about 79 (60-99) years with a predominance of women, which constituted 90% of our collective [16,[30][31][32][33][34][35][36].…”

“…We found five studies regarding fragility fractures of the pelvis which assessed operation times. Sanders 3), depending on whether the procedure was planned in advance or intra-operatively [30,32,34,35,37]. Percutaneous screw insertion is typically associated with considerable fluoroscopy use, although there have only been a few studies that fully assessed radiation doses in FFP.…”

Three-dimensional-guided navigation percutaneous screw fixation of fragility fractures of the pelvis

“…29 Published data from mechanical studies in cadaveric hip models are varied with cement-augmented sacroiliac screws shown to have similar to significantly higher construct stiffness and pull-out strength compared to uncemented screws. 30,31 In theory, bone union of the fracture surfaces are not jeopardized as they are spared of the cement, 29 but the long-term outcomes are uncertain due to paucity in clinical trials. A recent clinical trial demonstrated improved bone mass and reduced pedicle screw loosening with the use of teriparatide (human recombinant parathyroid hormone) for 6 months after spinal fusion compared to bisphosphonates alone.…”

Early Operative Versus Nonoperative Treatment of Fragility Fractures of the Pelvis: A Propensity-Matched Multicenter Study

“…Hence, especially percutaneous surgical techniques have been suggested as a valuable alternative to nonoperative treatment [8][9][10] . Operative treatment is thought to reduce pain and to facilitate mobilization in patients with FFPs 11,12 . Even though complications and overall mortality remain high among geriatric patients with a FFP when treated operatively 13 , a benefit of surgical over non-operative treatment with regard to mortality has been suggested 14 .…”