Minimal-invasive stabilization of anterior pelvic ring fractures with retrograde transpubic screws

Rommens, Pol Maria; Graafen, Marcus; Arand, Charlotte; Mehling, Isabella; Hofmann, Alexander; Wagner, Daniel

doi:10.1016/j.injury.2019.12.018

Cited by 42 publications

(37 citation statements)

References 32 publications

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“…Less loosening and backing out in IS screw fixation in elderly was shown by using multiple posterior implants 13 . Anterior fixation, whenever possible minimally invasive using retrograde trans-pubic screws 31 or alternatively using plate osteosynthesis 32 , is important to allow immediate mobilization if there is a concomitant anterior instability. Half of the loosened TB were observed in patients with persistent anterior instability 3 .…”

Section: Discussionmentioning

confidence: 99%

Trans-sacral bar osteosynthesis provides low mortality and high mobility in patients with fragility fractures of the pelvis

Wagner

Kisilak

Porcheron

et al. 2021

Sci Rep

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Operative treatment of osteoporosis-associated fragility fractures of the pelvis (FFP) and the sacrum is advocated with immobilizing or longstanding pain, fracture progression and displacement. We analyzed clinical outcomes regarding mobility, quality of life, and mortality of patients with FFP treated with trans-sacral bar (TB) osteosynthesis through S1. Demographics, clinical data, and operation-related data of patients with an FFP treated with TB were acquired from chart review. We assessed mortality, quality of life (EQ-5D), mobility, and residential status at follow-up. Seventy-nine females and six males with a median age of 78.0 years (IQR 73–84) were included, median follow-up was 3.2 years. Medical complications during hospitalization occurred in 28%. Operative revision was carried out in 15% of patients. One-year survival was 90.4%, this was associated with shorter preoperative and total length of stay in hospital (p 0.006 and 0.025, respectively). At follow-up, 85% lived at home and 82% walked with or without walking aid. Higher EQ-5D was reached with higher mobility status and living at home (p < 0.001 and < 0.001, respectively). TB osteosynthesis is an adequate and reliable method for fixation of FFP in the posterior pelvic ring to ensure timely mobilization. Shorter preoperative and total length of stay had lower mortality rates, advocating a standardized management protocol to limit time delay to operative therapy. Patients treated with TB osteosynthesis had low 1-year mortality of less than 10%.

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Section: Discussionmentioning

confidence: 99%

Trans-sacral bar osteosynthesis provides low mortality and high mobility in patients with fragility fractures of the pelvis

Wagner

Kisilak

Porcheron

et al. 2021

Sci Rep

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“…However, anatomical reduction in the elderly is considered to be unnecessary, and manipulation with a short screw can be performed [ 30 , 31 ]. Furthermore, most superior pubic ramus fractures can be treated minimally invasively using a retrograde transpubic screw [ 32 ]. Our results demonstrating the biomechanical equality of plating and retrograde screw fixation may contribute to this discussion, and hopefully facilitate clinical decision making.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Comparison of Five Fixation Techniques for Unstable Fragility Fractures of the Pelvic Ring

Lodde

Katthagen

Schopper

et al. 2021

JCM

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Background: Incidence of pelvic ring fractures has increased over the past four decades, especially after low-impact trauma—classified as fragility fractures of the pelvis (FFP). To date, there is a lack of biomechanical evidence for the superiority of one existing fixation techniques over another. An FFP type IIc was simulated in 50 artificial pelvises, assigned to 5 study groups: Sacroiliac (SI) screw, SI screw plus supra-acetabular external fixator, SI screw plus plate, SI screw plus retrograde transpubic screw, or S1/S2 ala–ilium screws. The specimens were tested under progressively increasing cyclic loading. Axial stiffness and cycles to failure were analysed. Displacement at the fracture sites was evaluated, having been continuously captured via motion tracking. Results: Fixation with SI screw plus plate and SI screw plus retrograde transpubic screw led to higher stability than the other tested techniques. The S1/S2 ala–ilium screws were more stable than the SI screw or the SI screw plus external fixator. Conclusions: In cases with displaced fractures, open reduction and plate fixation provides the highest stability, whereas in cases where minimally invasive techniques are applicable, a retrograde transpubic screw or S1/S2 ala–ilium screws can be considered as successful alternative treatment options.

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“…Retrograde transpubic screw fixation is a frequently used surgical procedure for the treatment of fractures of the anterior pelvic ring 1 – 4 . It is a minimally invasive procedure which can be used in minimally or non-displaced fractures of the superior pubic ramus.…”

Section: Introductionmentioning

confidence: 99%

“…Several biomechanical studies have investigated the stability of screw osteosynthesis of the anterior pelvic ring 16 , 17 . Various clinical studies and case series have demonstrated low complication rates and good to excellent clinical results 1 . However, some concerns regarding this method are remaining.…”

Section: Introductionmentioning

confidence: 99%

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Anatomical evaluation of the transpubic screw corridor based on a 3D statistical model of the pelvic ring

Arand

Wagner

Richards

et al. 2021

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Retrograde transpubic screw fixation is a common procedure for the treatment of anterior pelvic ring fractures. With its sparing surgical approach and significant pain relief after screw fixations allowing early mobilisation, it has gained importance especially in the treatment of insufficiency fractures in elderly patients. However, positioning of transpubic screw osteosynthesis is not always possible due to narrowness and curvature of the screw corridor. The aim of the present study was to evaluate availability and length of the screw corridor using a 3D statistical model of the pelvic ring consisting out of 150 uninjured pelves. Virtual bore probes with a diameter of 7.5 mm were analysed as to accessibility, length and grey value distribution in Hounsfield Unit (HU). A transpubic corridor with a diameter of ≥ 7.5 mm was available in 185 of 300 investigated superior pubic rami with mean screw length of 131.7 mm. Accessibility of the screw corridor was higher in males than in females. However, screw length showed no systematic differences between the sexes or ethnicities. Analysis of the grey value distribution demonstrated the strongest bone to be located at the lateral ilium and the supraacetabular region.

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Minimal-invasive stabilization of anterior pelvic ring fractures with retrograde transpubic screws

Cited by 42 publications

References 32 publications

Trans-sacral bar osteosynthesis provides low mortality and high mobility in patients with fragility fractures of the pelvis

Trans-sacral bar osteosynthesis provides low mortality and high mobility in patients with fragility fractures of the pelvis

Biomechanical Comparison of Five Fixation Techniques for Unstable Fragility Fractures of the Pelvic Ring

Anatomical evaluation of the transpubic screw corridor based on a 3D statistical model of the pelvic ring

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