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

Abstract

Purpose Fragility fractures of the pelvis (FFP) are common in older patients. We evaluated the clinical outcome of using a minimally invasive posterior locked compression plate (MIPLCP) as therapeutic alternative. Methods 53 Patients with insufficiency fractures of the posterior pelvic ring were treated with MIPLCP when suffering from persistent pain and immobility under conservative treatment. After initial X-ray, CT-scans of the pelvis were performed. In some cases an MRI was also performed to detect occult fractures. Postoperatively patients underwent conventional X-ray controls. Data were retrospectively analyzed for surgical and radiation time, complication rate, clinical outcome and compared to the literature. Results Patients (average age 79.1 years) underwent surgery with operation time of 52.3 min (SD 13.9), intra-operative X-ray time of 9.42 s (SD 9.6), mean dose length product of 70.1 mGycm (SD 57.9) and a mean hospital stay of 21.2 days (SD 7.7). 13% patients (n = 7) showed surgery-related complications, such as wound infection, prolonged wound secretion, irritation of the sacral root or clinically inapparent screw malpositioning. 17% (n = 9) showed postoperative complications (one patient died due to pneumonia 24 days after surgery, eight patients developed urinal tract infections). 42 patients managed to return to previous living situation. 34 were followed-up after a mean period of 31.5 (6–90) months and pain level at post-hospital examination of 2.4 (VAS) with an IOWA Pelvic Score of 85.6 (55–99). Conclusion We showed that MIPLCP osteosynthesis is a safe surgical alternative in patients with FFP 3 and FFP 4. This treatment is another way of maintaining a high level of stability in the osteoporotic pelvic ring with a relatively low complication rate, low radiation and moderate operation time and a good functional outcome.

Minimally invasive transiliac anatomical locking plate for posterior pelvic ring injury: A technical trick of the gull wing plate

“…13e15 Even among them, locking compression plates appear to have replaced conventional non-locking plates. 16 The GWP is the modified upgrade version of the M-shaped pelvic plate by Shirahama et al 17 The concept of the GWP is to sandwich and bridge the sacrum between the bilateral ilium without direct exposure of the sacral fracture. This plate is inserted beneath the PVM through bilateral longitudinal 5 cm incisions, which have only minimal invasion to soft tissue.…”

Winkelstabile Platte zur Behandlung der Insuffizienzfrakturen des Beckens („minimally invasive posterior locked compression plate“)

“…Das Verfahren wird minimal-invasiv durchgeführt. Im Gegensatz zu der am häufigsten eingesetzten iliosakralen Schraubenosteosynthese wurden Implantatlockerungen bis dato nicht beobachtet, bei vergleichbaren Eingriffs- und niedrigeren Durchleuchtungszeiten [ 11 ]. Das Verfahren kann als „Stand-alone“-Verfahren eingesetzt werden; eine zusätzliche ventrale Versorgung ist nur sehr selten notwendig [ 6 ].…”

“…Im Rahmen einer Nachuntersuchung wurden die Ergebnisse der Operationsmethode erfasst und insbesondere mit der iliosakralen Schraubenosteosynthese verglichen. Dabei zeigte sich eine vergleichbare Komplikationsrate bei deutlich niedriger Durchleuchtungszeit [ 11 ].…”

Does Cement Augmentation of the Sacroiliac Screw Lead to Superior Biomechanical Results for Fixation of the Posterior Pelvic Ring? A Biomechanical Study

“…Full weight bearing mobilization and pain reduction are the goals of the treatment of fragility fractures of the pelvis [6,7]. Several treatment options for posterior pelvic ring fractures are described [8][9][10]. Fixation of sacrum fractures with a percutaneous sacroiliac (SI) screw is widely accepted as standard of care treatment of posterior ring fractures [9,11].…”