Percutaneous treatment of insufficiency fractures

Abstract

Insufficiency fractures of the pelvis, sacrum, spine, and long bones are painful, debilitating, and are common consequences of osteoporosis. Conventional treatment for these fractures varies from conservative therapy to surgery with plate and screw fixation. The former fails to address the underlying problem of fracture and frequently does not alleviate symptoms, while the latter is invasive and not always possible in older populations with low bone density and numerous co-morbidities. Osseous augmentation with polymethylmethacrylate (PMMA) has been used for over two decades to treat fractures related to osteoporosis, but has not been commonly used to treat fractures outside of the vertebral bodies. Osseous augmentation with PMMA is an image-guided procedure and various techniques have been utilized to treat fracture in different locations. We describe various techniques for image-guided osseous augmentation and treatment of insufficiency fractures with bothPMMA and allograft bone for fractures of the pelvis including sacrum, acetabulum, pubic symphysis, pubic rami ilium; appendicular skeleton including distal radius, proximal femur, and vertebral body. We also describe the potential risks and complications associated with percutaneous treatment of insufficiency fractures and techniques to avoid the pitfalls of the various procedures. We will present the process for patient follow-up and data regarding the pre- and postprocedure pain response in patients undergoing treatment for pelvic insufficiency fractures.

Surgical management of osteoporotic pelvic fractures: a new challenge

“…Smaller series published in radiological and spine journals present cases of nondisplaced fractures, for which this technique has been used [47–61]. The technique relies on the same principles as vertebroplasty.…”

Fracturas osteoporóticas de ramas pélvicas: ¿Son una lesión benigna?

“…Algunos autores, para evitar las complicaciones debidas a la inmovilización, proponen una alta dosis analgésica que permita la carga y la deambulación casi inmediata [22] . Otros optan por el tratamiento quirúrgico mediante el atornillado percutáneo de la rama iliopubiana, que en nuestra revisión se realizo a una paciente permitiendo el inicio inmediato de la movilización y mejorando el control del dolor [23] . La ''ramoplastia'', tratamiento más novedoso, consiste en la inyección percutánea de cemento poli-metil-metacrilato que logra una mejoría inmediata del dolor [24,25] al igual que se hace en fracturas osteoporóticas de otras localizaciones, como las vertebrales.…”

Related Biological Research in the Interface between Bone Cement and Bone after Percutaneous Vertebroplasty

“…Although good clinical results have been reported in several series of both vertebroplasty and kyphoplasty procedures [15–21], it is still unclear whether some component of the pain relief is secondary to the mechanical stabilization, chemical toxicity, or thermal necrosis of surrounding tissues and nerve ends; in addition, the other surgery-related factors would affect the inflammatory progress. The concern regarding thermal bone necrosis is still theoretical, as to date, there has been no obvious evidence to support this [17, 22, 23]. In a baboon vertebral augmentation study, there were a few necrotic segment of bone present in both the vertebroplasty and kyphoplasty vertebrae.…”