Safety, Effect and Feasibility of Percutaneous SI-Screw with and without Augmentation—A 15-Year Retrospective Analysis on over 640 Screws

Abstract

Background: Minimally invasive sacroiliac-screw (SI-screw) fixation of the pelvis is used in energy trauma (Arbeitsgemeinschaft für Osteosynthesefragen (AO) classified) and fragility fractures (Fragility Fracture of the Pelvis (FFP) classified). However, available clinical data are based on small case series and biomechanical data seem to be contradictory. Methods: The present single center retrospective cohort study investigated percutaneous SI-screw fixation and augmentation over 15 years. Groups were compared concerning the general epidemiological data, mobilization, complication rates, duration of stay, and safety of SI-screw insertion. Multivariable analyses were performed using logistic regression. Results: Between 2005 and March 2020, 448 patients with 642 inserted SI-screws were identified. Iatrogenic neurological impairment was documented in 2.47% and correlated with screw misplacement. There was an increased complication risk in patients with AO type C over patients with AO type B and in FFP II over FFP III/IV patients. Cement-augmented FFP patients showed a 25% reduced stay in hospital and a reduced complication risk. Cement-associated complications were seen in 22% without correlation to neurologic impairment. Conclusions: The present study confirms the safety and usability of percutaneous SI-screw fixation, despite specific risks. Cement augmentation seems to reduce the complication risk in FFP patients and shorten hospital stay for some reasons, without increased specific complications or correlated neurological impairment.

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

“…Re-establishing mobility with as little additionally morbidity as possible, as well as shorter duration of the surgical procedures, are both crucially important [ 8 ]. It has been shown that the percutaneous SI screw insertion is a safe and effective surgical procedure for stabilisation of the posterior pelvic ring [ 20 ]. However, there is insufficient evidence in the literature for the superiority of one the literature for the superiority [ 8 ], and it remains unclear whether simultaneous stabilisation of the anterior pelvic ring should be performed in anterior and posterior pelvic ring injuries [ 9 ], although this is recommended from a clinical point of view [ 10 ].…”

Kompetenz, Kreativität und Kommunikation: Grundlagen zur Qualitätsverbesserung in der Traumatologie

“…Moderne operative Techniken, wie z. B. die Zementaugmentation bei sakroiliakaler Verschraubung nach Beckeninsuffizienzfraktur erlauben außerdem eine frühzeitige Mobilisierung und beugen zusätzlich einem Delir vor [ 10 , 24 ].…”

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].…”

“…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]. However, SI screw loosening occurs in up to 20% of the cases [12,13].…”