Surgical Fixation of Geriatric Sacral U-Type Insufficiency Fractures: A Retrospective Analysis

Abstract

Objectives: To define the incidence of sacral U-type insufficiency fracture and describe management of a consecutive series of patients with this injury. Design: Retrospective analysis. Setting: Single Level II trauma center. Patients/Participants: Sixteen adult patients with sacral U-type insufficiency fractures treated over a 36-month period. Intervention: Patients were indicated for percutaneous screw fixation of the posterior pelvis if they had posterior pelvic pain that prohibited mobilization. Main Outcome Measurements: Visual analog scale for pain, distance ambulated on postoperative day 1, and change in sacral kyphosis. Results: The sacral U-type insufficiency fracture incidence was 16.7% (19/114); average patient age was 75 years. Delayed surgery was performed after primary nonoperative treatment had failed in 62.5% (10/16) at an average 83 days postinjury. Acute surgery was performed in 37.5% (6/16) at an average 5 days postinjury. Distance ambulated on postoperative day 1 was 114.4 feet [95% confidence interval (CI) (50.6, 178.2)] and 88.7 feet [95% CI (2.8, 174.6)] in the delayed and acute surgery groups, respectively, P = 0.18. Change in visual analog scale for pain was −3.2 [95% CI (−5.0, −1.4)] and −3.7 [95% CI (−7.0, −0.4)] in the delayed and acute surgery groups, respectively, P = 0.15. Change in sacral kyphosis from presentation to surgery was 12.3 degrees [95% CI (6.7, 17.9)] and 0.3 degrees [95% CI (−0.2, 0.9)] in the delayed and acute surgery groups, respectively, P < 0.01. Minimum follow-up was 12 months. Conclusions: Treatment of sacral U-type insufficiency fractures by percutaneous screw fixation permits early mobilization, provides rapid pain relief, and prevents progressive deformity. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Is pelvic mapping applicable in iliosacral screw fixation to determine screw entry point and screw trajectory?

“…Particularly in the elderly osteoporotic patient population, the engagement of the screw in the S1 body may not provide adequate fixation. [18,19] It would therefore be appropriate for the screw to reach the opposite sacroiliac joint.…”

Modified therapy concepts for fragility fractures of the pelvis after additional MRI

“…He found a frequency of 16.7% (n = 19/114). Pulley diagnosed the fractures in CT and an MRI was supplemented only in some cases [10]. Insufficiency fractures were not detected.…”

Surgical Fixation of Sacral Fractures in the Elderly Population: Are There Predictors of Outcome? An Analysis of Return to Ambulation and Residential Living Status

“…As a result, the literature has seen an emergence of evidence characterizing the utility of surgical fixation in treating sacral fractures within the aging population. [9][10][11][12] Outcomes suggest that surgical fixation in these patients can afford immediate ambulation (mean distance post-operative Day 1: 114.4 feet), as well as a high rate of return to independent living (73-75%). [10][11][12] However, while this evidence has been encouraging and effective in establishing the utility of surgical fixation in the elderly population, especially in comparison to non-operative treatment, it has yet to explore many factors that may influence outcome.…”

“…[9][10][11][12] Outcomes suggest that surgical fixation in these patients can afford immediate ambulation (mean distance post-operative Day 1: 114.4 feet), as well as a high rate of return to independent living (73-75%). [10][11][12] However, while this evidence has been encouraging and effective in establishing the utility of surgical fixation in the elderly population, especially in comparison to non-operative treatment, it has yet to explore many factors that may influence outcome. [9][10][11][12] It is unclear whether such variables as baseline function (i.e.…”

“…[10][11][12] However, while this evidence has been encouraging and effective in establishing the utility of surgical fixation in the elderly population, especially in comparison to non-operative treatment, it has yet to explore many factors that may influence outcome. [9][10][11][12] It is unclear whether such variables as baseline function (i.e. ambulation status, place of residence), time-tosurgery, concomitant injury, and fracture mechanism (i.e.…”