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Open Access 01-12-2022 | Incision | Research article

Comparative retrospective study of triangular osteosynthesis with and without robotic assistance for unilateral unstable sacral fractures combined with lumbosacral junction injuries

Authors: Zhao-Jie Liu, Ya Gu, Jian Jia

Published in: BMC Surgery | Issue 1/2022

Abstract

Background

To compare the clinical efficacy of unilateral unstable sacral fractures (USFs) involving the lumbosacral region treated with and without robot-aided triangular osteosynthesis (TOS).

Methods

Patients of the unilateral USF combined with the ipsilateral lumbosacral junction injury (LSJI) treated with TOS were retrospectively analyzed and divided into two groups: the robot group (TOS with robotic assistance) and the conventional group (TOS with open procedure). Screw placement was assessed using the modified Gras criterion. Patients were followed up with routine visits for clinical and radiographic examinations. At the final follow-up, clinical outcomes were recorded and scored using the Majeed scoring system.

Results

Eleven patients in the robot group and seventeen patients in the conventional group were recruited into this study. Significant differences in surgical bleeding (P < 0.001) and fluoroscopy time (P = 0.002) were noted between the two groups. Operation time (P = 0.027) and fracture healing time (P = 0.041) was shorter in the robot group. There was no difference in postoperative residual displacement between the two groups (P = 0.971). According to the modified Gras criterion, the percentages of grade I for sacroiliac screws in the two groups were 90.9% (10/11) and 70.6% (12/17), and for pedicle screws were 100% (11/11) and 100% (17/17), respectively. The rate of incision-related complications was 0% (0/11) in the robot group and 11.8% (2/17) in the conventional group. Statistical differences were shown on the Majeed criterion (P = 0.039), with higher scores in the robot group.

Conclusion

TOS with robotic assistance for the treatment of unilateral USFs combined with ipsilateral LSJIs is safe and feasible, with the advantages of less radiation exposure and fewer incision-related complications.

Oransky M, Gasparini G (1997) Associated lumbosacral junction injuries (LSJIs) in pelvic fractures. J Orthop Trauma 11:509⁃512. https://doi.org/10.1097/00005131-199710000-00008.

Isler B (1990) Lumbosacral lesions associated with pelvic ring injuries. J Orthop Trauma 4:1⁃6. https://doi.org/10.1097/00005131-199003000-00001.

Iorio JA, Jakoi AM, Rehman S (2015) Percutaneous sacroiliac screw fixation of the posterior pelvic ring. Orthop Clin North Am 46:511⁃521. https://doi.org/10.1016/j.ocl.2015.06.005.

Acklin YP, Marco G, Sommer C. Double locking plate fixation of sacral fractures in unstable pelvic ring C⁃type injuries. Oper Orthop Traumatol. 2015;27:74–9. https://doi.org/10.1007/s00064-014-0307-2.CrossRef

Kach K, Trentz O. Distraction spondylodesis of the sacrum in “vertical shear lesions” of the pelvis. Unfallchirurg. 1994;97:28–38. https://doi.org/10.1097/00007890-199401001-00030.CrossRef

Schildhauer TA, Ledoux WR, Chapman JR, Henley MB, Tencer AF, Routt ML Jr. Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads. J Orthop Trauma. 2003;17:22–31. https://doi.org/10.1097/00005131-200301000-00004.CrossRef

Schildhauer TA, Josten Ch, Muhr G. Triangular osteosynthesis of vertically unstable sacrum fractures: a new concept allowing early weight-bearing. J Orthop Trauma. 2006;20:S44-51. https://doi.org/10.1097/00005131-199806000-00002.CrossRef

Acklin YP, Zderic I, Richards RG, Schmitz P, Gueorguiev B, Grechenig S. Biomechanical investigation of four different fixation techniques in sacrum Denis type II fracture with low bone mineral density. J Orthop Res. 2018;36:1624–9. https://doi.org/10.1002/jor.23798.CrossRef

Berber O, Amis AA, Day AC. Biomechanical testing of a concept of posterior pelvic reconstruction in rotationally and vertically unstable fractures. J Bone Joint Surg Br. 2011;93:237–44. https://doi.org/10.1302/0301-620X.93B2.24567.CrossRef

10.

Sagi HC, Militano U, Caron T, Lindvall E (2009) A comprehensive analysis with minimum 1⁃year follow⁃up of vertically unstable transforaminal sacral fractures treated with triangular osteosynthesis. J Orthop Trauma 23:313⁃321. https://doi.org/10.1097/BOT.0b013e3181a32b91.

11.

Bellabarba C, Schildhauer TA, Vaccaro AR, Chapman JR (2006) Complications associated with surgical stabilization of high-grade sacral fracture dislocations with spinopelvic instability. Spine (Phila Pa 1976) 31:S80–88. https://doi.org/10.1097/01.brs.0000217949.31762.be.

12.

Tan GQ, He JL, Fu BS, Li LX, Wang BM, Zhou DS. Lumbopelvic fixation for multiplanar sacral fractures with spinopelvic instability. Injury. 2012;43:1318–25. https://doi.org/10.1016/j.injury.2012.05.003.CrossRef

13.

Templeman D, Schmidt A, Freese J, Weisman I. Proximity of iliosacral screws to neurovascular structures after internal fixation. Clin Orthop Relat Res. 1996;329:194–8. https://doi.org/10.1097/00003086-199608000-00023.CrossRef

14.

Hinsche AF, Giannoudis PV, Smith RM. Fluoroscopy-based multiplanar image guidance for insertion of sacroiliac screws. Clin Orthop Relat Res. 2002;395:135–44. https://doi.org/10.1097/00003086-200202000-00014.CrossRef

15.

Wang JQ, Wang Y, Feng Y, Han W, Su YG, Liu WY. Percutaneous sacroiliac screw placement: a prospective randomized comparison of robot-assisted navigation procedures with a conventional technique. Chin Med J (Engl). 2017;130:2527–34. https://doi.org/10.4103/0366-6999.217080.CrossRef

16.

Liu ZJ, Hu YC, Tian W, Jin X, Qi HT, Sun YX. Robot-aided minimally invasive lumbopelvic fixation in treatment of traumatic spinopelvic dissociation. Orthop Surg. 2021;13:563–72. https://doi.org/10.1111/os.12908.CrossRef

17.

Liu ZJ, Gu Y, Jin X, Tian W, Qi HT, Sun YX (2021) Comparison of outcomes following TiRobot-assisted sacroiliac screw fixation with bone grafting and traditional screw fixation without bone grafting for unstable osteoporotic sacral fracture: a single-center retrospective study of 33 patients. Med Sci Monit 27:e932724. https://doi.org/10.12659/MSM.932724.

18.

Lindahl J, Hirvensalo E, Bostman O, Santavirta S. Failure of reduction with an external fixator in the management of injuries of the pelvic ring. Long-term evaluation of 110 patients. J Bone Joint Surg Br. 1999;81:955–62. https://doi.org/10.1302/0301-620x.81b6.8571.CrossRef

19.

Gras F, Marintschev I, Wilharm A, Klos K, Mückley T, Hofmann GO. 2D-fluoroscopic navigated percutaneous screw fixation of pelvic ring injuries- a case series. BMC Musculoskelet Disord. 2010;11:153. https://doi.org/10.1186/1471-2474-11-153.CrossRef

20.

Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg Br. 1989;71:304–6. https://doi.org/10.1007/BF02471596.CrossRef

21.

Gibbons KJ, Soloniuk DS, Razack N (1990) Neurological injury and patterns of sacral fractures. J Neurosurg 72: 889⁃893. https://doi.org/10.3171/jns.1990.72.6.0889.

22.

Tile M. Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br. 1988;70:1–12. https://doi.org/10.1302/0301-620X.70B1.3276697.CrossRef

23.

Karthik K, Colegate-Stone T, Dasgupta P, Tavakkolizadeh A, Sinha J (2015) Robotic surgery in trauma and orthopaedics: a systematic review. Bone Joint J 97-B: 292–299. https://doi.org/10.1302/0301-620X.97B3.35107.

24.

Long T, Li KN, Gao JH, Liu TH, Mu JS, Wang XJ. Comparative study of percutaneous sacroiliac screw with or without TiRobot assistance for treating pelvic posterior ring fractures. Orthop Surg. 2019;11:386–96. https://doi.org/10.1111/os.12461.CrossRef

25.

Gardner MJ, Morshed S, Nork SE, Ricci WM, Chip Routt ML, Jr,. Quantification of the upper and second sacral segment safe zones in normal and dysmorphic sacra. J Orthop Trauma. 2010;24:622–9. https://doi.org/10.1097/BOT.0b013e3181cf0404.CrossRef

26.

Takao M, Hamada H, Sakai T, Sugano N. Factors influencing the accuracy of iliosacral screw insertion using 3D fluoroscopic navigation. Arch Orthop Trauma Surg. 2019;139:189–95. https://doi.org/10.1007/s00402-018-3055-1.CrossRef

Title: Comparative retrospective study of triangular osteosynthesis with and without robotic assistance for unilateral unstable sacral fractures combined with lumbosacral junction injuries
Authors: Zhao-Jie Liu
Ya Gu
Jian Jia
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Incision
Minimally Invasive Surgery
Published in: BMC Surgery / Issue 1/2022
Electronic ISSN: 1471-2482
DOI: https://doi.org/10.1186/s12893-022-01857-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparative retrospective study of triangular osteosynthesis with and without robotic assistance for unilateral unstable sacral fractures combined with lumbosacral junction injuries

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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