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International Orthopaedics

Published in:

01-06-2013 | Original Paper

Cement augmentation of the navigated iliosacral screw in the treatment of insufficiency fractures of the sacrum. A new method using modified implants

Authors: Dirk Wähnert, Michale J. Raschke, Thomas Fuchs

Published in: International Orthopaedics | Issue 6/2013

Abstract

Purpose

Pelvis ring fractures of geriatric patients are currently a serious problem in orthopedic and trauma surgery. One controversy that remains is the insufficiency fracture of the sacrum with treatment options ranging from conservative to operative. We modified standard 7.3-mm screws with additional perforations at the tip to allow cement injection trough the screw to improve implant anchorage.

Method

We describe a new method of treatment of sacral insufficiency fractures. We use modified cannulated 7.3-mm screws (Synthes) with additional perforations at the screw tip. This allows the implant augmentation after proper implant positioning and contrast medium instillation for leakage detection.

Results

All patients (12 female) treated this way, are allowed to weight bear as tolerated immediately after surgery. The pain level (measured by the visual analog scale—VAS) was significantly reduced due to surgery (mean 8.2 pre-operatively, mean 2.6 postoperatively), the pain medication could be reduced rapidly.

Conclusion

The described procedure for the treatment of sacral insufficiency fractures has the potential to increase the safety of cement injection into the sacrum because of the possibility of contrast agent instillation prior to cement injection. Furthermore, the amount of cement can be reduced and additional stability can be attained due to iliosacral screw osteosynthesis compared to sacroplasty.

Tosounidis G, Holstein JH, Culemann U, Holmenschlager F, Stuby F, Pohlemann T (2010) Changes in epidemiology and treatment of pelvic ring fractures in Germany: an analysis on data of German pelvic multicenter study groups I and III (DGU/AO). Acta Chir Orthop Traumatol Cech 77(6):450–456PubMed

Morris RO, Sonibare A, Green DJ, Masud T (2000) Closed pelvic fractures: characteristics and outcomes in older patients admitted to medical and geriatric wards. Postgrad Med J 76(900):646–650PubMedCrossRef

Pohlemann T, Stengel D, Tosounidis G, Reilmann H, Stuby F, Stockle U, Seekamp A, Schmal H, Thannheimer A, Holmenschlager F, Gansslen A, Rommens PM, Fuchs T, Baumgartel F, Marintschev I, Krischak G, Wunder S, Tscherne H, Culemann U (2011) Survival trends and predictors of mortality in severe pelvic trauma: estimates from the German pelvic trauma registry initiative. Injury 42(10):997–1002. doi:10.1016/j.injury.2011.03.053 PubMedCrossRef

Lourie H (1982) Spontaneous osteoporotic fracture of the sacrum. An unrecognized syndrome of the elderly. JAMA 248(6):715–717PubMedCrossRef

Frey ME, Depalma MJ, Cifu DX, Bhagia SM, Carne W, Daitch JS (2008) Percutaneous sacroplasty for osteoporotic sacral insufficiency fractures: a prospective, multicenter, observational pilot study. Spine J 8(2):367–373. doi:10.1016/j.spinee.2007.05.011 PubMedCrossRef

Fuchs T, Rottbeck U, Hofbauer V, Raschke M, Stange R (2011) Pelvic ring fractures in the elderly. Underestimated osteoporotic fracture. Unfallchirurg 114(8):663–670. doi:10.1007/s00113-011-2020-z PubMedCrossRef

Tjardes T, Paffrath T, Baethis H, Shafizadeh S, Steinhausen E, Steinbuechel T, Rixen D, Bouillon B (2008) Computer assisted percutaneous placement of augmented iliosacral screws: a reasonable alternative to sacroplasty. Spine (Phila Pa 1976) 33(13):1497–1500. doi:10.1097/BRS.0b013e318175c25c CrossRef

Wahnert D, Hofmann-Fliri L, Schwieger K, Brianza S, Raschke MJ, Windolf M (2013) Cement augmentation of lag screws: an investigation on biomechanical advantages. Arch Orthop Trauma Surg 133(3):373–379. doi:10.1007/s00402-012-1676-3 PubMedCrossRef

Mears SC, Berry DJ (2011) Outcomes of displaced and nondisplaced pelvic and sacral fractures in elderly adults. J Am Geriatr Soc 59(7):1309–1312. doi:10.1111/j.1532-5415.2011.03455.x PubMedCrossRef

10.

Lin J, Lachmann E, Nagler W (2001) Sacral insufficiency fractures: a report of two cases and a review of the literature. J Wom Health Gend Base Med 10(7):699–705. doi:10.1089/15246090152563588 CrossRef

11.

Babayev M, Lachmann E, Nagler W (2000) The controversy surrounding sacral insufficiency fractures: to ambulate or not to ambulate? Am J Phys Med Rehabil 79(4):404–409PubMedCrossRef

12.

Buerger PM, Peoples JB, Lemmon GW, McCarthy MC (1993) Risk of pulmonary emboli in patients with pelvic fractures. Am Surg 59(8):505–508PubMed

13.

Bayley E, Srinivas S, Boszczyk BM (2009) Clinical outcomes of sacroplasty in sacral insufficiency fractures: a review of the literature. Eur Spine J 18(9):1266–1271. doi:10.1007/s00586-009-1048-z PubMedCrossRef

14.

Richards AM, Mears SC, Knight TA, Dinah AF, Belkoff SM (2009) Biomechanical analysis of sacroplasty: does volume or location of cement matter? AJNR Am J Neuroradiol 30(2):315–317. doi:10.3174/ajnr.A1358 PubMedCrossRef

15.

Bastian JD, Keel MJ, Heini PF, Seidel U, Benneker LM (2012) Complications related to cement leakage in sacroplasty. Acta Orthop Belg 78(1):100–105PubMed

16.

Sermon A, Boner V, Boger A, Schwieger K, Boonen S, Broos PL, Richards RG, Windolf M (2012) Potential of polymethylmethacrylate cement-augmented helical proximal femoral nail antirotation blades to improve implant stability—a biomechanical investigation in human cadaveric femoral heads. J Trauma Acute Care Surg 72(2):E54–E59PubMed

17.

Sermon A, Boner V, Schwieger K, Boger A, Boonen S, Broos P, Richards G, Windolf M (2012) Biomechanical evaluation of bone-cement augmented proximal femoral nail antirotation blades in a polyurethane foam model with low density. Clin Biomech (Bristol, Avon) 27(1):71–76. doi:10.1016/j.clinbiomech.2011.07.006 CrossRef

18.

Routt ML Jr, Simonian PT, Mills WJ (1997) Iliosacral screw fixation: early complications of the percutaneous technique. J Orthop Trauma 11(8):584–589PubMedCrossRef

Title: Cement augmentation of the navigated iliosacral screw in the treatment of insufficiency fractures of the sacrum. A new method using modified implants
Authors: Dirk Wähnert
Michale J. Raschke
Thomas Fuchs
Publication date: 01-06-2013
Publisher: Springer-Verlag
Published in: International Orthopaedics / Issue 6/2013
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-013-1875-8

At a glance: The STEP trials

Springer Medicine

Cement augmentation of the navigated iliosacral screw in the treatment of insufficiency fractures of the sacrum. A new method using modified implants

Abstract

Purpose

Method

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Method

Results

Conclusion

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