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

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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.

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References

  1. 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):450–456

    PubMed  CAS  Google Scholar 

  2. 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):646–650

    Article  PubMed  CAS  Google Scholar 

  3. 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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. 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

    Article  PubMed  CAS  Google Scholar 

  7. 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

    Article  Google Scholar 

  8. 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

    Article  PubMed  CAS  Google Scholar 

  9. 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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  Google Scholar 

  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):404–409

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  Google Scholar 

  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–E59

    PubMed  CAS  Google Scholar 

  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

    Article  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Alber-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany

    Dirk Wähnert, Michale J. Raschke & Thomas Fuchs

Authors
  1. Dirk Wähnert
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  2. Michale J. Raschke
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  3. Thomas Fuchs
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Corresponding author

Correspondence to Thomas Fuchs.

Additional information

Dirk Wähnert and Michale J. Raschke both authors contributed equally.

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Wähnert, D., Raschke, M.J. & Fuchs, T. Cement augmentation of the navigated iliosacral screw in the treatment of insufficiency fractures of the sacrum. A new method using modified implants. International Orthopaedics (SICOT) 37, 1147–1150 (2013). https://doi.org/10.1007/s00264-013-1875-8

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  • DOI: https://doi.org/10.1007/s00264-013-1875-8

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