Screw-in-screw fixation of fragility sacrum fractures provides high stability without loosening-biomechanical evaluation of a new concept.
SI screw
backing out
biomechanical testing
cutthrough
fragility fracture
locking screw
pelvis
sacroiliac screw
screw loosening
screw tilt
screw-in-screw
transsacral fixation
transsacral screw
unscrewing
Journal
Journal of orthopaedic research : official publication of the Orthopaedic Research Society
ISSN: 1554-527X
Titre abrégé: J Orthop Res
Pays: United States
ID NLM: 8404726
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
revised:
20
09
2020
received:
03
05
2020
accepted:
21
10
2020
pubmed:
25
10
2020
medline:
18
5
2021
entrez:
24
10
2020
Statut:
ppublish
Résumé
Surgical treatment of fragility sacrum fractures with percutaneous sacroiliac (SI) screw fixation is associated with high failure rates. Turn-out is detected in up to 20% of the patients. The aim of this study was to evaluate a new screw-in-screw implant prototype for fragility sacrum fracture fixation. Twenty-seven artificial hemipelvises were assigned to three groups (n = 9) for instrumentation of an SI screw, the new screw-in-screw implant prototype, ora transsacral screw. Before implantation, a vertical osteotomy was set in zone 1 after Denis. All specimens were biomechanically tested to failure in upright position. Validated setup and test protocol were used for complex axial and torsional loading applied through the S1 vertebral body to promote turn-out of the implants. Interfragmentary movements were captured via optical motion tracking. Screw motions were evaluated by means of triggered anteroposterior X-rays. Interfragmentary movements and implant motions were significantly higher for SI screw fixation compared to both transsacral and screw-in-screw fixations. In addition, transsacral screw and screw-in-screw fixations revealed similar construct stability. Moreover, screw-in-screw fixation successfully prevented turn-out of the implant that remained during testing at 0° rotation for all specimens. From biomechanical perspective, fragility sacrum fracture fixation with the new screw-in-screw implant prototype provides higher stability than an SI screw, being able to successfully prevent turn-out. Moreover, it combines the higher stability of transsacral screw fixation with the less risky operational procedure of SI screw fixation and can be considered as their alternative treatment option.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
761-770Informations de copyright
© 2020 Orthopaedic Research Society. Published by Wiley Periodicals LLC.
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