Compressive effect and collapse behavior of three different transsacral implants in sacral fragility fractures - a retrospective analysis of 106 cases.

Compressive effect Fragility fractures of the pelvis Marquardt rod Sacroiliac screw Transsacral bar Transsacral stabilization

Journal

European journal of trauma and emergency surgery : official publication of the European Trauma Society
ISSN: 1863-9941
Titre abrégé: Eur J Trauma Emerg Surg
Pays: Germany
ID NLM: 101313350

Informations de publication

Date de publication:
27 Aug 2024
Historique:
received: 30 05 2024
accepted: 26 07 2024
medline: 27 8 2024
pubmed: 27 8 2024
entrez: 27 8 2024
Statut: aheadofprint

Résumé

The aim of this study were the retrospective evaluation of the compressive effect and complication rates of transsacral stabilization of osteoporosis-associated sacral fragility fractures in 106 patients using three different implants (6.0 mm sacral bar, n = 32; 7.3 mm screw, n = 26; 7.5 mm ISG-Rod System, n = 48) with regard to the image morphological and clinical-perioperative outcome. For this purpose, the sacral width was determined preoperatively and postoperatively using multiplanar CT reconstructions and correlated with the measured bone density (HU). The results were compared with each other on an implant-specific basis. A significant compressive effect was found for all implants (6.0 mm sacral bar 7.1 ± 3.4 mm, 7.3 mm screw 6.9 ± 1.8 mm, 7.5 mm ISG-Rod System 8 ± 2.4 mm). No implant-specific difference in compression could be detected. Overall, the washers broke into the iliac cortex in 9% of cases. The subgroups did not differ significantly in this respect (6.0 mm sacral bar: 4 [13%], 7.3 mm screw 1 [1%], 7.5 mm ISG-Rod System (5 [10%], p = 0.581). A correlation between the degree of osteoporosis and the compressive effect could not be demonstrated. Significant implant-specific differences were found in the incision-suture time, with only ø0:39 ± 0:13 h required for implantation of the 7.5 mm ISG Rod System (6.0 mm sacral bar: ø1:09 ± 0:22 h, 7.3 mm screw: ø0:55 ± 0:20 h). The fluoroscopy time was significantly lower with the 7.3 mm screw (ø0:57 ± 0:23 min) and the 7.5 mm ISG Rod System (ø0:42 ± 00:17 min) than with the 6.0 mm sacral bar (ø1:36 ± 0:46 min). A significant compressive effect was demonstrated with all three implants. No implant-specific complications or surgical site complications were identified in either the overall cohort or the subgroups. The 7.5 mm ISG Rod System shows advantages with regard to the duration of surgery and fluoroscopy.

Identifiants

pubmed: 39190062
doi: 10.1007/s00068-024-02629-1
pii: 10.1007/s00068-024-02629-1
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024. The Author(s).

Références

Oberkircher L, Ruchholtz S, Rommens PM, Hofmann A, Bücking B, Krüger A. Osteoporotic Pelvic Fractures. Vol. 115, Deutsches Arzteblatt international. NLM (Medline); 2018. pp. 70–80.
Andrich S, Haastert B, Neuhaus E, Neidert K, Arend W, Ohmann C et al. Epidemiology of pelvic fractures in Germany: considerably high incidence rates among older people. PLoS ONE. 2015;10(9).
Rupp M, Walter N, Pfeifer C, Lang S, Kerschbaum M, Krutsch W, et al. Originalarbeit: Inzidenz Von Frakturen in Der Erwachsenenpopulation in Deutschland. Dtsch Arztebl Int. 2021;118(40):665–9.
pubmed: 34140088 pmcid: 8727861
Wagner D, Hofmann A, Kamer L, Sawaguchi T, Richards RG, Noser H, et al. Fragility fractures of the sacrum occur in elderly patients with severe loss of sacral bone mass. Arch Orthop Trauma Surg. 2018;138(7):971–7.
doi: 10.1007/s00402-018-2938-5 pubmed: 29700604
Linstrom NJ, Heiserman JE, Kortman KE, Crawford NR, Baek S, Anderson RL, et al. Anatomical and biomechanical analyses of the unique and consistent locations of sacral insufficiency fractures. Spine (Phila Pa 1976). 2009;34(4):309–15.
doi: 10.1097/BRS.0b013e318191ea01 pubmed: 19214089
Rommens PM, Arand C, Hopf JC, Mehling I, Dietz SO, Wagner D. Progress of instability in fragility fractures of the pelvis: an observational study. Injury. 2019;50(11):1966–73.
doi: 10.1016/j.injury.2019.08.038 pubmed: 31492514
Rommens PM, Boudissa M, Krämer S, Kisilak M, Hofmann A, Wagner D. Operative treatment of fragility fractures of the pelvis is connected with lower mortality. A single institution experience. PLoS ONE. 2021;16(7 July).
Mendel T, Ullrich BW, Schenk P, Hofmann GO, Goehre F, Schwan S, et al. Perioperative outcome of minimally invasive stabilisation of bilateral fragility fractures of the sacrum: a comparative study of bisegmental transsacral stabilisation versus spinopelvic fixation. Eur J Trauma Emerg Surg. 2023;49(2):1001–10.
doi: 10.1007/s00068-022-02123-6 pubmed: 36255462
Mendel T, Schenk P, Ullrich BW, Hofmann GO, Goehre F, Schwan S, et al. Cite this article. Bone Joint J. 2021;103(3):462–8.
doi: 10.1302/0301-620X.103B3.BJJ-2020-1454.R1 pubmed: 33641427
Rommens PM, Wagner D, Arand C, Boudissa M, Hopf J, Hofmann A. Minimally invasive stabilization of fragility fractures of the pelvis with transsacral bar and retrograde transpubic screw. Oper Orthop Traumatol. 2022;34(2):153–71.
doi: 10.1007/s00064-022-00763-w pubmed: 35301551
Wagner D, Kisilak M, Porcheron G, Krämer S, Mehling I, Hofmann A et al. Trans-sacral bar osteosynthesis provides low mortality and high mobility in patients with fragility fractures of the pelvis. Sci Rep. 2021;11(1).
Berk T, Zderic I, Varga P, Schwarzenberg P, Lesche F, Halvachizadeh S et al. Evaluation of Cannulated Compression Headless Screw (CCHS) as an alternative implant in comparison to standard S1-S2 screw fixation of the posterior pelvis ring: a biomechanical study. BMC Musculoskelet Disord. 2023;24(1).
Cintean R, Fritzsche C, Zderic I, Gueorguiev-Rüegg B, Gebhard F, Schütze K. Sacroiliac versus transiliac–transsacral screw osteosynthesis in osteoporotic pelvic fractures: a biomechanical comparison. Eur J Trauma Emerg Surg. 2023.
Giannoudis PV, Schneider E. Principles of fixation of osteoporotic fractures. Br]. 2006;88:1272–80.
Bogunovic L, Cherney SM, Rothermich MA, Gardner MJ. Biomechanical Considerations for Surgical Stabilization of Osteoporotic Fractures. 44, Orthopedic Clinics of North America. 2013. p. 183–200.
Hollensteiner M, Sandriesser S, Bliven E, von Rüden C, Augat P. Biomechanics of osteoporotic fracture fixation. Current Osteoporosis Reports. Volume 17. Springer; 2019. pp. 363–74.
Deshpande N, Hadi MS, Lillard JC, Passias PG, Linzey JR, Saadeh YS, et al. Alternatives to DEXA for the assessment of bone density: a systematic review of the literature and future recommendations. J Neurosurg Spine. 2023;38(4):436–45.
doi: 10.3171/2022.11.SPINE22875 pubmed: 36609369
Pinto EM, Neves JR, Teixeira A, Frada R, Atilano P, Oliveira F, et al. Efficacy of Hounsfield Units measured by lumbar computer tomography on Bone Density Assessment: a systematic review. Spine (Phila Pa 1976). 2022;47(9):702–10.
doi: 10.1097/BRS.0000000000004211 pubmed: 34468433
Ullrich BW, Schenk P, Spiegl UJ, Mendel T, Hofmann GO. Hounsfield units as predictor for cage subsidence and loss of reduction: following posterior-anterior stabilization in thoracolumbar spine fractures. Eur Spine J. 2018;27(12):3034–42.
doi: 10.1007/s00586-018-5792-9 pubmed: 30341626
Pickhardt PJ, Pooler B, Dustin, Lauder T, Muñ O, Del Rio A, Bruce RJ, Binkley N. Opportunistic Screening for Osteoporosis Using Abdominal Computed Tomography Scans Obtained for Other Indications [Internet]. 2013. Available from: www.annals.org.
Schreiber JJ, Anderson PA, Rosas HG, Buchholz AL, Au AG. Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg. 2011;93(11):1057–63.
doi: 10.2106/JBJS.J.00160 pubmed: 21655899
Vanderschot P, Meuleman C, Lefèvre A, Broos P. Trans iliac-sacral-iliac bar stabilisation to treat bilateral lesions of the sacro-iliac joint or sacrum: anatomical considerations and clinical experience [Internet]. Vol. 32, Int. J. Care Injured. 2001. www.elsevier.com/locate/injury
Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury. 2013;44(12):1733–44.
doi: 10.1016/j.injury.2013.06.023 pubmed: 23871193
Ullrich BW, Schnake KJ, Spiegl UJA, Schenk P, Mendel T, Behr L et al. OF-Pelvis classification of osteoporotic sacral and pelvic ring fractures. BMC Musculoskelet Disord. 2021;22(1).
GERTZBEIN SD, ROBBINS SE. Accuracy of Pedicular Screw Placement in vivo. Spine (Phila Pa 1976). 1990;15(1):11–4.
doi: 10.1097/00007632-199001000-00004 pubmed: 2326693
Nanninga GL, de Leur K, Panneman MJM, van der Elst M, Hartholt KA. Increasing rates of pelvic fractures among older adults: the Netherlands, 1986–2011. Age Ageing. 2014;43(5):648–53.
doi: 10.1093/ageing/aft212 pubmed: 24419459
Breuil V, Roux CH, Carle GF. Pelvic fractures: Epidemiology, consequences, and medical management. Current Opinion in Rheumatology. Volume 28. Lippincott Williams and Wilkins; 2016. pp. 442–7.
Hopf JC, Krieglstein CF, Müller LP, Koslowsky TC. Percutaneous iliosacral screw fixation after osteoporotic posterior ring fractures of the pelvis reduces pain significantly in elderly patients. Injury. 2015;46(8):1631–6.
doi: 10.1016/j.injury.2015.04.036 pubmed: 26052052
Mears SC, Sutter EG, Wall SJ, Rose DM, Belkoff SM. Biomechanical Comparison of Three Methods of Sacral Fracture Fixation in Osteoporotic Bone. Vol. 35, SPINE.
Bradley H, Pierce B, O’neill D, Jo CH, Ahn J, Farahani F, et al. Biomechanical comparison of 4 Transsacral Fixation Constructs in a type 61 C, Zone II pelvic fracture model. J Orthop Trauma. 2022;36(10):503–8.
doi: 10.1097/BOT.0000000000002381 pubmed: 35551158
Hack J, Safi M, Bäumlein M, Lenz J, Bliemel C, Ruchholtz S et al. Is cement-augmented sacroiliac screw fixation with partially threaded screws superior to that with fully threaded screws concerning compression and pull-out force in fragility fractures of the sacrum?– a biomechanical analysis. BMC Musculoskelet Disord. 2021;22(1).
Wagner D, Ossendorf C, Gruszka D, Hofmann A, Rommens PM. Fragility fractures of the sacrum: how to identify and when to treat surgically? European Journal of Trauma and Emergency Surgery. Volume 41. Springer Berlin; 2015. pp. 349–62.
Osterhoff G, Dodd AE, Unno F, Wong A, Amiri S, Lefaivre KA, et al. Cement augmentation in Sacroiliac Screw fixation offers Modest Biomechanical advantages in a Cadaver Model. Clin Orthop Relat Res. 2016;474(11):2522–30.
doi: 10.1007/s11999-016-4934-9 pubmed: 27334321 pmcid: 5052190
Fan S, Chen S, Xiang H, Mai Q, Zhu Z, Chen Y et al. Biomechanical comparison of ve iliosacral screw xation techniques for Tile C1.3 pelvic fracture under two-legged standing load: a cadaver study. 2024; https://doi.org/10.21203/rs.3.rs-4005527/v1
chiproutt1995.
Schep NWL, Haverlag R, Van Vugt AB. Computer-assisted versus conventional surgery for insertion of 96 cannulated iliosacral screws in patients with postpartum pelvic pain. J Trauma - Injury Infect Crit Care. 2004;57(6):1299–302.
doi: 10.1097/01.TA.0000133573.53587.2E
Rommens PM, Wagner D, Hofmann A. Fragility fractures of the pelvis. JBJS Rev. 2017;5(3).
Deutsches Ärzteblatt: Archiv Osteoporotic Pelvic Fractures (02.02.2018).

Auteurs

C Fischer (C)

Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, Merseburger Strasse 165, 06120, Halle (Saale), Germany. christian.fischer@bergmannstrost.de.
Department of Trauma, Hand and Reconstructive Surgery, Martin Luther University Halle-Wittenberg, University Hospital Halle, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany. christian.fischer@bergmannstrost.de.

F Klauke (F)

Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, Merseburger Strasse 165, 06120, Halle (Saale), Germany.
Department of Trauma, Hand and Reconstructive Surgery, Martin Luther University Halle-Wittenberg, University Hospital Halle, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.

P Schenk (P)

Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, Merseburger Strasse 165, 06120, Halle (Saale), Germany.
Department of Science, Research and Education, BG Klinikum Bergmannstrost Halle gGmbH, 06112, Halle, Germany.

H Bauerfeld (H)

Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, Merseburger Strasse 165, 06120, Halle (Saale), Germany.
Department of Trauma, Hand and Reconstructive Surgery, Martin Luther University Halle-Wittenberg, University Hospital Halle, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.

P Kobbe (P)

Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, Merseburger Strasse 165, 06120, Halle (Saale), Germany.
Department of Trauma, Hand and Reconstructive Surgery, Martin Luther University Halle-Wittenberg, University Hospital Halle, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.

T Mendel (T)

Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, Merseburger Strasse 165, 06120, Halle (Saale), Germany.
Department of Trauma, Hand and Reconstructive Surgery, Martin Luther University Halle-Wittenberg, University Hospital Halle, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.

Classifications MeSH