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Arand C, Hartung C, Mehler D, Gercek E, Wollstädter J, Wagner D, Rommens PM. Biomechanical evaluation of an experimental internal ring fixator (RingFix) for stabilization of pelvic ring injuries on an osteoporotic bone model. Sci Rep 2024; 14:20823. [PMID: 39242670 PMCID: PMC11379716 DOI: 10.1038/s41598-024-71138-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 08/26/2024] [Indexed: 09/09/2024] Open
Abstract
During the last decades, effective pain reduction and early mobilization were identified as the central priorities in therapy of insufficiency fractures of the pelvis. For operative treatment minimally-invasive stabilization techniques are favored. While there is consensus on the significance of sufficient dorsal stabilization the role of additional fixation of the anterior fracture component stays under discussion. Within the present study we developed an internal ring fixator system (RingFix) with the question whether an in-itself-closed construct can improve stability of the entire ring structure. RingFix was evaluated on an osteoporotic bone model with a standardized FFP IIIc fracture within an established biomechanical setup regarding its primary stabilization potential. Further, it was compared to transiliac-transsacral screw fixation with and without stabilization of the anterior fracture component. The transiliac-transsacral fixation with separate screw fixation of the anterior fracture showed significantly higher stability than the RingFix and the transiliac-transsacral screw fixation without anterior stabilization. Our results show that stabilization of the anterior fracture component relevantly improves the stability of the entire ring construct. As a bridging stabilizer, RingFix shows biomechanical advantages over an isolated dorsal fracture fixation, but inferior results than direct stabilization of the single fracture components.
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Affiliation(s)
- Charlotte Arand
- Department of Orthopaedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Christian Hartung
- Department of Orthopaedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Dorothea Mehler
- Department of Orthopaedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Erol Gercek
- Department of Orthopaedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Jochen Wollstädter
- Department of Orthopaedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Daniel Wagner
- Departement of Orthopedics and Tramatology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Pol M Rommens
- Department of Orthopaedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
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Stolberg-Stolberg J, Lodde MF, Seiß D, Köppe J, Hartensuer R, Raschke MJ, Riesenbeck O. Long-Term Follow-Up after Iliosacral Screw Fixation of Unstable Pelvic Ring Fractures. J Clin Med 2024; 13:1070. [PMID: 38398383 PMCID: PMC10889108 DOI: 10.3390/jcm13041070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: High-energy injuries of the pelvic ring are rare. The wide application of iliosacral screw fixation of the posterior pelvic ring is relatively new. The aim of the present study was to evaluate the long-term quality of life. (2) Methods: All patients treated with an iliosacral screw for a posterior pelvic ring stabilization after high-energy trauma at a level 1 trauma center between 2005 and 2015 were included. Pelvic ring injuries were classified according to the Tile classification adapted by AO/ASIF. The clinical evaluation included the patient-oriented questionnaires surveys of the Majeed Score, Iowa Pelvic Score (IPS), Work Ability Index (WAI), SF-36, EQ5D-5L. (3) Results: A total of 84 patients were included with a median follow-up of 130.1 months (IQR 95.0-162.0 months). The median ISS was 22.5 (IQR 16.0-29.0), mean Majeed Score 83.32 (SD ± 19.26), IPS 77.88 (SD ± 13.96), WAI 32.71 (SD ± 11.31), SF-36 PF 71.25 (SD ± 29.61) and EQ5D-5L 0.83 (SD ± 0.21). There was a notably difference between uni- and bilateral pelvic fractures (p = 0.033) as well as a correlation with the ISS (p = 0.043) with inferior functional outcome measured by IPS. (4) Conclusions: Long-term follow-up of iliosacral screw fixation of unstable pelvic ring fractures showed a good quality of life and functional outcome with equal EQ5D-5L results and inferior SF-36 physical functioning compared to the German population.
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Affiliation(s)
- Josef Stolberg-Stolberg
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W 1, 48149 Muenster, Germany; (J.S.-S.); (D.S.); (M.J.R.); (O.R.)
| | - Moritz F. Lodde
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W 1, 48149 Muenster, Germany; (J.S.-S.); (D.S.); (M.J.R.); (O.R.)
| | - Dominik Seiß
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W 1, 48149 Muenster, Germany; (J.S.-S.); (D.S.); (M.J.R.); (O.R.)
| | - Jeanette Köppe
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstrasse 56, 48149 Muenster, Germany;
| | - René Hartensuer
- Department of Orthopedics, Trauma-, Handsurgery and Sportsmedicine, Klinikum Aschaffenburg-Alzenau, Am Hasenkopf 1, 63739 Aschaffenburg, Germany;
| | - Michael J. Raschke
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W 1, 48149 Muenster, Germany; (J.S.-S.); (D.S.); (M.J.R.); (O.R.)
| | - Oliver Riesenbeck
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W 1, 48149 Muenster, Germany; (J.S.-S.); (D.S.); (M.J.R.); (O.R.)
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Arand C, Mehler D, Sauer A, Hartung C, Gercek E, Rommens PM, Wagner D. Do we need to fix the anterior fracture component in insufficiency fractures of the pelvis? A biomechanical comparison on an FFP type IIIc fracture in an osteoporotic pelvic bone model. Injury 2023; 54:111096. [PMID: 37833233 DOI: 10.1016/j.injury.2023.111096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023]
Abstract
There is a growing understanding of the specific characteristics of insufficiency fractures of the pelvis and of general requirements for the treatment of affected patients with focus on early mobilization and effective pain reduction as the main goals of therapy. While there is consensus on the significance of achieving stability of the dorsal pelvic ring structures there is still an open discussion about the potential benefits of additional stabilization of an anterior fracture component. Within a biomechanical test setup, two established methods of dorsal fracture fixation were tested under axial loading (25-1200 N; 1000 test cycles) on an explicit osteoporotic bone model (n = 32) with a standardized FFP type IIIc fracture with and without additional fixation of the anterior fracture component. Dorsal fixation was performed with and long and a short 7.3 mm cannulated screw in S1 in one group (n = 16), and a trans sacral bar with an additional short 7.3 mm cannulated screw in S1 in the other group (n = 16). Half of the samples received a 7.3 mm cannulated retrograde transpubic screw for anterior fixation. The fixation with the trans sacral bar and the additional anterior screw fixation showed the highest rate of stability (p = 0.0014), followed by the double SI-screw fixation with stabilization of the anterior fracture (p = 0.0002). During testing, we observed the occurrence of new sacral fractures contralateral to the initial fracture in 22/32 samples. The results let us assume that stabilization of an additional anterior fracture component relevantly improves the stability of the entire ring construct and might prevent failure of the dorsal stabilization or further fracture progression.
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Affiliation(s)
- Charlotte Arand
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstraße 1, Mainz 55131, Germany.
| | - Dorothea Mehler
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstraße 1, Mainz 55131, Germany
| | - Anne Sauer
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstraße 1, Mainz 55131, Germany
| | - Christian Hartung
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstraße 1, Mainz 55131, Germany
| | - Erol Gercek
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstraße 1, Mainz 55131, Germany
| | - Pol M Rommens
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstraße 1, Mainz 55131, Germany
| | - Daniel Wagner
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstraße 1, Mainz 55131, Germany; Department of Orthopedics and Trauamtology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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Mahato NK. Topographic localization of the sacroiliac joint and superior gluteal artery branches on the posterolateral ilium. Clin Anat 2023; 36:971-976. [PMID: 36601727 DOI: 10.1002/ca.24005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/24/2022] [Accepted: 12/24/2022] [Indexed: 01/06/2023]
Abstract
Latrogenic vascular injuries at the posterior ilium during sacroiliac screw placements are not uncommon. Though intra-operative imaging reduces the risk of such injuries, anatomical localization of the sacral segments using discrete topographical landmarks is not currently available. This descriptive study proposes the use of an anatomical grid system to localize the sacroiliac articulation on the posterolateral ilium. It also investigates the positional variability of the branches of the superior gluteal artery (SGA) within areas defined by the grid. 48 dried adult hip bones were examined to determine the position of the sacral articular surface on the posterolateral surface of the ilium. A novel grid-system was defined and used to map the positions of the articulation of the first two sacral segments on the posterolateral ilium. Superficial and deep branches of the SGA were dissected in donor cadavers and their courses were virtually overlayed on the grid system. The grid system localized the sacral articular surfaces within a defined area on the posterior ilium. Arterial distributions indicated the presence of the superficial branch of SGA more frequently over the screw insertion area (at an intermuscular plane), while the deep branch ran closer to the ilium but antero-inferior to the screw placement areas. This study proposes a new topographical perspective of visualizing SGA branches with respect to the cranial sacral segments. Precise localization of vascular anatomy may help to reduce potential risk of injury during sacroiliac screw placements.
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Affiliation(s)
- Niladri Kumar Mahato
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
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Lodde MF, Fischer TM, Riesenbeck O, Roßlenbroich S, Katthagen JC, Rometsch D, Günes D, Schneider M, Raschke MJ, Liljenqvist U. Analysis of the Spinopelvic Parameters in Patients with Fragility Fractures of the Pelvis. J Clin Med 2023; 12:4445. [PMID: 37445480 DOI: 10.3390/jcm12134445] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND We investigated the spinopelvic parameters of lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS) in patients with fragility fractures of the pelvis (FFPs). We hypothesized that these parameters differ from asymptomatic patients. METHODS All patients treated for FFPs in a center of maximal care of the German Spine Society (DWG) between 2017 and 2021 were included. The inclusion criteria were age ≥ 60 years and the availability of a standing lateral radiograph of the spine and pelvis in which the spine from T12 to S1 and both femoral heads were visible. The baseline characteristics and study parameters were calculated and compared with databases of asymptomatic patients. The two-sample t-Test was performed with p < 0.05. RESULTS The study population (n = 57) consisted of 49 female patients. The mean age was 81.0 years. The mean LL was 47.9°, the mean PT was 29.4°, the mean SS was 34.2° and the mean PI was 64.4°. The mean value of LLI was 0.7. LL, LLI and SS were significantly reduced, and PI and PT were significantly increased compared to asymptomatic patients. CONCLUSIONS The spinopelvic parameters in patients with FFPs differ significantly from asymptomatic patients. In patients with FFPs, LL, LLI and SS are significantly reduced, and PI and PT are significantly increased. The sagittal spinopelvic balance is abnormal in patients with FFPs.
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Affiliation(s)
- Moritz F Lodde
- Department for Trauma Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany
| | - Thies M Fischer
- Department for Spine Surgery and Scoliosis, St. Franziskus-Hospital GmbH Münster, Hohenzollernring 70, 48145 Münster, Germany
| | - Oliver Riesenbeck
- Department for Trauma Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany
| | - Steffen Roßlenbroich
- Department for Trauma Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany
| | - J Christoph Katthagen
- Department for Trauma Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany
| | - Daria Rometsch
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Münster, Kardinal-von-Galen-Ring 10, 48149 Münster, Germany
| | - Dennis Günes
- Department for Spine Surgery and Scoliosis, St. Franziskus-Hospital GmbH Münster, Hohenzollernring 70, 48145 Münster, Germany
| | - Marc Schneider
- Department for Spine Surgery and Scoliosis, St. Franziskus-Hospital GmbH Münster, Hohenzollernring 70, 48145 Münster, Germany
| | - Michael J Raschke
- Department for Trauma Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany
| | - Ulf Liljenqvist
- Department for Spine Surgery and Scoliosis, St. Franziskus-Hospital GmbH Münster, Hohenzollernring 70, 48145 Münster, Germany
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Mostert CQB, Timmer RA, Krijnen P, Meylearts SAG, Schipper IB. Rates and risk factors of complications associated with operative treatment of pelvic fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:1973-1980. [PMID: 36059040 PMCID: PMC10276111 DOI: 10.1007/s00590-022-03375-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Post-operative complications following fixation of pelvic fractures can lead to mortality and increased morbidity. Available literature regarding complications is heterogeneous and knowledge on risk factors is limited. This study aims to identify the most common post-operative complications and their possible risk factors following pelvic fracture surgery. METHODS A retrospective cohort study was performed in two level-1 trauma centers in the Netherlands between January 2015 and January 2021. Included patients were all adult patients (≥ 18 years) with an operatively treated pelvic fracture (pelvic ring and/or acetabular fractures). Post-operative complications included surgical site infections (SSI), material-related complications, neurological complications, malunion/non-union and performed reoperations. A forward stepwise multivariable logistic regression analysis was used to identify any risk factors associated with these complications. RESULTS Complications occurred in 55 (24%) of the 233 included patients. SSI's were most common, occurring in 34 (15%) patients. Duration of surgery (odds ratio 1.01 per minute, 95% confidence interval 1.00-1.01) and obesity (odds ratio 1.10 per BMI point, 95% confidence interval 1.29-7.52) were independent risk factors for development of SSI. Less common post-operative complications were material-related complications (8%) and neurological damage (5%). CONCLUSION Limiting operation time by using less invasive and less time-consuming surgical approaches may reduce the risk of SSI. More awareness and post-operative screening for early signs of SSI is mandatory, especially in obese patients. Future research should include large prospective patient cohorts to determine risk factors for other post-operative complications associated with pelvic fracture surgery.
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Affiliation(s)
- C Q B Mostert
- Department of Trauma Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - R A Timmer
- Department of Trauma Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
| | - P Krijnen
- Department of Trauma Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - S A G Meylearts
- Department of Trauma Surgery, Haaglanden Medical Centre, The Hague, The Netherlands
| | - I B Schipper
- Department of Trauma Surgery, Leiden University Medical Centre, Leiden, The Netherlands
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Briggs P, King SW, Staniland T, Gopal S, Shah R, Chimutengwende-Gordon M. A Systematic Review of Sacral Insufficiency Fractures: Treatment Modalities and Outcomes. Cureus 2023; 15:e41745. [PMID: 37575865 PMCID: PMC10415627 DOI: 10.7759/cureus.41745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Sacral insufficiency fractures can be managed conservatively, by surgical fixation or by sacroplasty. This systematic review compared the outcomes of different treatment modalities to ascertain the best. Studies included in this systematic review were those with sacral insufficiency fracture in elderly patients with some measure of outcomes reported. Fractures due to high-energy trauma or malignancy or in non-elderly patients were excluded. The review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE and Embase databases were searched from inception to January 6, 2022, yielding a total of 4299 papers of which 35 were eligible for inclusion. Pain reduction following sacroplasty (Visual Analogue Scale (VAS) difference 5.83, SD 1.14, n = 901) was superior compared with conservative management (VAS difference 3.7, SD 2.71, n = 65) (p <0.0001) and surgical fixation (with screws/rods +/- cement augmentation; VAS difference 4.1, SD 1.106, n = 154) (p< 0.001). There was no significant difference between pain relief following screw fixation and after conservative management (p = 0.1216). Hospital stay duration was shorter following sacroplasty (4.1 days )SD 3.9)) versus fixation (10.3 days (SD 5.59)) (p= 0.0001). Available evidence points to sacroplasty resulting in better pain relief and shorter hospital stay than other treatment options.
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Affiliation(s)
- Praise Briggs
- Trauma and Orthopaedics, Hull University Teaching Hospitals NHS Trust, Kingston upon Hull, GBR
| | - Samuel W King
- Trauma and Orthopaedics, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, GBR
| | - Tim Staniland
- Knowledge and Library Services, Hull University Teaching Hospitals NHS Trust, Kingston upon Hull, GBR
| | - Shivkumar Gopal
- Pelvic and Hip Orthopaedic Surgery, Hull University Teaching Hospitals NHS Trust, Kingston upon Hull, GBR
| | - Rajesh Shah
- Pelvic and Spinal Orthopaedic Surgery, Hull University Teaching Hospitals NHS Trust, Kingston upon Hull, GBR
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Baumann F, Pagano S, Alt V, Freigang V. Bony Sacral Volume after Sacro-Iliac Screw Fixation of Pelvic Fractures Is Dependent on Reduction of the Anterior Pelvic Ring. J Clin Med 2023; 12:4169. [PMID: 37373862 DOI: 10.3390/jcm12124169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Pelvic ring injuries are uncommon but serious injuries. Percutaneous sacro-iliac screw fixation (SSF) is the standard treatment for posterior stabilization of pelvic fractures. Compression forces of the SSF might cause deformity of the sacrum and the pelvic ring. The aim of this radio-volumetric study is to evaluate the morphometry of the sacrum and pelvic ring in SSF for posterior pelvic fractures. (1) Methods: We conducted a radio-volumetric study measuring the bony sacral volume before and after SSF for a pelvic fracture based on a three-dimensional reconstruction of the pre- and postoperative computed tomography scan of 19 patients with a C-type pelvic fracture. In addition to the bony sacral volume, we assessed the pelvic deformity and the load bearing axis. We compared the results of patients without anterior stabilization (Group A) to patients who had additional ORIF of the anterior pelvic ring. (2) Results: Median age of the patients was 41.2 years (±17.8). All patients received percutaneous SSF with partially threaded 7.3 mm screws. The sacral volume decreased from 202.9 to 194.3 cm3 in group A (non-operative treatment anterior, n = 10) and an increase of sacral volume from 229.8 to 250.4 cm3 in group B (anterior ORIF; n = 9). Evaluation of the pelvic deformity also reflected this trend by a decrease of the ipsilateral load-bearing angle in group A (37.0° to 36.4°) and an increase of this angle in group B (36.3 to 39.9°). (3) Conclusions: Bony sacral volume and pelvic deformity after sacro-iliac screw fixation in pelvic fractures depend on treatment of the anterior pelvic ring. Reduction and fixation of the anterior fracture shows an increase of the bony sacral volume and the load bearing angle leading to a closer to normal reconstruction of the pelvic anatomy.
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Affiliation(s)
- Florian Baumann
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Stefano Pagano
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Viola Freigang
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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Lodde MF, Raschke MJ, Riesenbeck O. FFP: Indication for minimally invasive navigation technique. Trauma Case Rep 2023; 45:100829. [PMID: 37091838 PMCID: PMC10113893 DOI: 10.1016/j.tcr.2023.100829] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/20/2023] [Accepted: 04/02/2023] [Indexed: 04/25/2023] Open
Abstract
An 85-year-old female patient was transferred to our clinic for surgical treatment of a complex FFP IIc. She had suffered a ground level fall 10 days ago and was still living independently. The patient was initially treated conservatively with pain medication and immobilization in an outward hospital. Due to the clinical symptoms and complex fracture pattern a physiotherapeutic assisted mobilization was not possible. The clinical examination revealed severe bilateral pain at the anterior and posterior pelvic ring. We performed a minimally invasive and an image-guided surgical stabilization. After surgical treatment the patient was mobilized with crutches for short distances. On the third day after surgical intervention the patient was discharged from our hospital into rehabilitation. This case shows the successful use of minimally invasive and modern navigation technique for treatment of a complex FFP.
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10
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Reply to Letter to the Editor: Spinopelvic Dissociation: A Systematic Review and Meta-analysis. J Am Acad Orthop Surg 2023; 31:e175-e176. [PMID: 36126157 DOI: 10.5435/jaaos-d-22-00185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 02/01/2023] Open
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11
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The efficacy of "TiRobot"orthopaedic robot-assisted VS conventional fluoroscopic percutaneous screw fixation of the sacroiliac joint. INTERNATIONAL ORTHOPAEDICS 2023; 47:351-358. [PMID: 36572784 PMCID: PMC9876857 DOI: 10.1007/s00264-022-05655-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/03/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE This study is to compare the precision and safety of the orthopaedic robot with conventional fluoroscopy for assisted percutaneous sacroiliac joint screw implantation. METHODS Retrospective analysis was performed on the clinical data of 57 patients with unstable posterior pelvic ring injuries who were admitted and met the criteria between January 2017 and January 2022. All of these patients underwent percutaneous sacroiliac joint screw implantation, and their clinical data were split into two groups based on the surgical technique: a RA group (robot-assisted implantation, 30 patients, 54 screws) and a CF group (conventional fluoroscopic freehand implantation, 27 patients, 42 screws). There were 96 screws placed in total. The durations of the two groups' operations, fluoroscopy examinations, fluoroscopy doses, total number of fluoroscopies, and intra-operative guide pin applications were noted and compared. On post-operative CT scans, the placement of each screw was assessed using the Gertzbein-Robbins classification. Finally, imaging Matta criteria were used to assess the sacroiliac joint fracture reduction. The Majeed functional score was used to assess clinical function. RESULTS Both groups successfully completed 57 procedures in total. In both groups, there were no consequences from vascular injury, wound infection, or urinary tract infection. Additionally, there were no complications from robotic-induced nerve injury, operating time, fluoroscopic dose, and the frequency of fluoroscopic; the number of percutaneous punctures in the RA group was lower than that of the CF group.There were statistically significant differences between the aforementioned data (P < 0.05). The modified Matta evaluated the effectiveness of fracture reduction. In the RA group, there was no statistically significant difference between the CF group (P > 0.05). According to the modified Gertzbein-Robbins classification criteria, the 54 screws implanted in the RA group were classified as follows: class A (45), class B (5), class C (4), and class D (0); the accuracy rate of the implants was 92.59%. Forty-two screws implanted in the CF group, 30 screws were defined class A, class B (3), class C (7), and class D (2). The accuracy rate of the implants was 78.57%(χ2 = 3.967, P < 0.05). There was a statistically significant difference between the two groups. The Majeed score 30 patients in RA group, one month post-operation, 16 considered exceptional, eight decent, six moderate, and zero bad. Post-operation more than six months,25 recorded exceptional, five decent. By the time,27 patients in CF group,12 exceptional grade, eight decent, six moderate, and one bad,one month post-operation. Post-operation more than six months,22 recorded exceptional, five decent.Both group (P > 0.05). CONCLUSION "TiRobot" robot-assisted screw implant treatment for unstable posterior pelvic ring injury has a greater success rate than traditional surgery as compared to conventional percutaneous screw implant. It is a precise, secure, and minimally invasive surgical technique that can also be applied to severe pelvic injuries even congenital sacral deformities.
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12
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Andresen JR, Radmer S, Andresen R, Prokop A, Schröder G, Nissen U, Schober HC. Comparative outcome of different treatment options for fragility fractures of the sacrum. BMC Musculoskelet Disord 2022; 23:1106. [PMID: 36536363 PMCID: PMC9762048 DOI: 10.1186/s12891-022-06039-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Fragility fractures of the sacrum (FFS) have been detected more and more frequently in recent times, and the incidence will continue to increase due to increasing life expectancy. The aim of this study was to compare the clinical outcome of conservative, interventional and surgical treatment of FFS. METHODS Retrospectively, 292 patients (276 women, 16 men) with confirmed FFS were followed up over a period of 2 years. The age of the women was Ø 81.2 (58 - 99) and that of the men Ø 78.1 (76 - 85) years. The pain was quantified using a VAS. Fractures were classified in accordance with the Rommens and Hofmann and with the Denis classification using conventional X-rays, CT and MRI. A QCT of the lumbar spine was performed to quantify bone mineral density. Concomitant diseases of every patient were recorded. An interdisciplinary case conference determined the individual treatment concept considering the age, type of fracture, pain level and comorbidities with classification into conservative, interventional (any type of sacroplasty) or surgical treatment. Over the course pain and independence were measured, complications and patient satisfaction were documented. A vitamin D determination was done, and existing comorbidities were included. RESULTS Patients with a pain level of ≤5 benefited from the conservative therapy measures, with pain levels > 5 significantly delaying the development of mobility. After sacroplasty, the pain reduced significantly, which caused a rapid improvement in mobility without any significant difference being found between vertebro- (VSP), balloon (BSP), radiofrequency (RFS) and cement sacroplasty (CSP). In terms of pain reduction and mobilization, the surgical treated patients benefited from osteosynthesis, although more complex fracture types with lumbopelvic stabilization took longer. Overall, there were no deaths during the hospital stay. Mortality after 12 months was 21.7% for the conservative, 8.4% for the interventional and 13.6% for the surgical therapy group; the differences are significant. For patients in the conservative therapy group who were difficult to mobilize due to pain, the mortality increased to 24.3%. Over 24 months, patients achieved the best independence after sacroplasty. At 12 and 24 months, subjective satisfaction with the therapies was best after sacroplasty, followed by osteosynthesis and conservative measures. All patients had a pronounced vitamin D deficiency and manifest osteoporosis. Cardiovascular pathologies were the main concomitant diseases. CONCLUSIONS Patients with FFS with a low level of pain benefit from conservative therapy measures, whereby complications and mortality increase significantly in the case of persistent immobilizing pain. Patients with an unacceptable level of pain resulting from non-dislocated fractures benefit significantly from sacroplasty. Patients with unstable and displaced fractures (Rommens and Hofmann type III and IV) should be operated on promptly. Different techniques are available for sacroplasty and osteosynthesis, which lead to an improvement of independence and a reduction in mortality.
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Affiliation(s)
- Julian Ramin Andresen
- grid.263618.80000 0004 0367 8888Medical School, Sigmund Freud University, Vienna, Austria
| | | | - Reimer Andresen
- grid.9764.c0000 0001 2153 9986Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westküstenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Heide, Germany
| | - Axel Prokop
- grid.10392.390000 0001 2190 1447Department of Trauma Surgery, Sindelfingen, Academic Teaching Hospital of the University of Tübingen, Tübingen, Germany
| | - Guido Schröder
- Clinic of Orthopaedics and Trauma Surgery, Warnow Klinik, Bützow, Germany
| | - Urs Nissen
- grid.9764.c0000 0001 2153 9986Department of Neurosurgery and Spine Surgery, Westküstenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Heide, Germany
| | - Hans-Christof Schober
- grid.10493.3f0000000121858338Department of Internal Medicine IV, Municipal Hospital Südstadt Rostock, Academic Teaching Hospital of the University of Rostock, Rostock, Germany
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13
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Albers CE, Zderic I, Kastner P, Gueorguiev B, Tosounidis TH, Keel MJB, Bastian JD. The ideal site of cement application in cement augmented sacroiliac screw fixation: the biomechanical perspective. Eur J Trauma Emerg Surg 2022; 49:1449-1458. [DOI: 10.1007/s00068-022-02187-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022]
Abstract
Abstract
Purpose
To compare construct stability of cement augmented sacroiliac screws using two different cementation sites in a biomechanical fragility fracture model of the pelvis.
Methods
A fracture model with an incomplete fracture of the sacral ala and complete fracture of the anterior pelvic ring mimicking a FFP IIB fragility fracture of the pelvis was established in five fresh frozen human cadaveric pelvises. Sacral fracture stabilization was achieved with bilateral 7.3 mm fully threaded sacroiliac screws. Cement augmentation was performed at the tip of the screw (body of S1; Group A) on one side, and at the midshaft of the screw (sacral ala; Group B) on the contralateral side. Biomechanical testing was conducted separately on both sides comprising cyclic loading of axial forces transferred through the tested hemipelvis from L5 to the ipsilateral acetabulum. Combined angular displacement in flexion and internal rotation (“gap angle”), angular displacement of the ilium in relation to the screw (“screw tilt ilium”), and screw tip cutout were evaluated.
Results
Relative interfragmentary movements were associated with significantly higher values in group A versus group B for “gap angle” (2.4° vs. 1.4°; p < 0.001), and for “screw tilt ilium” (3.3° vs. 1.4°; p < 0.001), respectively. No significant difference was indicated for screw tip cutout between the two groups (0.6 mm [Group A] vs. 0.8 mm [Group B]; p = 0.376).
Conclusion
The present study demonstrated less fragment and screw displacements in a FFP IIB fracture model under physiologic cyclic loading by cement augmentation of sacroiliac screws at the level of the lateral mass compared to the center of vertebral body of S1.
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14
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Baumann F, Becker C, Freigang V, Alt V. Imaging, post-processing and navigation: Surgical applications in pelvic fracture treatment. Injury 2022; 53 Suppl 3:S16-S22. [PMID: 36028373 DOI: 10.1016/j.injury.2022.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/16/2022] [Accepted: 08/20/2022] [Indexed: 02/02/2023]
Abstract
Technical advancements of the past decade have led to massive improvements regarding imaging and visualization in trauma care. Digital imaging technology has fundamentally changed most processes in fracture management. However, the digital revolution in trauma surgery has just begun. Optical tracking navigation is currently the gold standard for positioning of implants for advanced applications in trauma surgery. Digital technology may enable the surgeon to achieve the same level of safety even in non-navigated placement of screws: We developed a new planning tool to transcript a preoperative into a semi-transparent "fluoroscopic like" image that can be identified intraoperatively and used as a map for the safe placement of sacro-iliac screws based on the "vestibule concept". In the future, development of artificial intelligence algorithms may provide features like automated segmentation of bone-fragments and other applications for a systematic fracture analysis to improve the standard of care in trauma surgery. Digital transformation has massive impact on diagnostics and surgical management of pelvic fractures. Improved visualization technology provides a better understanding of the surgical anatomy of the pelvis and may enable the surgeon to achieve greatest safety in percutaneous placement of screws even without using optical tracking navigation tools. The "para-axial fusion technique" is a useful tool to plan fluoroscopic views based on a 3D dataset prior to the surgery.
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Affiliation(s)
- Florian Baumann
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany.
| | - Claus Becker
- Institute of Diagnostic Radiology, Regensburg University Medical Center, Regensburg, Germany
| | - Viola Freigang
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
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15
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Ellmerer AE, Küper MA, Rollmann MF, Herath SC, Histing T. [Cement augmentation in pelvic ring fractures]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:443-451. [PMID: 35925151 DOI: 10.1007/s00113-022-01186-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
Cement augmentation of sacroiliac (SI) screws in the posterior pelvic ring has been shown to provide greater biomechanical stability in cadaveric studies. Pelvic ring fractures are relatively rare compared to the total number of fractures. Nevertheless, the 1‑year mortality rate of up to 27% is very high, especially for geriatric pelvic ring fractures and is also largely associated with reduced mobility due to the fracture. The primary goal of treatment is therefore the restoration of patient mobility. This requires the achievement of sufficient stability of the pelvic ring. As osteoporosis is often a causative factor for the pelvic ring fracture, a more stable anchoring of the implants in the osteoporotic bone can be achieved by cement augmentation. This article presents the possibilities of cement augmentation of the pelvic ring and describes the technique of cement-augmented SI screws.
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Affiliation(s)
- Andreas E Ellmerer
- Klinik für Unfall- und Wiederherstellungschirurgie an der Eberhard Karls Universität, BG Unfallklinik Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Deutschland
| | - Markus A Küper
- Klinik für Unfall- und Wiederherstellungschirurgie an der Eberhard Karls Universität, BG Unfallklinik Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Deutschland
| | - Mika F Rollmann
- Klinik für Unfall- und Wiederherstellungschirurgie an der Eberhard Karls Universität, BG Unfallklinik Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Deutschland
| | - Steven C Herath
- Klinik für Unfall- und Wiederherstellungschirurgie an der Eberhard Karls Universität, BG Unfallklinik Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Deutschland
| | - Tina Histing
- Klinik für Unfall- und Wiederherstellungschirurgie an der Eberhard Karls Universität, BG Unfallklinik Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Deutschland.
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16
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Luo Y, Li Y, He L, Yin E, Gu M, Xu Z, Chen H, Hou Z, Yi C. Lumbopelvic fixation with S2 alar-iliac screws for U-shaped sacral fractures. Injury 2022; 54 Suppl 2:S8-S14. [PMID: 35180997 DOI: 10.1016/j.injury.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/10/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the surgical methods and clinical effects of lumbopelvic fixation (LPF) with S2 alar-iliac (S2AI) screws for U-shaped sacral fractures. METHODS From December 2019 to August 2020, 14 patients with U-shaped sacral fractures were treated with LPF using S2AI screws. Demographics, fracture classification, mechanism of injury, surgical treatment, complications and clinical results were assessed. All patients had a LPF with or without nerve decompression. The reduction quality was evaluated according to the Matta criteria. Neurological function was evaluated according to the Gibbons grading. The activities of daily life were evaluated according to the Majeed scoring system at the last follow-up. RESULTS Among 14 consecutive patients with U-shaped sacral fractures, the age at injury ranged from 13 to 72 years (average 30.3 ± 17.5 years). There were 4 males and 10 females. All patients were followed up for 6-15 months (average 7.8 ± 2.7 months). Thirteen patients were fixed with bilateral S2AI screws, and one patient was fixed only unilaterally due to unilateral spinopelvic dissociation. The excellent and good rate of postoperative pelvic reduction quality was 92% (excellent 10, good 3, fair 1). At the latest follow-up, the excellent and good rate of pelvic function was 100% (excellent 9, good 5) and all patients achieved different extents of neurological recovery. One patient had a postoperative superficial surgical site infection, which healed after debridement. Radiological examination at 3-6 months after operation showed that all fractures had healed. No complications were found in any patients during follow-up, such as implant fracture, loss of reduction, deep wound infection, wound dehiscence and screw protrusion discomfort. CONCLUSION LPF with S2AI screws for the treatment of U-shaped sacral fractures has exhibited distinct advantages, including firm fixation, a low rate of surgical site complications and satisfactory clinical efficacy. This approach provides sufficient stability to accelerate the commencement of postoperative rehabilitation.
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Affiliation(s)
- Yangxing Luo
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yue Li
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Li He
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Enzhi Yin
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Meiqi Gu
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhe Xu
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hua Chen
- Department of Orthopaedic Trauma, Chinese PLA General Hospital (301 Hospital), Beijing 100853, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Chengla Yi
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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17
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Complications after surgical treatment of pelvic fractures: a five-year follow-up of 194 patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:877-882. [PMID: 35142922 PMCID: PMC10125928 DOI: 10.1007/s00590-022-03215-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Surgical treatment of pelvic fractures is an advanced intervention associated with multiple complications. The primary aim of this study was to investigate the rate of unplanned reoperations after pelvic fracture surgery. Secondary aims included occurrence of other adverse events and mortality. METHODS All adult patients ≥ 18 years with surgically treated pelvic fracture operated at the Karolinska University Hospital in Sweden between 2010 and 2019 were identified and retrospectively included. Data were collected through review of medical records and radiographs. Logistic regression analysis was performed to evaluate factors associated with unplanned reoperations and other adverse events. RESULTS A total of 194 patients were included with mean age (± SD, range) 45.4 (16, 18-83) years. 62% were males (n = 121) and the median (IQR) follow-up time was 1890 (1791) days (4.9 years). Forty-eight patients (25%) had an unplanned reoperation, with infection being the most common cause of reoperation (n = 18, 9.3%). Seventy-eight (40%) patients had an adverse event not requiring reoperation and the most common event was nerve injury (n = 34, 18%). Concomitant abdominal injury was identified as a risk factor for an adverse event (OR 2.5, 95% CI 1.3-4.9, p < 0.01). 30-day mortality was 1.5% and 1-year mortality 6.2%. CONCLUSION The rate of unplanned reoperation after pelvic fracture surgery was high, as was the rate of other adverse events not requiring surgery. No identified risk factor was found to predict further surgery, but concomitant abdominal injury was a risk factor for other adverse events. Mortality was low at both 30 days and 1 year.
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18
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Heiman E, Gencarelli P, Tang A, Yingling JM, Liporace FA, Yoon RS. Fragility Fractures of the Pelvis and Sacrum: Current Trends in Literature. Hip Pelvis 2022; 34:69-78. [PMID: 35800130 PMCID: PMC9204239 DOI: 10.5371/hp.2022.34.2.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/20/2022] [Accepted: 03/02/2022] [Indexed: 11/24/2022] Open
Abstract
Fragility fractures of the pelvis (FFP) and fragility fractures of the sacrum (FFS), which are emerging in the geriatric population, exhibit characteristics that differ from those of pelvic ring disruptions occurring in the younger population. Treatment of FFP/FFS by a multidisciplinary team can be helpful in reducing morbidity and mortality with the goal of reducing pain, regaining early mobility, and restoring independence for activities of daily living. Conservative treatment, including bed rest, pain therapy, and mobilization as tolerated, is indicated for treatment of FFP type I and type II as loss of stability is limited with these fractures. Operative treatment is indicated for FFP type II when conservative treatment has failed and for FFP type III and type IV, which are displaced fractures associated with intense pain and increased instability. Minimally invasive stabilization techniques, such as percutaneous fixation, are favored over open reduction internal fixation. There is little evidence regarding outcomes of patients with FFP/FFS and more literature is needed for determination of optimal management. The aim of this article is to provide a concise review of the current literature and a discussion of the latest recommendations for orthopedic treatment and management of FFP/FFS.
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Affiliation(s)
- Erick Heiman
- Division of Orthopedic Trauma and Adult Reconstruction, Department of Orthopedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Pasquale Gencarelli
- Division of Orthopedic Trauma and Adult Reconstruction, Department of Orthopedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Alex Tang
- Division of Orthopedic Trauma and Adult Reconstruction, Department of Orthopedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - John M. Yingling
- Division of Orthopedic Trauma and Adult Reconstruction, Department of Orthopedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Frank A. Liporace
- Division of Orthopedic Trauma and Adult Reconstruction, Department of Orthopedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Richard S. Yoon
- Division of Orthopedic Trauma and Adult Reconstruction, Department of Orthopedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
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Lodde MF, Katthagen JC, Schopper CO, Zderic I, Richards RG, Gueorguiev B, Raschke MJ, Hartensuer R. Does Cement Augmentation of the Sacroiliac Screw Lead to Superior Biomechanical Results for Fixation of the Posterior Pelvic Ring? A Biomechanical Study. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121368. [PMID: 34946313 PMCID: PMC8706027 DOI: 10.3390/medicina57121368] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 12/29/2022]
Abstract
Background and Objectives: The stability of the pelvic ring mainly depends on the integrity of its posterior part. Percutaneous sacroiliac (SI) screws are widely implanted as standard of care treatment. The main risk factors for their fixation failure are related to vertical shear or transforaminal sacral fractures. The aim of this study was to compare the biomechanical performance of fixations using one (Group 1) or two (Group 2) standard SI screws versus one SI screw with bone cement augmentation (Group 3). Materials and Methods: Unstable fractures of the pelvic ring (AO/OTA 61-C1.3, FFP IIc) were simulated in 21 artificial pelvises by means of vertical osteotomies in the ipsilateral anterior and posterior pelvic ring. A supra-acetabular external fixator was applied to address the anterior fracture. All specimens were tested under progressively increasing cyclic loading until failure, with monitoring by means of motion tracking. Fracture site displacement and cycles to failure were evaluated. Results: Fracture displacement after 500 cycles was lowest in Group 3 (0.76 cm [0.30] (median [interquartile range, IQR])) followed by Group 1 (1.42 cm, [0.21]) and Group 2 (1.42 cm [1.66]), with significant differences between Groups 1 and 3, p = 0.04. Fracture displacement after 1000 cycles was significantly lower in Group 3 (1.15 cm [0.37]) compared to both Group 1 (2.19 cm [2.39]) and Group 2 (2.23 cm [3.65]), p ≤ 0.04. Cycles to failure (Group 1: 3930 ± 890 (mean ± standard deviation), Group 2: 3676 ± 348, Group 3: 3764 ± 645) did not differ significantly between the groups, p = 0.79. Conclusions: In our biomechanical setup cement augmentation of one SI screw resulted in significantly less displacement compared to the use of one or two SI screws. However, the number of cycles to failure was not significantly different between the groups. Cement augmentation of one SI screw seems to be a useful treatment option for posterior pelvic ring fixation, especially in osteoporotic bone.
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Affiliation(s)
- Moritz F. Lodde
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (C.O.S.); (I.Z.); (R.G.R.); (B.G.)
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany; (J.C.K.); (M.J.R.); (R.H.)
- Correspondence: ; Tel.: +49-251-83-59264
| | - J. Christoph Katthagen
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany; (J.C.K.); (M.J.R.); (R.H.)
| | - Clemens O. Schopper
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (C.O.S.); (I.Z.); (R.G.R.); (B.G.)
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, 4040 Linz, Austria
| | - Ivan Zderic
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (C.O.S.); (I.Z.); (R.G.R.); (B.G.)
| | - R. Geoff Richards
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (C.O.S.); (I.Z.); (R.G.R.); (B.G.)
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (C.O.S.); (I.Z.); (R.G.R.); (B.G.)
| | - Michael J. Raschke
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany; (J.C.K.); (M.J.R.); (R.H.)
| | - René Hartensuer
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany; (J.C.K.); (M.J.R.); (R.H.)
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20
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Rommens PM, Hofmann A. The FFP-classification: From eminence to evidence. Injury 2021:S0020-1383(21)00790-7. [PMID: 34598791 DOI: 10.1016/j.injury.2021.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/10/2021] [Indexed: 02/02/2023]
Abstract
Fragility fractures of the pelvis (FFP) are a clinical entity with a rapidly growing incidence among elderly women. The characteristics of these fractures are different from those appearing after high-energy trauma. In 2013, the comprehensive FFP-classification provided a new framework for analysis of these fractures. It is based on the estimation of loss of stability in the pelvic ring. It is connected with recommendations for surgical treatment, justified by the fact that higher instabilities will need surgical stabilization. Since ist appearance, we can observe an increasing clinical-scientific interest in FFP. Multiple publications use the FFP-classification studying the characteristics of fractures, choice of treatment and outcome. Other studies focus on minimal-invasive techniques for stabilization. The actual knowledge describes higher mortality rates as the reference population, lower mortality rates after operative treatment but for the price of surgery-related complications. Mobility, independency and quality of life are worse than before the fracture, independent of the FFP-classification and the type of treatment. The classification triggered a rapid increase of expertise. This publication gives a detailed overview on the evolution from eminence to evidence.
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Affiliation(s)
- Pol Maria Rommens
- Department of Orthopaedics and Traumatology, University Medical Center, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | - Alexander Hofmann
- Department of Orthopaedics and Traumatology, Westpfalz Clinics Kaiserslautern Helmut-Hartert-Strasse 1, 67655 Kaiserslautern, Germany.
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21
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Lodde MF, Katthagen JC, Schopper CO, Zderic I, Richards G, Gueorguiev B, Raschke MJ, Hartensuer R. Biomechanical Comparison of Five Fixation Techniques for Unstable Fragility Fractures of the Pelvic Ring. J Clin Med 2021; 10:jcm10112326. [PMID: 34073570 PMCID: PMC8199358 DOI: 10.3390/jcm10112326] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Incidence of pelvic ring fractures has increased over the past four decades, especially after low-impact trauma—classified as fragility fractures of the pelvis (FFP). To date, there is a lack of biomechanical evidence for the superiority of one existing fixation technique over another. An FFP type IIc was simulated in 50 artificial pelvises, assigned to 5 study groups: Sacroiliac (SI) screw, SI screw plus supra-acetabular external fixator, SI screw plus plate, SI screw plus retrograde transpubic screw, or S1/S2 ala–ilium screws. The specimens were tested under progressively increasing cyclic loading. Axial stiffness and cycles to failure were analysed. Displacement at the fracture sites was evaluated, having been continuously captured via motion tracking. Results: Fixation with SI screw plus plate and SI screw plus retrograde transpubic screw led to higher stability than the other tested techniques. The S1/S2 ala–ilium screws were more stable than the SI screw or the SI screw plus external fixator. Conclusions: In cases with displaced fractures, open reduction and plate fixation provides the highest stability, whereas in cases where minimally invasive techniques are applicable, a retrograde transpubic screw or S1/S2 ala–ilium screws can be considered as successful alternative treatment options.
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Affiliation(s)
- Moritz F. Lodde
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (C.O.S.); (I.Z.); (G.R.); (B.G.)
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany; (J.C.K.); (M.J.R.); (R.H.)
- Correspondence: ; Tel.: +49-251-83-59264
| | - J. Christoph Katthagen
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany; (J.C.K.); (M.J.R.); (R.H.)
| | - Clemens O. Schopper
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (C.O.S.); (I.Z.); (G.R.); (B.G.)
| | - Ivan Zderic
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (C.O.S.); (I.Z.); (G.R.); (B.G.)
| | - Geoff Richards
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (C.O.S.); (I.Z.); (G.R.); (B.G.)
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (C.O.S.); (I.Z.); (G.R.); (B.G.)
| | - Michael J. Raschke
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany; (J.C.K.); (M.J.R.); (R.H.)
| | - René Hartensuer
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany; (J.C.K.); (M.J.R.); (R.H.)
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22
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Stolberg-Stolberg J, Milstrey A, Schliemann B, Horn D, Abshagen KF, Raschke M, Roßlenbroich S. [Competence, creativity and communication: basics for quality improvement in traumatology : Reality and future challenges]. Chirurg 2021; 92:210-216. [PMID: 33512560 PMCID: PMC7845268 DOI: 10.1007/s00104-020-01347-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 11/06/2022]
Abstract
Interdisciplinary collaboration is one of the key factors for successful treatment of patients with complex injuries and diseases. Hence, several innovative concepts have been initiated to improve the treatment quality within the field of trauma surgery. The implementation of a ward pharmacist with the daily discussion of prescribed medications shows a reduction of side effects, costs for medicaments and the use of antibiotics. An interdisciplinary and multimodal delirium team was introduced and every patient over the age of 65 years was screened for the risk of perioperative and postoperative delirium, the medication was adjusted and expert advice was available in the case of acute delirium. Corresponding to the well-established tumor boards, an interdisciplinary musculoskeletal conference to decide on the treatment of complex interdisciplinary injuries of the musculoskeletal system should be established. The future challenges will include the digital connection of hospitals within the already existing trauma networks in order to provide rapid access to this interdisciplinary expertise also outside maximum care hospitals.
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Affiliation(s)
- Josef Stolberg-Stolberg
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude W1, 48149, Münster, Deutschland
| | - Alexander Milstrey
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude W1, 48149, Münster, Deutschland
| | - Benedikt Schliemann
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude W1, 48149, Münster, Deutschland
| | - Dagmar Horn
- Geschäftsbereich Apotheke, Universitätsklinikum Münster, Münster, Deutschland
| | - Karl-Friedrich Abshagen
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude W1, 48149, Münster, Deutschland
| | - Michael Raschke
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude W1, 48149, Münster, Deutschland
| | - Steffen Roßlenbroich
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude W1, 48149, Münster, Deutschland.
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23
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New Diagnostic and Therapeutic Approaches for the Care of the Severely Injured Patient. J Clin Med 2020; 9:jcm9113468. [PMID: 33126502 PMCID: PMC7693027 DOI: 10.3390/jcm9113468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 11/17/2022] Open
Abstract
Severe trauma remains a leading cause of death, especially in the younger population [...].
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