Hip Pelvis.  2013 Dec;25(4):306-310. 10.5371/hp.2013.25.4.306.

Percutaneous Iliosacral Screw Fixation with Cement Augmentation in Sacral Insufficient Fracture: A Case Report

• Lim CH
• Chung YY
• Heo JY
• Jang YJ

• KMID: 1808141
• DOI: http://doi.org/10.5371/hp.2013.25.4.306

Abstract

Sacral insufficiency fractures (SIFs) are no longer a rare type of fracture in the elderly. To date, SIFs have typically been treated conservatively. Sacroplasty has recently been used in treatment of SIFs, with a good result. In order to solve the problems of sacroplasty, the authors performed a new surgical technique, percutaneous iliosacral screw fixation with cement augmentation, for SIFs. Secure fixation of the screw in osteoporotic bone was achieved and biological bone union was obtained. We present this case with a review of the literature.

Keyword

Sacral insufficient fracture; Cement augmentation; Percutaneousiliosacral screw fixation

MeSH Terms

Aged
Fractures, Stress
Humans

Figure

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  Fig. 1 A 78 year-old patient with right buttock pain for several months when walking. No fracture in plain hip x-ray.

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  Fig. 2 Radiotracer uptake in an H-pattern was seen on the posterior planar scintigraphic image of a Tc99 m-labeled MDP bone scan.

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  Fig. 3 On coronal T1-weighted MR images, there was low-signal intensity edema and a hypointense fracture line.

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  Fig. 4 Percutaneous iliosacral screw fixation was performed under fluoroscopic guidance. (A) Immediate post operation x-ray of sacrum. (B) On follow up radiography 3 days after operation, the screw had migrated out backward. (C) On the radiography of 6months after reoperation, there was no sign of screw loosening.

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  Fig. 5 After remove the loosened screw, contrast media was injected through the needle to determine the safety of cement injection.

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  Fig. 6 After confirmation that the cement would not enter the spinal canal or critical areas, 2 cc cement was injected into the sacrum in the region of screw thread. (A) When the cement had attained a dough-like state, guide wire was inserted and cannulated screw was inserted over guide wire. (B) Immediate post operation x-ray.

Reference

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