J Korean Fract Soc.  2019 Oct;32(4):165-172. 10.12671/jkfs.2019.32.4.165.

Percutaneous Iliosacral Screw Fixation with Cement Augmentation in Osteoporotic Sacral Fracture

• Kim CH
• Chung YY
• Shim SW
• Baek SN
• Kim CY

• KMID: 2468678
• DOI: http://doi.org/10.12671/jkfs.2019.32.4.165

Abstract

PURPOSE
The prevalence of osteoporotic sacral fractures is increasing. Traditionally, conservative treatment is the 1st option, but it can increase the risk of comorbidity in the elderly. To reduce the complications and allow early mobility, iliosacral screw fixation with cement augmentation will be one of the treatment options for patients with osteoporotic sacral fractures.
MATERIALS AND METHODS
This study reviewed 25 patients (30 cases) who had undergone percutaneous iliosacral screw fixation with cement augmentation for osteoporotic sacral fractures from July 2012 to December 2018 with a minimum follow up of six months. The clinical outcomes were assessed using the measures of pain (visual analogue scale [VAS] score), hospital stay and the date when weight-bearing started. All patients were evaluated radiologically for pull-out of screw, bone-union, and cement-leakage.
RESULTS
Bone union was achieved in 30 cases (100%). The mean duration of the hospital stay was 24 days (4-66 days); weight-bearing was performed on an average nine days after surgery. The VAS scores immediately (3.16) and three months after surgery (2.63) were lower than that of the preoperative VAS score (8.3) (p<0.05). No cases of cement-leakage or neurologic symptoms were encountered. Two patients (6.7%) experienced a pulling-out of the screw, but bone-union was accomplished without any additional procedures.
CONCLUSION
Percutaneous iliosacral fixation with cement augmentation will be an appropriate and safe surgical option for osteoporotic sacral fractures in the elderly in terms of early weight-bearing, pain reduction, and bone-union.

Keyword

Osteoporotic fractures; Sacrum; Fracture internal-fixation; Bone-cement

MeSH Terms

Aged
Comorbidity
Follow-Up Studies
Humans
Length of Stay
Neurologic Manifestations
Osteoporotic Fractures
Prevalence
Sacrum
Weight-Bearing

Figure

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  Fig. 1. A) Guide-wire was inserted through the fracture sited guided C-arm. (B) A cannulated screw was then inserted. (C) The cannulated screw was pulled out as long as the thread of the screw. Contrast media injected. (D) Cement (2–3 ml) was injected into the sacrum in the region of screw thread. The cannulated screw was then inserted.

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  Fig. 2. A 78-year-old female patient had a sacral fracture without trauma. Her bone mineral density was −3.9. (A) Right sacral fracture was diagnosed by magnetic resonance imaging. (B) Percutaneous screw fixation was performed. (C) There is a pull-out screw within four days after surgery. (D) Re-operation was performed with cement augmentation. Bone union was achieved within six months of surgery.

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  Fig. 3. (A-C) A 70-year-old female patient was diagnosed with osteoporotic sacral fracture by simple radiography, computed tomography, and bone scan. (D) There is no cement-leakage on postoperative radiography. (E, F) Bone-union was achieved within six months of surgery. There was no screw-exchange six months and one year after surgery.

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  Fig. 4. (A) Percutaneous screw fixation with cement augmentation was conducted on an 81-year-old female patient. There is a pull-out screw one month after surgery. (B) Percutaneous screw fixation with cement augmentation was conducted on a 78-year-old female patient. There is a pull-out screw after 12 days of surgery.

Reference

References

1. Heo DH, Park CK. Percutaneous sacroplasty for non-neoplastic osteoporotic sacral insufficiency fractures. Pain Physician. 20:89–94. 2017.

2. Sanders D, Fox J, Starr A, Sathy A, Chao J. Transsacral-transiliac screw stabilization: effective for recalcitrant pain due to sacral insufficiency fracture. J Orthop Trauma. 30:469–473. 2016.

3. Gotis-Graham I, McGuigan L, Diamond T, et al. Sacral insufficiency fractures in the elderly. J Bone Joint Surg Br. 76:882–886. 1994.

4. Lim CH, Chung YY, Heo JY, et al. Percutaneous Iliosacral screw fixation with cement augmentation in sacral insufficient fracture – a case report-. Hip Pelvis. 25:306–310. 2013.

5. Collinge CA, Crist BD. Combined percutaneous Iliosacral screw fixation with sacroplasty using resorbable calcium phosphate cement for osteoporotic pelvic fractures requiring surgery. J Orthop Trauma. 30:e217–e222. 2016.

6. Ries T. Detection of osteoporotic sacral fractures with radionuclides. Radiology. 146:783–785. 1983.

7. Wild A, Jaeger M, Haak H, Mehdian SH. Sacral insufficiency fracture, an unsuspected cause of low-back pain in elderly women. Arch Orthop Trauma Surg. 122:58–60. 2002.

8. Taillandier J, Langue F, Alemanni M, Taillandier-Heriche E. Mortality and functional outcomes of pelvic insufficiency fractures in older patients. Joint Bone Spine. 70:287–289. 2003.

9. Garant M. Sacroplasty: a new treatment for sacral insufficiency fracture. J Vasc Interv Radiol. 13:1265–1267. 2002.

10. Richards AM, Mears SC, Knight TA, Dinah AF, Belkoff SM. Biomechanical analysis of sacroplasty: does volume or location of cement matter? AJNR Am J Neuroradiol. 30:315–317. 2009.

11. Bayley E, Srinivas S, Boszczyk BM. Clinical outcomes of sacroplasty in sacral insufficiency fractures: a review of the literature. Eur Spine J. 18:1266–1271. 2009.

12. Gupta AC, Chandra RV, Yoo AJ, et al. Safety and effectiveness of sacroplasty: a large singlecenter experience. AJNR Am J Neuroradiol. 35:2202–2206. 2014.

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

14. Wähnert D, Raschke MJ, Fuchs T. Cement augmentation of the navigated iliosacral screw in the treatment of insufficiency fractures of the sacrum: a new method using modified implants. Int Orthop. 37:1147–1150. 2013.

15. Tsiridis E, Upadhyay N, Gamie Z, Giannoudis PV. Percutaneous screw fixation for sacral insufficiency fractures: a review of three cases. J Bone Joint Surg Br. 89:1650–1653. 2007.

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

17. Kim JW, Oh CW, Oh JK, et al. The incidence of and factors affecting iliosacral screw loosening in pelvic ring injury. Arch Orthop Trauma Surg. 136:921–927. 2016.

18. Tjardes T, Paffrath T, Baethis H, et al. Computer assisted percutaneous placement of augmented iliosacral screws: a reasonable alternative to sacroplasty. Spine (Phila Pa 1976). 33:1497–1500. 2008.

19. Carlson GD, Abitbol JJ, Anderson DR, et al. Screw fixation in the human sacrum. An in vitro study of the biomechanics of fixation. Spine (Phila Pa 1976). 17:S196–S203. 1992.

20. Papanastassiou ID, Setzer M, Eleraky M, et al. Minimally invasive sacroiliac fixation in oncologic patients with sacral insufficiency fractures using a fluoroscopy-based navigation system. J.