Acta Chir Orthop Traumatol Cech. 2018; 85(2):85-88 | DOI: 10.55095/achot2018/013

Balloon Guided Cement Augmentation of Iliosacral Screws in the Treatment of Insufficiency Fractures of the Sacrum - Description of a New Method and Preliminary ResultsOriginal papers

G. H. SANDMANN1,3,*, U. STÖCKLE1, T. FREUDE1,2, F. M. STUBY1
1 BG Unfallklinik Tuebingen, Eberhard-Karls-Universitaet Tuebingen, Germany
2 Salzburger Landeskliniken, Paracelsus Universitaet Salzburg, Austria
3 Sportklinik Ravensburg, Germany

PURPOSE OF THE STUDY:
Fragility fractures of the pelvic ring in the elderly population are a serious problem in orthopaedics. The treatment options range from conservative treatment to diverse operative options. We present a balloon guided new technique of implanting cement augmented screws aiming at improved implant anchorage and reduced cement leakage.

MATERIAL AND METHODS:
We describe a new technique of balloon- guided cement augmented iliosacral screws. After the balloon has been insufflated and contrast medium has been instillated for leakage detection, iliosacral screws can safely be placed with a relevant cement depot.

RESULTS:
All patients (n = 8) treated in this way were allowed to weight bear on both legs and mobilisation was tolerated the next day after surgery. In the post-operative controls including X-ray and CT scan we noticed no cement leakage. Pain level as measured by the visual analog scale was significantly reduced to pre- surgery (mean 7.6 pre-operatively, mean 2.5 post-operatively). In addition pain medication could be reduced gradually soon after surgery.

CONCLUSIONS:
The described procedure to address fragility fractures of the pelvic ring is a safe and easy to handle method. There are three advantages: First the osteoporotic S1 vertebral body can by stabilised by the amount of cement; second the cement leakage can be prevented by the balloon-compaction of the cancellous bone and the possibility to control the created cavity with contrast medium; third the bone - screw interface is much stronger compared to other procedures and is biomechanically superior against vertical shear stress. In contrast to sacroplasty, the cement application is guided by the previous use of a balloon.

Keywords: pelvic ring, fragility fracture, osteoporosis, elderly

Published: April 1, 2018  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
SANDMANN GH, STÖCKLE U, FREUDE T, STUBY FM. Balloon Guided Cement Augmentation of Iliosacral Screws in the Treatment of Insufficiency Fractures of the Sacrum - Description of a New Method and Preliminary Results. Acta Chir Orthop Traumatol Cech. 2018;85(2):85-88. doi: 10.55095/achot2018/013. PubMed PMID: 30295592.
Download citation

References

  1. Andresen R, Radmer S, Andresen JR, Schober HC. Comparison of the 18-month outcome after the treatment of osteoporotic insufficiency fractures by means of balloon sacroplasty (BSP) and radiofrequency sacroplasty (RFS) in comparison: a prospective randomised study. Eur Spine J. [Epub 2017]. Go to original source... Go to PubMed...
  2. Babayev M, Lachmann E, Nagler W. The controversy surrounding sacral insufficiency fractures: to ambulate or not to ambulate? Am J Phys Med Rehabil. 2000;79:404-409. Go to original source... Go to PubMed...
  3. Barber SM, Livingston AD, Cech DA. Sacral radiculopathy due to cement leakage from percutaneous sacroplasty, successfully treated with surgical decompression. J Neurosurg Spine. 2013;18:524-528. Go to original source... Go to PubMed...
  4. Bastian JD, Keel MJ, Heini PF, Seidel U, Benneker LM. Complications related to cement leakage in sacroplasty. Acta Orthop Belg. 2012;78:100-105. Go to PubMed...
  5. Bayley E, Srinivas S, Boszczyk BM. Clinical outcomes of sacroplasty in sacral insufficiency fractures: a review of the literature. Eur Spine J. 2009;18:1266-1271. Go to original source... Go to PubMed...
  6. Binaghi S, Guntern D, Schnyder P, Theumann N. A new, easy, fast, and safe method for CT-guided sacroplasty. Eur Radiol. 2006;16:2875-2878. Go to original source... Go to PubMed...
  7. Binaghi S, Guntern D, Schnyder P, Theumann N. [Percutaneous sacroplasty]. Rev Med Suisse. 2006;2:1747-1751. Go to original source... Go to PubMed...
  8. Collinge CA, Christ BD. Combined Percutaneous Iliosacral Screw Fixation With Sacroplasty Using Resorbable Calcium Phosphate Cement for Osteoporotic Pelvic Fractures Requiring Surgery. J Orthop Trauma. 2016;30:e217-222. Go to original source... Go to PubMed...
  9. Dhanwal DK, Dennison EM, Harvey NC, Cooper C. Epidemiology of hip fracture: Worldwide geographic variation. Indian J Orthop. 2011;45:15-22. Go to original source... Go to PubMed...
  10. Fensky F, Nuchtern JV, Kolb JP, Huber S, Rupprecht M, Jauch SY, Sellenschloh K, Püschel K, Morlock MM, Rueger JM, Lehmann W. Cement augmentation of the proximal femoral nail antirotation for the treatment of osteoporotic pertrochanteric fractures-a biomechanical cadaver study. Injury. 2013;44:802-807. Go to original source... Go to PubMed...
  11. Frey ME, Depalma MJ, Cifu DX, Bhagia SM, Carne W, Daitch JS. Percutaneous sacroplasty for osteoporotic sacral insufficiency fractures: a prospective, multicenter, observational pilot study. Spine J. 2008;8:367-373. Go to original source... Go to PubMed...
  12. Fuchs T, Rottbeck U, Hofbauer V, Raschke M, Stange R. [Pelvic ring fractures in the elderly. Underestimated osteoporotic fracture]. Unfallchirurg. 2011;114:663-670. Go to original source... Go to PubMed...
  13. Fu S, Zhao Y, Lian W. Comparison of the risk of breakage of two kinds of sacroiliac screws in the treatment of bilateral sacral fractures. Eur Spine J. 2014;23:1558-1567. Go to original source... Go to PubMed...
  14. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17:1726-1733. Go to original source... Go to PubMed...
  15. Lourie H. Spontaneous osteoporotic fracture of the sacrum. An unrecognized syndrome of the elderly. JAMA. 1982;248:715-717. Go to original source... Go to PubMed...
  16. Mears SC, Sutter EG, Wall SJ, Rose DM, Belkoff SM. Biomechanical comparison of three methods of sacral fracture fixation in osteoporotic bone. Spine (Phila Pa 1976). 2010;35:E392-395. Go to original source... Go to PubMed...
  17. Mehling I, Hessmann MH, Rommens PM. Stabilization of fatigue fractures of the dorsal pelvis with a trans-sacral bar. Operative technique and outcome. Injury. 2012;43:446-451. Go to original source... Go to PubMed...
  18. Morris RO, Sonibare A, Green DJ, Masud T. Closed pelvic fractures: characteristics and outcomes in older patients admitted to medical and geriatric wards. Postgrad Med J. 2000;76:646-650. Go to original source... Go to PubMed...
  19. Osterhoff G, Dodd AE, Unno F, Wong A, Amiri S, Lefaivre KA, Guy P. Cement augmentation in sacroiliac screw fixation offers modest biomechanical advantages in a cadaver model. Clin Orthop Relat Res. 2016;474:2522-2530. Go to original source... Go to PubMed...
  20. Pohlemann T, Stengel D, Tosounidis G, Reilmann H, Stuby F, Stöckle U, Seekamp A, Schmal H, Thannheimer A, Holmenschlager F, Gänsslen A, Rommens PM, Fuchs T, Baumgärtel F, Marintschev I, Krischak G, Wunder S, Tscherne H, Culemann U. Survival trends and predictors of mortality in severe pelvic trauma: estimates from the German Pelvic Trauma Registry Initiative. Injury. 2011;42:997-1002. Go to original source... Go to PubMed...
  21. Pommersheim W, Huang-Hellinger F, Baker M, Morris P. Sacroplasty: a treatment for sacral insufficiency fractures. AJNR Am J Neuroradiol. 2003;24:1003-1007.
  22. 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. 2009;30:315-317. Go to original source... Go to PubMed...
  23. Richter PH, Gebhard F, Dehner C, Scola A. Accuracy of computer-assisted iliosacral screw placement using a hybrid operating room. Injury. 2016;47:402-407. Go to original source... Go to PubMed...
  24. Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: Recommendations for surgical treatment. Injury. 2013;44:1733-1744. Go to original source... Go to PubMed...
  25. Rommens PM, Ossendorf C, Pairon P, Dietz SO, Wagner D, Hofmann A. Clinical pathways for fragility fractures of the pelvic ring: personal experience and review of the literature. J Orthop Sci. 2015;20:1-11. Go to original source... Go to PubMed...
  26. Routt ML, Jr, Simonian PT, Mills WJ. Iliosacral screw fixation: early complications of the percutaneous technique. J Orthop Trauma. 1997;11:584-589. Go to original source... Go to PubMed...
  27. Stuby FM, Schaffler A, Haas T, Konig B, Stockle U, Freude T. [Insufficiency fractures of the pelvic ring]. Unfallchirurg. 2013;116:351-364. Go to original source... Go to PubMed...
  28. Tosounidis G, Holstein JH, Culemann U, Holemnschlager F, Stuby F, Pohlemann T. Changes in epidemiology and treatment of pelvic ring fractures in Germany: an analysis on data of German Pelvic Multicenter Study Groups I and III (DGU/AO). Acta Chir Orthop Traumatol Cech. 2010;77:450-456. Go to original source... Go to PubMed...
  29. Tjardes T, Paffrath T, Baethis H, Shafizadeh S, Steinhausen E, Steinbuechel T, Rixen D, Bouillon B. Computer assisted percutaneous placement of augmented iliosacral screws: a reasonable alternative to sacroplasty. Spine (Phila Pa 1976). 2008;33:1497-1500. Go to original source... Go to PubMed...
  30. Wahnert 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. 2013;37:1147-1150. Go to original source... Go to PubMed...